The country’s life expectancy problem gained renewed attention in recent years after seeing the largest drop since World War II during the COVID-19 pandemic.
As U.S. life expectancy continues to plummet, a new report found the country has been at a life expectancy disadvantage since the 1950s, and it has only gotten worse since then.
The study, published Thursday in the American Journal of Public Health, also shows more than 50 countries have surpassed the U.S. in life expectancy since the 1930s and a handful of states may be partly responsible.
“The scale of the problem is bigger than we ever thought . . . older than we thought (and) the number of countries outperforming the United States is much larger than we thought,” said study author Dr. Steven Woolf, director emeritus of the Center on Society and health at Virginia Commonwealth University in Richmond.
The findings offer a new perspective on U.S. life expectancy and shed light on how to reverse the current trend, experts say.
‘Taking the historical perspective’
The U.S. began seeing dramatic increases in life expectancy in the early 20th century, mainly due to public health advances such as vaccines and sanitation, Woolf said.
The new report shows how that growth continued into the ’50s, with U.S. life expectancy ranking 12th highest in the world. However, that growth rate began declining in 1955 so that by 1968, the U.S. had fallen to 29th place.
This is much earlier than what many researchers previously thought, Woolf said.
“When asked when did this problem began, we cited the 1980s… Because we haven’t gone back far enough in the historical data to see what happened before,” he said. “That there was a decline in the 1950s raises questions about what was going on then.”
The life expectancy growth rate rebounded in 1974, according to the study, but then decelerated again in 1983. The study relied on estimates from the UN Population Division and the U.S. Mortality Database, Woolf said, which “could potentially skew” exact rankings and “year-over-year changes.”
But the general takeaway remains the same, said Michal Engelman, associate professor of sociology at the University of Wisconsin-Madison. Th timeline shows how life expectancy may be heavily influenced by systemic issues that are larger than just individual health choices.
“Taking the historical perspective teaches us that things are not predetermined,” Engelman said. “Things change and that means there’s a possibility for more improvement in the future.”
More countries are surpassing the US
The report also looked beyond the same small subset of peer countries – like the United Kingdom or Canada – that are typically included when studying life expectancy.
By expanding the pool to include countries with populations over 500,000, the report found 56 countries had surpassed the U.S. in life expectancy since 1950 and included countries with smaller economies, lower populations, and different government systems.
Middle-income countries made enough gains in life expectancy to catch up and then surpass the U.S. during times when the country’s acceleration slowed, Woolf said. By 2019, the U.S. ranked 40th among populous countries – lower than Lebanon and Albania.
“Countries that don’t necessarily have all the support systems and infrastructure and policies that exist in higher income countries are still outperforming” the U.S., he said. “What are they doing in those countries that have enabled their people to live longer.”
Some US states are worse than others
Since the fifties, life expectancy grew at a different pace throughout the country, according to the report.
Northeastern and western states experienced the fastest growth, Woolf said, while south central and midwestern states saw the slowest growth.
“This cluster of states really played an outsized role in producing these poor rankings for the United States,” he said. “States doing very well like Hawaii, New York and other high performers are ranked among some the same life expectancy as some of the healthiest countries in the world.”
The findings support previous research showing how policy decisions impact health outcomes and, ultimately, life expectancy.
“The things that influence health and longevity are operating on multiple levels,” Engelman said. “The story of our health goes far beyond thing that we can personally control.”