The United States is experiencing a measurable decline in life expectancy that is not seen in other high‑income nations. A study by researchers at Boston University’s School of Public Health quantified the gap and identified a “crisis of early death” driven by excess mortality across all age groups.
Scale of the problem
- Excess deaths: 1.1 million U.S. deaths in 2021 would have been avoided if the country had mortality rates comparable to other wealthy nations.
- Missing Americans: The term used for these excess deaths; the study estimates a cumulative total of about 13.1 million “missing” Americans from 1980 to 2021.
- Working‑age impact: Nearly 50 % of excess deaths occurred before age 65, indicating a stark rise in premature mortality among adults.
- Historical trend: Mortality rates in the U.S. were on par with peer nations during World II and the 1960s‑70s, but began diverging in the 1980s. By 2019 the excess death count exceeded one million, spiking to 1.1 million during the COVID‑19 pandemic.
International comparison
The study compared U.S. age‑specific mortality (1933‑2021) with that of Canada, Japan, Australia, and 18 European nations. Key findings include:
- Life expectancy: While most comparator countries continued to see modest gains, U.S. life expectancy plateaued after 2010 and fell during the pandemic.
- Regional outliers: Certain U.S. locales, such as parts of Texas, now record infant mortality rates comparable to Syria and Sudan.
- Emerging nations: Countries traditionally viewed as developing—e.g., Malaysia, Thailand, the United Arab Emirates, and parts of Eastern Europe—show higher life expectancy than the United States, largely due to better food quality and more accessible health care.
Primary drivers
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Health‑care quality and access
- Out‑of‑pocket costs in the U.S. are substantially higher than in many other nations, limiting preventive care and early intervention.
- In several foreign medical centers (e.g., Prince Court Hospital in Malaysia, Bumrungrad International in Thailand), patients receive more personalized attention at a fraction of U.S. prices.
- Some U.S. regions exhibit health‑care outcomes (e.g., infant mortality) that match low‑income countries, suggesting systemic disparities.
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Food quality and diet
- The U.S. diet is characterized by high processed‑food consumption, larger portion sizes, and a sedentary lifestyle.
- In contrast, many Asian and European locales maintain “farm‑to‑table” food systems, resulting in fresher produce and lower obesity rates.
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Lifestyle and environment
- Walkable urban designs, milder climates, and cultural norms that encourage outdoor activity are more common abroad, reducing reliance on automobiles and associated health risks.
- The “soft freedom” of living abroad—fewer regulatory constraints and lower tax burdens—can also contribute to reduced stress and better overall well‑being.
Practical considerations for U.S. residents
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Medical tourism:
- Identify accredited hospitals abroad (e.g., Prince Court Hospital, Bumrungrad International).
- Compare procedure costs and post‑procedure support, noting that many facilities provide direct physician contact and follow‑up care.
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Relocation for health:
- Evaluate countries with strong health‑care systems, affordable living costs, and favorable tax regimes (e.g., Malaysia, Portugal, Panama).
- Consider age and health status; younger individuals may prioritize entrepreneurial opportunities, while older adults may seek locations with higher health‑care standards.
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Lifestyle adjustments without moving:
- Increase walkability by choosing neighborhoods with nearby amenities.
- Prioritize whole, minimally processed foods and reduce reliance on fast‑food options.
- Seek preventive health services, even if it means paying out‑of‑pocket for higher‑quality care.
Risks and caveats
- Quality variance: Not all foreign medical facilities meet the same standards; thorough research and verification of accreditation are essential.
- Regulatory and insurance issues: U.S. health insurance typically does not cover overseas treatment; individuals must budget for full costs.
- Cultural adaptation: Relocating involves navigating language barriers, legal residency requirements, and differing social norms.
- Long‑term care: For older adults, the availability of comprehensive geriatric services may be limited in some emerging markets.
Decision criteria
When assessing whether to seek health care abroad or relocate, weigh the following:
| Factor | Consideration |
|---|---|
| Cost | Direct medical expenses vs. U.S. out‑of‑pocket costs; tax implications of residency change |
| Quality | Hospital accreditation, physician credentials, patient outcomes |
| Access | Travel distance, visa requirements, language support |
| Lifestyle | Climate, walkability, food culture, social integration |
| Long‑term security | Availability of chronic disease management, emergency services, pension portability |
The Boston University study underscores that the United States’ mortality profile is now worse than many nations that were once considered less developed. Improving longevity may require a combination of better preventive health practices, dietary changes, and, for some, seeking higher‑quality, lower‑cost health care outside the United States.
