It’s well-documented that the U.S. had more deaths due to COVID than any other country on the planet (excluding authoritarian countries whose reporting is highly politicized). According to a study published by the Journal of the American Medical Association (JAMA), U.S. life expectancy – which was previously lowest among 21 high-income advanced democracies with available data sources for calculations – had further declined significantly more than in those other countries after the pandemic struck. As of 2020 overall U.S. life expectancy has dropped to 77 years, the lowest of the 21 peer countries. Switzerland continues to have the highest at almost 83 years, while the second worst country (Scotland) maintains a life expectancy of 78.3 years. This should be of concern to all American retirees since they tend to bear a disproportionate burden of health problems and costs.

What are the primary causes of the U.S. disparity? Compared with other high-income countries, the report cites numerous factors in which the U.S. ranks poorly. These include basic social and economic conditions such as education, poverty, income inequality, and affordable housing, access to public transit and healthy foods, racial segregation and social isolation, and access to health care and insurance. In contrast to policies adopted by the peer countries, American social welfare spending is less equitable and less beneficial to children and families. The U.S. also lacks universal health care and provides weaker protections for public health and safety. The authors further allege that mismanagement of federal, state, and local pandemic responses and factional public resistance to practices to prevent viral transmission drove U.S. COVID death rates above those experienced by other countries.

What can be done? The McKinsey Health Institute (MHI) recommends some key shifts in public policy.

1. Invest more on prevention and promoting optimal health. Developed countries spend on average just 2.8% of their health budgets on organized prevention programs such as vaccinations, disease screenings, and health education, while low-income economies spend ten times as much as a proportion of their budgets. In addition, improving the health of populations with historically reduced access to care or poorer health outcomes can give societies an economic boost.

2. Standardize measurement & data collection to better understand what works and what doesn’t so we can allocate resources effectively. MHI estimates that fewer than 5% of factors that influence and measure a modern understanding of health are defined consistently (or at all), captured systematically, and made broadly available as data.

3. Scale what works. A commitment from people, governments, payers (including employers), and healthcare providers is needed to increase the application of known solutions with high ROI (including leveraging what works well elsewhere in the world).

4. Innovate more via foundational research, better collaboration, and quicker and more effective nurturing and scaling of the most promising concepts. This will require engaging all the stakeholders who affect a desired health outcome.

5. Educate & empower individuals to manage their own health. Improving behaviors associated with diet, sleep and activity levels, adherence to medication, and tobacco use can eliminate as much as 60% of deaths worldwide. Insights from behavioral economics – traditionally used for financial decision-making – can also be used to motivate individuals to make healthcare decisions that are in their own best interest.

The JAMA study concludes that until this country makes policy choices that optimize health and well-being, Americans will continue to die at higher rates than those in other advanced democracies, and our health outcomes will remain sharply divided along racial and ethnic lines.

Here’s a link to the JAMA study: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2791004.

Here’s a link to the MHI report: McKinsey: https://www.mckinsey.com/mhi/our-insights/adding-years-to-life-and-life-to-years.