41 nations top U.S. life expectancy

WASHINGTON — Americans are living longer than ever, but not as long as people in 41 other countries.

For decades, the United States has been slipping in international rankings of life expectancy, as other countries improve health care, nutrition and lifestyles.

Countries that surpass the United States include Japan, most of Europe and Jordan.

"Something's wrong here when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries," said Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation at the University of Washington.

A baby born in the United States in 2004 will live an average of 77.9 years. That life expectancy ranks 42nd, down from 11th two decades earlier, according to international numbers provided by the Census Bureau and domestic numbers from the National Center for Health Statistics.

Andorra, a tiny country in the Pyrenees mountains between France and Spain, had the longest life expectancy, at 83.5 years, according to the Census Bureau. It was followed by Japan, Macau, San Marino and Singapore.

The shortest life expectancies were clustered in sub-Saharan Africa, a region that has been hit hard by an epidemic of HIV/AIDS, famine and civil strife. Swaziland has the shortest, at 34.1 years, followed by Zambia, Angola, Liberia and Zimbabwe.

Researchers said several factors contributed to the United States' falling behind other industrialized nations. A major one is that 45 million Americans lack health insurance, while Canada and many European countries have universal health care, they say.

But "it's not as simple as saying we don't have national health insurance," said Sam Harper, an epidemiologist at McGill University in Montreal. "It's not that easy."

Among the other factors:

• Adults in the United States have one of the highest obesity rates in the world. Nearly one-third of U.S. adults 20 years and older are obese, while about two-thirds are overweight, according to the National Center for Health Statistics.

• Racial disparities. Black Americans have an average life expectancy of 73.3 years, five years shorter than white Americans.

• A relatively high percentage of babies born in the United States die before their first birthday, compared with other industrialized nations. Forty countries, including Cuba, Taiwan and most of Europe, had lower infant-mortality rates than the United States in 2004. The U.S. rate was 6.8 deaths for every 1,000 live births. It was 13.7 for black Americans, the same as Saudi Arabia.

Another reason for the U.S. drop in the ranking is that the Census Bureau tracks life expectancy for a lot more countries — 222 in 2004 — than it did in the 1980s. However, that does not explain why so many countries entered the rankings with longer life expectancies than the United States.

Murray, of the University of Washington, said improved access to health insurance could increase life expectancy. But, policymakers also should focus on ways to reduce cancer, heart disease and lung disease, Murray said. He advocates stepped-up efforts to reduce tobacco use, control blood pressure, reduce cholesterol and regulate blood sugar.

"Even if we focused only on those four things, we would go a long way toward improving health care in the United States," Murray said.