In the past 20 years America has outperformed other rich countries on economic measures. But on a more fundamental measure of wellness—how long people live—the country is falling behind
the Rebound recovery centre, on the Main Street of Hazard, Kentucky, a small Appalachian coalmining town, and you will get an instantly friendly welcome. Yet the stories you hear are bleak. On a white board at the end of the room, across from the sofas, the names of former clients who have died of overdoses in the past few years are listed. Though the town has a population of just 5,000, there are at least 20 names.
According to a study by Jessica Ho of the University of Southern California, published last year, which looked at 18 high-income countries, from a fairly average position in 1980, by 2018 America had fallen to dead last on life expectancy. In the 1960s Americans could expect to live seven or eight years longer than people from Portugal, the country in the study that now has the next-lowest life expectancy. By 2018 they could expect to live over a year less.
But this does not fully not explain why America is doing so much worse than elsewhere. Obesity and diabetes are rising almost everywhere; rates have been higher in America for decades. And indeed, increasing access to the best health care is one of the few ways in which Americans are catching up with, or even leaping ahead of, people in other rich countries. Cancer-survival rates in America are the highest in the world.
In fact, almost any horrible death you can think of, Americans are more likely to suffer it. Over 5,000 people died in 2021 in workplace accidents, up by 9% on the previous year; the figure in Britain was 123. Nearly 4,000 people died in fires, the highest number in close to 20 years, making for a death rate of nearly twice that of western Europe. Americans are more than twice as likely to drown as the Dutch .
The problem is not only that America has become less safe . It is also that other countries have improved and America has not. Take, for example, car crashes. Calculations by the Urban Institute, a think-tank, show that in the 1990s French people died in crashes at a rate slightly higher than Americans—and per mile driven, at a rate roughly double. Now, however, Americans are more than twice as likely to die in car crashes.