The U.S. is failing to keep pace with dozens of countries around the world due to the steady decline of the nation’s health progress, according to a detailed analysis of all 50 states and Washington, D.C..
Researchers have produced health estimates and forecasts of life expectancy, mortality, and morbidity due to more than 350 diseases and injuries and 68 risks in the U.S. from 1990 to 2050.
Life expectancy (LE) in the U.S. is forecasted to increase from 78.3 years in 2022 to 79.9 years in 2035 and to 80.4 years in 2050 for all sexes combined.
This modest increase lowers the country’s global ranking from 49th in 2022 to 66th in 2050 among the 204 countries and territories included in the latest Global Burden of Disease (GBD) study.
Nationally, mortality rates declined between 1990 and 2021 for many leading causes of death, most notably for ischemic heart disease, cancer, and stroke. That contributed to improvements in life expectancy.
Despite the progress the U.S. has made over the last three decades, the country is forecasted to rank progressively lower than other nations globally in the average number of years a person can expect to live in good health. Known as healthy life expectancy or health-adjusted life expectancy (HALE), its global ranking is forecasted to drop from 80th in 2022 to 108th by 2050.
Women’s health
Women’s health in the U.S. is falling behind other peer countries faster than men’s.
Female HALE is forecasted to decline by 2050 in 20 states2, including Ohio, Tennessee, and Indiana.
Only three states remain unchanged: Arizona, Idaho, and North Dakota. This gap between men and women is mainly due to the slow increases or no changes in female life expectancy and HALE rather than due to major improvements for males.
In fact, the global ranking for female LE in the U.S. is forecasted to drop to 74th in 2050. That’s a substantial decline from 19th in 1990 and 51st in 2022. U.S. male LE estimates are forecasted to rank 65th globally in 2050, a drop from 35th in 1990 and from 51st in 2022. These lower rankings put the U.S. below nearly all high-income and some middle-income countries.
When comparing LE in the best- and worst-performing U.S. states with the other 203 GBD countries and territories, the states’ global ranking also declined over the forecasted period.
The impact of obesity
The slight increase in U.S. LE that’s forecasted in 2050 is due to a decline in mortality rates, including a 49.4 per cent decline in ischemic heart disease death rates, a 40.5 per cent drop in stroke death rates, and a 35.7 per cent decrease in diabetes death rates.
“In spite of modest increases in life expectancy overall, our models forecast health improvements slowing down due to rising rates of obesity, which is a serious risk factor to many chronic diseases and forecasted to leap to levels never before seen,” said co-senior author professor Christopher Murray, director of IHME.
“The rise in obesity and overweight rates in the U.S., with IHME forecasting over 260 million people affected by 2050, signals a public health crisis of unimaginable scale.”
Highest drug use–related mortality rate in the world
The nation also faces other alarming trends. From 1990 to 2021, the U.S. recorded an 878 per cent increase in the mortality rate from drug use disorders, including from opioid use disorder, amphetamine use disorder, cocaine use disorder, and a group of other drug use disorders.
The death rate is forecasted to climb another 34 per cent between 2022 and 2050 (from 19.9 deaths to 26.7 deaths per 100,000). That’s the highest drug use–related mortality rate in the world and more than twice as high as the second-highest country, which is Canada.
“The stark contrast that’s forecasted in the next 30 years comes after a concerted effort by federal, state, and local government agencies and health systems launched after the opioid crisis was declared a public health emergency in 2017,” said lead author professor Ali Mokdad from IHME.
“The opioid epidemic is far from over, and greater effectiveness and continued expansion of programmes to prevent and treat drug use are still needed.”
Forecasted drivers for mortality and morbidity
IHME researchers produced several scenarios forecasted into the future to explore how the U.S. could have less devastating consequences of some health outcomes.
If major risk factors like obesity, high blood sugar, and high blood pressure were eliminated by 2050, 12.4 million deaths could be averted in the U.S.
That said, if these risk factors were eliminated globally, the health gains wouldn’t be enough for the U.S. to improve its global ranking, and it would still fall behind some peer countries. Some countries, like Canada, are so far ahead of the U.S. that U.S. LE would only catch up to that of Canada if these risks were only eliminated in the U.S.
However, the researchers estimate that tackling one risk factor can still save millions of lives. For example, if smoking alone were reduced across the U.S. to the level of the lowest smoking rates, the nation could have 2.1 million fewer deaths by 2050.
If the country were successful in lowering high body mass index levels and high blood sugar levels during the same three decades, it could prevent 1.4 million people from dying.
“The rapid decline of the U.S. in global rankings from 2022 to 2050 rings the alarm for immediate action. The U.S. must change course and find new and better health strategies and policies that slow down the decline in future health outcomes,” said co-senior author Dr. Stein Emil Vollset, affiliate professor from IHME.
IHME’s recommendations
IHME is providing these estimates and forecasts to policymakers, health professionals, and the public to urge all people living in the United States to work together in creating a healthier and stronger nation. Leaders from all sectors and industries can also use the forecasts to prepare for the potential economic impact.
“Poor health harms the economy because the nation suffers from a reduced workforce, lower productivity, and higher health care costs for companies and their employees. That leads to a lower GDP and a chance for peer countries with a stronger economy to overtake the U.S., creating a ripple effect around the world financially and geopolitically,” said Dr. Murray.
IHME’s scientific evidence has historically demonstrated that increasing access to preventive medical care is critical for early detection and disease management. Early intervention can also reduce complications and lower health care costs.
“All Americans must have access to high-quality health care through universal health coverage to prevent illness, stay healthy, and be protected from financial hardship regardless of their income,” said Dr. Mokdad.
IHME’s previous studies have also suggested that the higher the level of education people achieve, the lower the risk of dying because more schooling leads to less risk-taking and better-informed decisions. However, local leaders still need to invest their time and money in community health where disparities can be better addressed through personalised care and customised community programmes.
