The US is Not Healthy, But We Resist Tackling the Necessary Fixes

Several research articles in recent months all point to the same sobering conclusion: the United States is falling farther behind other developed nations in most health measures. While officials at the Department of Health and Human Services (HHS) and its agencies purport to want to make the country healthier, we remain resistant to acknowledging the real causes of our unhealthy status or taking steps to address them.

A study published last May in  JAMA Health Forum reported that between 1980 and 2023 there were 14.7 million excess deaths in the US compared to other high-income countries. The causes of these excess deaths included Covid-19, drug overdose, firearm injury, and cardiopulmonary disease. “These deaths,” the investigators wrote, “highlight the continued consequences of US health system inadequacies, economic inequality, and social and political determinants of health.”

Life expectancy in the US declined precipitously during the height of the Covid-19 pandemic. A  study published last month using data from California showed that, at least in that most populous US state, life expectancy still had not returned to pre-pandemic levels through 2024. The life expectancy gap between Black and white California residents widened between 2019 and 2024. Drug overdoses stood as one of the main drivers of increased premature death, especially among Black people.

In June,  researchers noted that “after decades of improvement, US mortality rates have stagnated or reversed since 2010.” In 2023, these investigators found, there were 525,505 excess deaths in the US. Most of these excess deaths occurred among people with lower educational attainment. Besides Covid-19, the leading causes of excess deaths were circulatory diseases, diabetes, and drug poisonings.

Children’s Health Also Declining in the US

Researchers from the University of Pennsylvania and the University of California, Los Angeles  compared the health of children in the US between 2007 and 2023 to children in other high-income countries that are members of the Organisation for Economic Co-operation and Development (OECD18). “Across the 16-year period,” they reported, “the US experienced 315,795 excess deaths compared with the OECD18, which is equivalent to 54 excess child deaths per day.” The increased deaths could be attributed in part to firearms, motor vehicle crashes, substance use, and homicide. They also found that US children had significantly higher rates of chronic illnesses like asthma and several mental health conditions. Obesity increased markedly among US children during the study period. The authors concluded that “This comprehensive evidence of deterioration highlights the importance of identifying and addressing the root causes of this fundamental decline in the nation’s health.”

This flurry of recent studies tells us several things. First, US American adults and children are dying at higher rates than seen in comparable countries and, even taking the Covid-19 pandemic into account, the situation seems to be getting worse. Second, the overall health of US Americans is worse than in other high-income countries. Third, obesity, which is a cause of both cardiopulmonary diseases and diabetes as well as firearm injury, motor vehicle crashes, and drug overdoses are responsible for much of our unhealthy status and excess mortality rates.

We Are Moving in the Wrong Direction

Yet we seem to be unwilling to have honest conversations acknowledging these problems or taking meaningful steps to address them. The obesity epidemic in the US is well-described at this point. Are we making new anti-obesity medications available to everyone who could benefit from them? Are we heeding research showing that  taxing sugary beverages works to decrease obesity? Could we adopt  Mexico’s approach to labeling foods with excessive amounts of sugar, fat, and salt?

Of course, any discussion about limiting firearm availability seems like an uphill battle right now, with states and the courts seeming to lean in the direction of making it less and less difficult for people to own guns. Right now, firearm injury is the leading cause of death among children in the US. Studies persistently show that greater gun availability is associated with more  suicides and  homicides. Is there any hope to enact broader gun control laws that are certain to reduce firearm-related deaths?

Only a  minority of people with substance use problems currently receive any treatment in the US. One way to address this problem would be to expand access to substance use treatment and rehabilitation, making it affordable and promoting evidence-based interventions. Yet, we seem to be moving in the opposite direction by cutting health insurance options and  closing the federal Substance Abuse and Mental Health Services Administration (SAMSHA).

This refusal to have frank discussions about the things that are ailing us is made worse by recent decisions to impose cuts on federal programs like Medicaid and the Supplemental Nutrition Assistance Program (SNAP). We know that programs like these are associated with improvements in health. For example, during the pandemic, Congress authorized emergency allotments to increase SNAP benefits to address mounting levels of food insecurity. A July  controlled study found that when those emergency allotments ended, resulted not only in significant worsening of food insecurity but also poorer physical health. Cutting SNAP benefits now will of course do nothing to improve the nation’s health.

Cuts to Medicaid will put enormous pressure on hospitals and healthcare systems that care for our most vulnerable people. Already, there are indications that hospitals and healthcare systems are responding to Medicaid cuts with plans to  cut back on what they call “low margin care,” meaning services for poor people. An example of how this could affect us is found with the disturbing trend of mass closings by hospitals around the country of their obstetric services. Between 2010 and 2022, nearly all US states saw decreases in the number of acute care hospitals that offered obstetric services. The decline is especially severe among rural hospitals. It is feared that newly enacted Medicaid cuts will further erode the ability of rural hospitals to offer obstetric care or even to remain functional at all.

There Is a Rational Path Forward

               If we want to improve on these dire health statistics, there are clear paths to take:

• Expand health insurance coverage to all US residents.
• Make substance use treatment available and affordable for everyone who needs it.
• Acknowledge that gun violence is a major public health problem and support gun control legislation.
• Take evidence-based approaches to attacking the overweight and obesity epidemic.

None of these solutions is currently in play in the US. That means people will continue to die prematurely, hospitals will shut down, and adults and children will continue to suffer with preventable chronic illnesses. There needs to be a broad outcry against this scenario and the political will to make the urgent changes necessary to reverse it. This is not an impossible task as data from every other high-income country in the world shows us. It is a matter of choice.