Last month, headlines announced that U.S. life expectancy has finally recovered from the pandemic. A new report from the National Center for Health Statistics showed national life expectancy at a record high, and this news has been greeted with cautious optimism.
But that news reflects only one side of the story. Other estimates, such as model-based work from the Institute for Health Metrics and Evaluation (IHME), show that even with this rebound the United States has suffered one of the most severe peacetime declines in longevity among wealthy nations and continues to lag far behind its peers. Taken together, the data suggests that while life expectancy has recovered relative to recent American history, America is experiencing the most dramatic peacetime decline in longevity when judged against other high-income countries.
According to IHME’s newest projections, the United States is expected to plummet from 49th in global life expectancy rankings in 2022 to 66th by 2050. We now trail Cuba, Estonia, and Saudi Arabia. We’ve already lost more than 2.5 years of life expectancy in a single decade—an unprecedented collapse that would have been unimaginable just a generation ago. The only comparable situation in modern times is the decline in longevity after the 1991 collapse of the Soviet Union, when men’s life expectancy plummeted by six years, driven by sudden massive increases in poverty and inequality.
While our peer nations continue extending the lives of their citizens, America is moving in the opposite direction. And we’re barely talking about it.
Public health researchers have a name for what we’re losing: the “Missing Americans.” A 2023 study by Jacob Bor, an epidemiologist at Boston University School of Public Health, and his colleagues examined international mortality databases and CDC statistics for every year from 1933 to 2021, comparing America’s mortality rates with the average of Canada, Japan, and 19 Western European nations. What they found, said Bor when I interviewed him for my recent book, “was shocking.”
If the United States had mortality rates comparable to other wealthy nations, we would have prevented more than one million deaths in 2020 and 1.1 million deaths in 2021, according to Bor’s findings. These aren’t deaths at the end of long lives—about half occurred in people under age 65, those who should be in the prime of their lives, raising families, contributing to communities, building careers. In 2021 alone, Bor and his colleagues noted, these preventable early deaths represented more than 25 million years of lost life.
To put that in perspective: we’ve created the statistical equivalent of wiping out a city the size of Austin, Texas, every single year.
And that doesn’t include the years preceding these deaths when people were hobbled by disabilities, illness, and despair that stopped them from fulfilling their potential and robbed us as a society of what they might have contributed. There is a ripple effect across communities and generations—the effects these early deaths have on children who grow up without a parent, families that become mired in poverty after the untimely death of their primary breadwinner. We’re talking about millions of missed soccer games, high school graduations, camping trips and anniversary celebrations, all the unrealized milestones of fully lived lives.
The disparities are staggering. Life expectancy gaps among American populations have nearly doubled since 2000. Native Americans in the western United States now have life expectancies below 64 years—on par with Haiti and the Democratic Republic of the Congo. Black and Native Americans bore a disproportionate share of these excess deaths. But the real surprise in Bor’s research was how poorly white Americans are doing, too: in 2021, they comprised seventy percent of those Missing Americans. In that year, young white Americans died at three times the rate of their counterparts in wealthy nations, according to Bor’s and his coauthors’ calculations, while death rates for young Black and Indigenous Americans were five times and eight times higher respectively.
This reveals something we’ve been missing. “Using the experiences of white Americans as a benchmark in studies renders the trends in the white population invisible,” Bor said in a recent interview. “In addition, it woefully underestimates the grim circumstances of Americans of color, in terms of their mortality shortfalls, because the baseline you’re using is already sub-standard.”
The inescapable fact is that millions of white Americans are dying too young, their lives cut short by the same policies and institutions that are killing Black, Latino and Indigenous populations. As Bor puts it, we’re all frogs boiling in that pot of water—it’s just that white people are boiling a little slower. Yet somehow, they are led to believe they’re better off, and we continue to muddle through this metastasizing crisis without doing anything about it.
How did we get here? This crisis began more than forty years ago, when our peer countries recovered from World War II and began surpassing us in building social safety nets, providing universal health care, and enacting policies that protected their most vulnerable citizens. We went in the opposite direction. Our mortality numbers began to diverge sharply from other wealthy countries in a downward slide that coincides with the dismantling of the social safety net that began in the 1980s and continued throughout the 1990s and 2000s, according to Bor and colleagues.
The chief culprits are familiar: structural racism, economic inequality, lack of access to quality health care, a bloated-broken national health care system, and chronic underinvestment in public health and social safety net programs. People die because of gun violence, traffic accidents, heart disease, diabetes, suicide, substance abuse and drug overdoses. A wave of deregulation left working-class Americans vulnerable to unhealthy foods, workplace dangers, environmental toxins, and the unchecked spread of guns and opioids.
Princeton economists Anne Case and Angus Deaton identified one critical piece of this puzzle in their landmark 2015 paper on the so-called “deaths of despair.” They found that working-age white men and women without four-year college degrees were dying at astonishing rates—more than 600,000 excess deaths between 1999 and 2017 among Americans aged 45 to 54. Death rates from suicide, drug overdoses and alcohol-related illnesses were directly correlated with chronic joblessness in regions hit hardest by globalization, communities set adrift by the export of once-stable jobs in mining, manufacturing and heavy industry.
The pandemic merely accelerated an already widening gap. As science journalist Ed Yong wrote in The Atlantic, “COVID simply did more of what life in America has excelled at for decades: killing Americans in unusually large numbers, and at unusually young ages.” The numbers behind this, as he noted, are stark: “From 2019 to 2021, deaths among working-age Americans increased by 233,000—and nine in 10 of those deaths wouldn’t have happened if the U.S. had mortality rates on par with its peers.”
Now, at precisely the moment when we should be mounting an aggressive response to this mortality crisis, the current administration is moving in the opposite direction. Proposed cuts to Medicaid and food assistance programs will strip healthcare and nutrition support from millions. Attacks on the Affordable Care Act threaten to eliminate coverage for tens of millions more. The dismantling of public health agencies and the sidelining of scientific expertise leave us more vulnerable to the next pandemic and less equipped to address ongoing health threats.
This isn’t happening in a poor country with limited resources. This is happening in the wealthiest nation on earth, one that spends more on healthcare per capita than any other country. Yet 66.5 percent of all bankruptcies are tied to medical issues, and every year, 530,000 Americans file for bankruptcy due to medical bills.
Other wealthy nations have proven that a different path is possible. Countries with strong social safety nets, universal healthcare, investments in public health infrastructure, and policies that reduce inequality consistently see their citizens live longer, healthier lives. They spend less on healthcare and get better results. The solutions aren’t revolutionary—they’re already working elsewhere.
What’s needed now is the political courage to acknowledge that America’s mortality crisis is neither normal nor inevitable, and the collective will to demand better. We need healthcare as a right, not a privilege. We need robust public health systems with the resources and authority to protect communities. We need policies that address the root causes of premature death: poverty, racism, violence, and environmental degradation. We need to strengthen labor protections and ensure living wages. We need to measure national success not by GDP growth or stock market performance, but by how long and how well our people live.
Every year we wait, another million people die who shouldn’t. Another 25 million years of human potential—of birthdays and graduations, of art and innovation, of love and laughter—vanish. These aren’t statistics. They’re our neighbors, our colleagues, our families. They’re us.
We can accept this slow-motion catastrophe as the price of American exceptionalism, or we can recognize it as the moral emergency it is. The question isn’t whether we know how to save the Missing Americans. We do. The question is whether we care enough to try.
