I’m just back from my home country, the United States. I always enjoy visiting, but every time I go between the US and my adopted home of Europe, I’m keenly aware of disparity in health: Americans live much shorter lives and spend more of their lifetime in poor health. This is despite Americans earning some of the highest salaries per capita in the world and spending twice as much as comparable countries on healthcare.
A recent study in the New England Journal of Medicine of 74,000 adults found that even the wealthiest Americans had higher mortality rates than the wealthiest Europeans – and that the richest Americans had mortality rates comparable to the poorest residents of northern and western Europe. Across every wealth category, Americans were more likely to die younger than Europeans, suggesting that even wealth doesn’t insulate from larger factors that impact life expectancy.
That the US has a health problem isn’t controversial. The Make America Healthy Again movement, led by US health secretary Robert F Kennedy Jr, has highlighted soaring rates of obesity, diabetes and chronic disease. The movement’s public face isn’t scientists or doctors, but influencers posting videos from saunas, gyms and parks talking about better choices and individual discipline. Eat more red meat. Do more push-ups. Drink raw milk. Avoid vaccines and boost your natural immunity. Sweat more. This health advice is given, while month by month, public health agencies are gutted, research is not funded and experts are sidelined and dismissed from advisory groups.
Of course, the public aren’t stupid. Polling consistently finds that scientists remain among the most trusted sources of information in the US, compared with politicians and influencers. RFK Jr himself isn’t popular, 60% of voters disapprove of the job he’s doing. People might enjoy following entertaining social media accounts, but when Americans want reliable health information, they still largely turn to doctors and scientists.
Why are Americans dying younger than Europeans? If we look at the data, several factors pop out. I’ll pick up a few here.
The US is a uniquely violent high-income country, with guns the leading cause of death for children and adolescents, followed by road traffic collisions. For example, the firearm death rate among American children (age 0-17) is 72 times higher in the US than in the UK, with one mass shooting taking place per day, on average.
Why? Because the US doesn’t regulate guns as tightly as the UK (which effectively banned handguns after the Dunblane shooting) and hasn’t addressed road safety as a government issue. No amount of cold plunges or protein shakes will prevent you from getting shot or being killed on the roads. Those are policy decisions that have to be addressed by government.
Additionally, the US is the only high-income country that doesn’t guarantee healthcare: around 26 million Americans remain uninsured while millions more carry insurance plans with loopholes or deductibles so high that it’s financially risky to access care. According to a Commonwealth Fund survey, an estimated 57% of underinsured adults delayed or avoided medical care because of cost. Diseases that could have been detected early become more serious and more expensive. Think of waiting with your asthmatic child outside an emergency room, hoping their breathing stabilises because otherwise you’ll face a $20,000-30,000 bill. As a result, Americans have substantially higher levels of preventable and treatable mortality than Europeans.
How to solve those challenges? Looking to the UK and European countries helps. While these nations differ politically and economically, most share universal healthcare, strong regulation of guns, investment in public transport alongside road infrastructure and safety, and through EU legislation an emphasis on food quality and safe ingredients.
In contrast, rooted in libertarianism and “freedom”, the Maha movement pushes individual solutions to the US’s health challenges. Of course, personal behaviour matters in health. Diet, exercise, smoking and alcohol consumption affect how long we live. Yet many of the largest contributors to premature mortality in the US cannot be solved by individual discipline. They require policies and institutions capable of reducing collective risks across society.
What does freedom even mean? It depends who you ask. I would define freedom as the ability to live a long and healthy life, and in that regard, public health policies can bring more freedom. People in the UK have given up their freedom to easily own a gun to gain the freedom for children to go to school safely without shooter drills. The UK has not had a school shooting since Dunblane – and not because individuals haven’t planned to carry one out. They just haven’t been able to find a gun.
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Maha is right: Americans need to become healthier and live longer. But this won’t happen with influencers telling people to do pull-ups or increase sunlight exposure. Otherwise, the wealthiest Americans would be outliving us all. What the US needs is public policy that makes daily life healthier and less dangerous. Unfortunately, the Maha movement, through its leader RFK Jr, has done the opposite in diminishing key US public health agencies such as the CDC, the FDA and the NIH, and removing the US from the World Health Organization.
How your community looks affects your health profoundly. Less me, more us. That’s the key health lesson the US could learn from Europe.
