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This section evaluates how U.S. population health compares among the other 36 member countries of the Organization for Economic Co-operation and Development (OECD). OECD’s mission is to promote economic development and social well-being of people worldwide. It collects and analyzes data from each of the member countries on a wide range of social, economic and health-related topics.
The following international perspective offers insight into how the health of the U.S. population compares with the health of its peers in key measures of population health. This analysis compared U.S. values with other OECD member countries on three health measures: infant mortality, health spending and life expectancy. Where data were available from America’s Health Rankings, the top and bottom states were included for reference.
Results showed the United States had a higher infant mortality rate and lower life expectancy compared with most other OECD member countries. Even the top U.S. state ranked low among member countries for the infant mortality and life expectancy measures. The United States also had the highest health spending of all OECD countries.

Infant mortality

Over the past 50 years, improvement in the U.S. infant mortality rate has not kept pace with other OECD countries. The average rate of infant mortality among OECD countries was 4.1 deaths per 1,000 live births. At 5.7 deaths per 1,000 live births, the United States ranked No. 33 out of the 37 OECD countries (Figure 73). Estonia (No. 1) had the lowest rate with 1.6 deaths per 1,000 live births. Mexico (No. 36) and Columbia (No. 37) had the highest infant mortality rates of OECD countries at 12.9 and 16.8 deaths per 1,000 live births, respectively.
New Hampshire was the top U.S. state with 3.5 deaths per 1,000 live births, placing it on par with Greece and the Netherlands (tied for No. 22). The bottom U.S. state, Mississippi, had an infant mortality rate of 8.4 deaths per 1,000 live births, which was two times higher than the OECD average.

Life expectancy

Life expectancy is a common and important long-term population health indicator. It describes how long a newborn can expect to live, on average, if current death rates remain the same. The average life expectancy in OECD countries was 80.7 years. The U.S. life expectancy at birth of 78.7 years ranked No. 28 out of the 37 OECD countries, falling between the Czech Republic (79.1 years, No. 27) and Estonia (78.4 years, No. 29) (Figure 74). Hawaii, the U.S. state with the highest life expectancy at 82.5 years, fell between Sweden (82.6 years, No.11) and Luxembourg (82.4 years, No.12). Mississippi, the U.S. state with the lowest life expectancy of 74.8 years, fell below Latvia (No. 37).

Health spending

Health spending represents the total consumption of goods and services; this includes personal health care (such as curative, rehabilitative and long-term care) and collective services (such as prevention and public health services). The average spending on health in OECD countries was $3,984 US dollars per capita. The United States spent almost three times that amount, totaling $10,637 U.S. dollars per capita in 2018 (No. 37 out of the 37 OECD countries) (Figure 75). Switzerland (No. 36), which spent the second most on health among OECD countries, still spent two-thirds the amount the United States spent in 2018. U.S. private sector spending on health has historically far exceeded that of other comparable nations, whereas U.S. public sector spending on health has been fairly similar to comparable countries. However, as a portion of total health spending in the United States, roughly 50% comes from public funds, which was much less than the OECD average of 71%. Within the United States, public expenditures on health also varied greatly. Alaska spent $289 dollars on public health services per person, the most spent per person of all U.S. states. Nevada, at $50 per person, was the state spending the least amount per person on public health services. The national average was $91 per person, an increase of $4 per person from last year’s report.

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