Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom. We examined historical trends dating back several decades, with a focus on the more extensive data available from the late 1990s to 2008.

Over this time period, we uncovered a strikingly consistent and pervasive pattern of higher mortality and inferior health in the United States, beginning at birth:

•   For many years, Americans have had a shorter life expectancy than people in almost all of the peer countries. For example, as of 2007, U.S. males lived 3.7 fewer years than Swiss males and U.S. females lived 5.2 fewer years than Japanese females.

•   For the past three decades, this difference in life expectancy has been growing, especially among women.

•   The health disadvantage is pervasive—it affects all age groups up to age 75 and is observed for multiple diseases, biological and behavioral risk factors, and injuries.

More specifically, when compared with the average for peer countries, the United States fares worse in nine health domains:

1.   Adverse birth outcomes: For decades, the United States has experienced the highest infant mortality rate of high-income countries and also ranks poorly on other birth outcomes, such as low birth weight. American children are less likely to live to age 5 than children in other high-income countries.

2.   Injuries and homicides: Deaths from motor vehicle crashes, nontransportation-related injuries, and violence occur at much higher rates in the United States than in other countries and are a leading cause of death in children, adolescents, and young adults. Since the 1950s, U.S. adolescents and young adults have died at higher rates from traffic accidents and homicide than their counterparts in other countries.

3.   Adolescent pregnancy and sexually transmitted infections: Since the 1990s, among high-income countries, U.S. adolescents have had the highest rate of pregnancies and are more likely to acquire sexually transmitted infections.

4.   HIV and AIDS: The United States has the second highest prevalence of HIV infection among the 17 peer countries and the highest incidence of AIDS.

5.   Drug-related mortality: Americans lose more years of life to alcohol and other drugs than people in peer countries, even when deaths from drunk driving are excluded.



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