Why Is America Such a Deadly Place?

Death is excessive in America, and the more you look the more distressing the picture seems.

You’ve probably heard about the “mortality crisis” in terms of its effect on average life spans — several years ago, after decades of steady improvements, life expectancy in the United States took an unprecedented turn for the worse, placing it not among its wealthy peers, but below Kosovo, Albania, Sri Lanka and Algeria (and just ahead of Panama, Turkey and Lebanon). And while the trend is clear, the change may seem small, because the impact is averaged over the country as a whole. American life expectancy dropped just 0.1 year between 2014 and 2019, before Covid.

But the loss is jaw-dropping by another measure — the sheer number of needless deaths. Before the pandemic, roughly a half million more people in America died each year than would have died, on average, in wealthy peer countries. In each of the first two years of the pandemic, the number surpassed one million.

Those are conclusions of a paper by a team of mortality researchers published in May that tabulated the number of “missing Americans” by comparing U.S. death rates to the average of 21 closely comparable countries, mostly pretty-rich nations across Europe. Led by Jacob Bor of Boston University, the group found that almost a quarter of all U.S. deaths in the years before the pandemic would not have happened had our mortality rates in those years matched those of our economic peers. During the pandemic, about one-third of all American deaths would have been avoided.

And although the problem is growing, it isn’t at all new. Over the past few years, we’ve seen the American mortality crisis as a matter of “deaths of despair”— a social crisis that swept through older middle-aged white men. Nowadays, we’re likelier to also mention gun violence, overdoses, maternal mortality and juvenile deaths. All of these are crises we understand as relatively recent phenomena. If not acute manifestations of the pandemic, or the Trump years, or the malaise that followed the Great Recession, they are surely a mark of the country struggling to find its footing on the unsteady ground of this 21st century.

But the “Missing Americans” data reveals a much longer national tragedy and shows just how long this increasingly dreary American exceptionalism has been around. Life-expectancy trends tell you only how the United States compares with its own past; this new metric shows much more starkly how far the country is falling behind everyone else.

The story begins at a familiar point, with the United States performing far better than its peers in the immediate aftermath of World War II, and then a bit better for the generation that followed.

But then, beginning in the mid-1980s, the gap reversed, then grew, quite steadily. It is a wound getting more swollen and more conspicuous over time, and it mirrors comparative longitudinal research on life expectancy, for which American deficits have grown for many decades, as well. According to life-expectancy