Why US Life Expectancy Continues to Trail Peer Nations

Racial and geographic disparities, high out-of-pocket costs, and lack of universal health coverage are among the key reasons that the US continues to fall behind in life expectancy compared with its peer nations, despite spending the most on health care. A new report from The Commonwealth Fund also found that the US had the fewest primary care doctors per capita when compared with other nations included in this study, such as Australia, Canada, and the United Kingdom.

How Does the US Compare to Other Countries on Health Care?

The U.S. Health Care from a Global Perspective 2026: Expanded Edition report used the 4 areas of insurance coverage and access to care, affordability of care, equity of outcomes, and care delivery to compare the US with 19 other countries across the world. The countries, which are part of the Organisation of Economic Co-operation and Development (OECD), are similar in economic status to that of the US. The countries included in the report were the United Kingdom, Australia, Canada, Denmark, Chile, Germany, France, Italy, Israel, Japan, Korea, the Netherlands, Mexico, Norway, New Zealand, Switzerland, Sweden, Spain, and Türkiye.

The authors of the report primarily found that the US was spending more on health care compared with their peers, totaling 18% of the gross domestic product (GDP) of the US budget. The US spends approximately $12,649 per capita between voluntary and household out-of-pocket payments and government payments. The next closest country in spending was Switzerland at approximately $7927 per capita.

Despite this increased spend, the US had a life expectancy of 79 years, which is lower than Japan’s, Spain’s, and Switzerland’s life expectancies. Avoidable deaths were also second highest among the countries included in the report, falling behind only Mexico.

Who Is Most Likely to Be Uninsured in the US?

The report also took a closer look at the uninsured population, as uninsured rates are higher in individuals who identify as Black, Hispanic, or American Indian or Alaska Native. Individuals who live in states that have not expanded Medicaid eligibility or are low-income were also more likely to be uninsured. Approximately 8% of the American population lived without health insurance, which will increase by 2034 due to recent policy changes.

The OECD has an average of 1.1 primary care physicians per capita and produces an average of 14.5 new physicians per 100,000 people each year. The US had lower rates in both, having 0.3 primary care physicians per capita and only 8.6 new physicians per 100,000 people each year. Limited numbers of residency training positions, underinvestment in primary care, high tuition costs, and physician burnout were cited as primary factors in these numbers.

Maternal Mortality in the US Remains the Highest Among Peer Nations

The maternal death rate is highest in the US at 19 deaths per 100,000 live births and 50 deaths per 100,000 live births in Black women. A total of 11 of the countries studied had a live birth maternal death rate of fewer than 5 deaths. The rate of maternal deaths in Black women was higher than any other country in the survey. These corroborate findings published in 2025, which found that the maternal mortality rate in the US and in specific states was higher than rates in almost all of the other high-income countries.²

Study Methods and Limitations

The study was conducted by gathering the health statistics in the 2026 release from the OECD, which includes 38 member countries. The data were extracted between January and February of 2026. A limitation of the study was that the OECD database may obscure the differences in measurement of the data, and fewer than 20 countries may be included in some of the measures due to the analysis only measuring within the past 6 years.

What Policy Changes Could Improve US Health Outcomes?

Ultimately, the authors of the study suggest that the US health care system can be improved through expanding access to affordable health coverage, strengthening primary care, reducing health care costs, and addressing inequities in health outcomes. Policies that address stronger oversight in health care prices, growing the workforce, and supporting care models supported by technology and teams could help to improve population health and health outcomes.

References

1. New international report: despite spending most on health care, U.S. has among the lowest life expectancies and the fewest primary care doctors per capita among peer nations. News release. The Commonwealth Fund. May 28, 2026. Accessed May 28, 2026.
2. Bonavitacola J. Maternal, child mortality higher in the US compared with majority of high-income countries. AJMC. October 2, 2025. Accessed May 27, 2026. https://www.ajmc.com/view/maternal-child-mortality-higher-in-the-us-compared-with-majority-of-high-income-countries