May 30, 2022 | News | Interview

Why is Health in the US Continuing to Lag Behind?


Health and mortality in the United States ranks poorly by international standards. In 2010, life expectancy at birth in the United States was a full year lower than the average of 27 European Union countries; in the subsequent decade the shortfall doubled; and the COVID-19 pandemic has further widened the gap. A new Special Issue published in the Journals of Gerontology: Series B analyses the reasons for the US poor performance.

This special issue is edited by Mikko Myrskylä from the Max Planck Institute for Demographic Research, Neil K. Mehta from the University of Texas Medical Branch, and the late Robert F. Schoeni from the University of Michigan.

Professor Myrskylä, what does this Special Issue include?

It presents an updated and wide-ranging analysis of the US shortfall in mortality and health by a multidisciplinary group of researchers. The articles encompass studies of mortality, disability and chronic disease. They cover various stages of life, addressing both proximal causes as well as those related to social and economic conditions, and consider the impact of the COVID-19 pandemic. Several of the studies highlight the role of cardio-metabolic health as one of the key reasons for the US shortfall in life expectancy and health.

What exactly are the nine studies about?

One paper demonstrates the worsening ranking of US mortality rates among 17 other high-income countries over time. Another one provides an in-depth analysis of the slowdown in mortality improvements since 2000 across high-income countries and a detailed cause-specific trend analysis for the US and UK. These two papers focus on national averages. Magali Barbieri focuses the lens on sub-national disparities. She tracks life expectancy across deciles of US counties based on socioeconomic status from 1982 to 2019.

… and the other five articles of the Special Issue?

Two papers compare cardiometabolic health in the US and England. Two other papers focus on the role of income in patterning health. Another one asks whether contextual income-mobility to which one is exposed to in early life shapes later life health behaviors and health.

In your view, what do these compiled studies show?

The results presented in this Issue provide a detailed account of the myriad ways health in the United States continues to lag its peers. They include specifics on age groups, death causes, risk factors and generational patterns.

Many details of the lag are documented, but what are solutions for the US health and mortality shortfall?

We see that violence and drug overdoses are both important contributors to the lag. They have both proximal features such as the availability of firearms or prescribing regulations, and structural features in economy and society. It is likely that they interact with each other in complex ways. Cardiovascular disease and its risk factors also explain some of the lag and may be prominent in recent trends. Appropriate interventions would require multi-level social and healthcare interventions. Such comprehensive approaches seem daunting in current policy and political contexts. The United States not only ranks poorly in terms of health but also in terms of its investments in social welfare and levels of income inequality. There is likely a correlation here.

What should research in this area focus on in the future?

Current social and health policies have an important role to play, but scientists are just beginning to tackle the complexities involved in identifying the effects of policies on aggregate measures of population health. This direction is encouraging and further advances in understanding the root causes of US health in comparison to peer nations might come from analysis of systemic, social, and political processes relevant for health.  

The special issue has been edited by Mikko Myrskylä, Director of the Max Planck Institute for Demographic Research, Neil K. Mehta, Associate Professor at the University of Texas Medical Branch, and the late Professor Robert F. Schoeni from the University of Michigan. Professor Schoeni passed away in October 2021 before the completion of the special issue, but his role in developing the Special Issue was instrumental. Bob, as he was known to his colleagues and friends, was a distinguished scholar having made an impact on multiple social science fields including economics, sociology and demography. A generation of scientists benefitted immensely from his commitment to building interdisciplinary social science research capacity. The Special Issue includes a tribute by Vicki Freedman and Linda Martin to Bob’s career and legacy.

Original Publication

Mehta, N.K., Myrskylä, M.: An Introduction to the Supplemental Issue on Why Does Health in the US Continue to Lag Behind. The Journals of Gerontology: Series B Volume 77, Issue Supplement_2 (2022) DOI: 10.1093/geronb/gbac050


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The Max Planck Institute for Demographic Research (MPIDR) in Rostock is one of the leading demographic research centers in the world. It's part of the Max Planck Society, the internationally renowned German research society.