In 1980 only 13 countries with more than a million people outlived the United States; by 2023 it was 38, with mortality among 25-to-44-year-olds up more than 70 percent in barely a decade.
In 1980, only 13 countries with a population over a million outlived the United States. By 2023, that number was 38.
The young are dying first
Steven Woolf of Virginia Commonwealth University combed mortality data from 1999 to 2023 and found the steepest fall among 25-to-44-year-olds: between 2010 and 2021 their death rate rose by more than 70 percent. The main causes were drug overdoses and conditions that belong to middle age — hypertension, metabolic disorders, alcoholic liver disease.
Ages 1 to 24 fared little better: sudden infant deaths, car crashes, homicide, suicide. People in 60 countries now have a better chance of reaching 40 than Americans do.
Drugs and guns are not the real story
Woolf argues that opioids, firearms and high-calorie diets are surface causes. What actually drags the country down is systemic: a broken healthcare system, a high poverty rate, and lax regulation that lets pollution and dangerous products through. Federalism then makes it worse in the South, Appalachia and rural communities.
In his words, the United States lacks not solutions but political will.
Why it matters
A gap in life expectancy is not explained by one epidemic or one bad habit; it is the bill for decades of policy choices. Other rich countries have shown for years that better outcomes are possible — the problem was never not knowing what to do.
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