Why do Americans have shorter life expectancy and worse health than do people in other high-income countries?
Level 5 - mechanism / opinion, no new human data
Narrative review synthesizing existing literature without systematic review methodology
PubMed 24422560 · doi:10.1146/annurev-publhealth-032013-182411
What was done
The authors conducted a narrative review of existing epidemiological and demographic literature to examine evidence and proposed explanations for why Americans have shorter life expectancy and poorer health compared to peers in other high-income countries.
What was found
The abstract provides no quantitative data or specific numerical estimates. The review notes that the US health disadvantage spans multiple mortality and morbidity outcomes, begins at birth, and persists across the life course. It is particularly pronounced among American women and in the US South and Midwest. The authors state that while proximal factors—such as health care access, individual health behaviors, socioeconomic inequalities, and the built environment—contribute, they fail to fully explain the widespread nature of the disadvantage, pointing instead toward fundamental differences in public and social policies.
Why it matters
This review synthesizes cross-national population health trends to argue that addressing the US health disadvantage requires structural and social policy reforms rather than relying solely on clinical care or individual behavior interventions.
Limits
As a narrative review, the methodology lacks systematic search parameters, quantitative meta-analysis, or formal risk-of-bias assessments. Specific effect sizes, population metrics, and comparative statistics are omitted in the abstract, and the causal impact of specific social policies remains observational.
Cited by
- supports The premature death rate in the United States is nearly twice the average of comparable peer nations.