America’s Rising Mortality

In a small clinic in rural Ohio, a 32-year-old construction worker sits across from his physician, his hands trembling as he confesses he’s been self-medicating chronic back pain with opioids.

Two states over, a 40-year-old teacher in Atlanta learns that her stage four breast cancer could have been caught years earlier — if only she’d been able to afford a screening. In Phoenix, a teenager survives a fentanyl-laced pill at a party but loses a friend to the same batch.

These scenes are not anomalies but tame examples of the preventable loss that is taking place in our country right now.

Pioneering vaccines, surgical breakthroughs, and life-saving technologies — all hallmarks of U.S. medical innovation — have benefited both Americans and people worldwide for generations.

Yet today, we face a tragic yet avoidable national emergency. For the first time in a century, the United States is witnessing a sustained decline in life expectancy, with young Americans dying at rates heretofore unseen.

While countries like Switzerland and South Korea celebrate citizens living into their mid-80s, the average American now dies at 76 — the same as it was in the late 90s.

As physicians, we are at the front lines of this crisis, witnessing firsthand the symptoms of a disease that is spreading silently through the lifeblood of our nation. We stand at the crossroads of science and humanity, uniquely positioned to provide answers as both healers and advocates for change.

The Current State

In 2024, the US life expectancy ranked 48th globally. Other first-world countries, like the UK and France, boast life expectancies surpassing 80 years, while we lag behind at 76.4 years, which is closer to developing nations than those we would consider our peers.

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According to a report by the Bloomberg American Health Initiative, Americans die 2.7 years younger, on average, than their British counterparts. These deaths are driven by four preventable killers: cardiovascular disease, drug overdoses, firearm-related homicide and suicide, and road accidents.

Research conducted by the Commonwealth Fund reveals that while the US outpaced nine other developed nations in healthcare spending, it ranked last in equity in healthcare access and also scored poorly in patient outcomes, with Americans facing the highest number of avoidable deaths.

“The U.S. continues to be in a class by itself in the underperformance of its health care sector,” wrote the researchers. “While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage.”

The disparity is even greater for marginalized groups. Black Americans live six years fewer than their white peers, and Native Americans live 11 years fewer. In fact, black men in Mississippi have a lower life expectancy than men in Bangladesh.

“We may be one of the richest countries in the world, and we certainly outspend every country on health care, but Americans are sicker and die earlier than people in dozens of countries. We’ll keep falling behind unless we get serious about policy solutions,” reported Dr. Steven Woolf, M.D., director emeritus of the Center on Society and Health at Virginia Commonwealth University.

Why Are Americans Dying Younger?

Nearly 40% of American adults are obese, and 38 million have diabetes. Cardiovascular disease remains the nation’s top killer, fueled by diets high in processed foods, sedentary lifestyles, and fragmented access to preventative care.

In low-income neighborhoods, “food deserts” force families to rely on convenience stores, while unsafe parks deter exercise. More than ever, we are seeing 25-year-olds with cholesterol levels that belong to 60-year-olds. The worst part is that they want to change, but poverty and stress make it impossible.

Over 100,000 overdose deaths occurred in 2022, with synthetic opioids like fentanyl now contaminating counterfeit pills and cocaine.

In the Midwest, particularly, hope is dwindling under a healthcare system ill-equipped to treat addiction. We’re on the verge of losing a generation to drug overdose. Not just that, the nature of the addictions in small towns and rural America inflicts moral injuries when parents overdose as their kids look on.

Firearm-related injuries are now the leading cause of death for American children and adolescents, surpassing car accidents in 2022. Every day, 120 Americans die from guns, including homicide and suicide, as well as accidents or undetermined circumstances. Compared to other high-income nations, the US gun homicide rate is 26 times higher, and the firearm suicide rate is 12 times greater.

Black Americans bear the brunt of this uniquely American epidemic, with them being 12 times more likely to die by gun homicide than white Americans.

With the systemic normalization of despair, suicide rates among Americans aged 10-24 rose by 62% between 2007 and 2021. Veterans, LGBTQ+ youth, and people living in rural areas are especially vulnerable.

Despite growing awareness, mental healthcare remains a luxury with 60% of counties lacking a single psychiatrist, and insurers often denying coverage for therapy. Firearms account for over 50% of these suicides.

Unlike other methods, gun suicide attempts are fatal 85% of the time. Easy access during moments of crisis — a loaded gun in a nightstand — turns transient despair into irreversible loss.

Motor vehicle crashes and unintentional injuries claimed 44,534 and 227,039 lives, respectively in 2022. Lax seatbelt laws and weak safety regulations in the workplace are part of the problem. While many believe accidents to be acts of God that cannot be dodged, having stricter safety laws should be a no-brainer to curtail the rise in avoidable deaths.

As if all that wasn’t enough, thirty million Americans remain uninsured, and millions more ration insulin or skip screenings due to costs. Over 600 rural hospitals were at risk of closing in 2023, leaving 15% of Americans in “healthcare deserts.” An individual’s ZIP code shouldn’t dictate their lifespan, but the unfortunate reality is that in America, it does.

The Ripple Effects

The toll of this increase in mortality on American minds is immeasurable. More and more parents are having to bury their children. Children have to grow up in foster care or be brought up by their grandparents.

Economically, premature deaths cost the country in lost productivity and medical expenses. For communities, trust in the healthcare system and the government can weaken under the weight of these harsh realities. For physicians, the emotional weight is crushing. Attending funerals of people in the prime of their lives only serves to exacerbate burnout.

What Doctors Want Americans to Know

The challenges we face are daunting, but history shows that progress is possible when society unites behind common-sense reforms and compassionate action. From curbing smoking rates to reducing drunk driving deaths, America has overcome public health crises before. The mortality crisis demands a similar mobilization, one that bridges clinical care, policy innovation, and community reliance.

The American Medical Association (AMA) has urged citizens to remain calm in the wake of this crisis but also understand the urgency to address it before things get out of hand. The age-old advice of “prevention is better than the cure” is more relevant now than ever. Regular screenings, vaccinations, and lifestyle counseling can save lives.

Disregarding mental health must stop. Mental health is health, and it’s about time we started treating it like it is. Integration of mental health into routine care by using validated tools like the PHQ-9 for depression screening can go a long way to curb the effects of poor mental health on life expectancy.

Addiction needs to be treated like a disease. Destigmatizing medication-assisted treatment (MAT) for opioid use disorder can save lives before a dreaded overdose takes place. Support for harm reduction strategies, including naloxone distribution and needle exchanges, will also help curb fatalities.

Advocacy goes a long way. If we want safer communities, we’ll have to speak up. Promoting universal background checks and secure firearm storage laws could turn the tide in firearm-related deaths.

States with “red flag” laws like Connecticut, have seen firearm suicide rates decline by up to 14%.

Turning the Tide

Not too long ago, doctors led the charge against COVID-19, sacrificing their health, sanity, and lives in order to save patient lives. With the pandemic not yet a distant memory, we’re faced with another test of our resolve.

We hold unmatched power to drive change, whether it’s by prescribing life-saving medications, advocating for a vulnerable patient, or voting for leaders who prioritize health equity. Every day, a physician’s kindness – a listening ear, a timely referral – alters a life’s trajectory.

We did not choose to be beset by this sense of impending doom, but we can choose our response. Our patients need us not just as healers of illness but also healers of systems that are failing them. Together, we can make sure that “life, liberty, and the pursuit of happiness” includes the right to grow old.