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When health in the United States is compared with health in other countries, the picture is disappointing. On nearly all indicators of mortality, survival, and life expectancy, the United States ranks at or near the bottom among high-income countries. World Health Organization (WHO) estimated the US infant mortality rate at 5.9 deaths per 1,000 live births in 2013, ranking the United States 45th among WHO nations. This ranks just below Bosnia, Serbia, and the former Yugoslavia Republic of Macedonia but slightly above Slovakia and Qatar. In 14 countries—including 7 western European countries, Japan, and Singapore—the infant mortality rate is less than half the US rate.
Another measure used to compare the health of nations is life expectancy, which is highly influenced by infant mortality rates as well as death at all ages. The United States, with a life expectancy of 79 years, ranks 34th and is tied with Costa Rica, Nauru, and Qatar. Almost all western European countries, Japan, Australia, Singapore, Canada, and New Zealand have a longer life expectancy than the United States. Nineteen countries have a life expectancy at least 3 years longer than the US life expectancy.
Global life expectancy at birth for both sexes rose 6.2 years (from 65.3 in 1990 to 71.5 in 2013). This reflects declines in death and illness caused by HIV/AIDS and malaria in the past decade and significant advances made in addressing communicable, maternal, neonatal, and nutritional disorders. Healthy life expectancy (HALE) at birth rose 5.4 years (from 56.9 in 1990 to 62.3 in 2013). HALE takes into account mortality and the impact of nonfatal conditions; it summarizes years lived with disability and years lost due to premature mortality. The HALE increase has not been as dramatic as the growth of life expectancy, and as a result, people—especially in the United States—are living more years with illness and disability. US life expectancy gains for men since 1990 was 4.4 years; for women, 2.6 years. However, men’s HALE rose 3.1 years while women’s went up only 1.6 years. Life expectancy for US women is still better than that of US men, 81.4 years versus 76.3 years.
In addition to US rankings for infant mortality and life expectancy being disappointingly low, US expenditure on health care, as measured by percent of gross domestic product (GDP) spent on health by private and public sectors, ranks second among 191 countries at 17.1% of GDP. Ranking first is Tuvalu at 19.7%. Only 20 countries, including 10 shown on Table 7, spend more than 10% of GDP on health care. All other developed countries with health expenditures more than 10% of GDP have both a lower infant mortality rate and a higher life expectancy than the United States.
Infant Mortality


TABLE 7 International Comparison

1 2013 Estimates, Global Health Observatory, World Health Organization, extracted Aug. 24, 2015. 2 2013 Estimates for both genders, Global Health Observatory, World Health Organization, extracted Aug. 23, 2015. 3 2013 Estimates, Global Health Observatory, World Health Organization, extracted Aug. 23, 2015.


Life Expectancy

Global life expectancy at birth for both sexes rose 6.2 years (from 65.3 in 1990 to 71.5 in 2013).

Expenditures on Health Care


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