(Photo by sasirin pamai on Shutterstock)

All 50 States Show Rising Rates of Avoidable Death, While Comparable Countries Improve

PROVIDENCE, R.I. — More money doesn’t mean better health—at least not in America. An eye-opening study reveals that Americans are dying from preventable and treatable causes at increasing rates compared to citizens of other wealthy nations, despite the U.S. outspending every other country on healthcare.

This research, led by researchers from Brown University and published in JAMA Internal Medicine, compared death rates from avoidable causes across all 50 US states and Washington DC against 40 countries in Europe and the developed world over 12 years (2009-2021).

The Troubling Trend: Every U.S. State Getting Worse

Between 2009 and 2019—before COVID-19 struck—every single US state saw increases in deaths that medical experts consider “avoidable.” These include deaths from conditions that could be prevented through good public health measures or treated effectively with proper medical care. Meanwhile, most other wealthy countries were saving more lives from these same conditions.

When researchers examined the relationship between healthcare spending and outcomes, they discovered other countries consistently get better results when they spend more money. In the United States? No such connection exists. American healthcare dollars simply don’t translate to saved lives the way they do elsewhere.

West Virginia experienced the most dramatic deterioration, with nearly 100 additional avoidable deaths per 100,000 people over the decade. Even New York, which performed best among U.S. states, still showed an increase of 4.9 deaths per 100,000. Meanwhile, countries like Lithuania, Latvia, Estonia, and Hungary—which started with higher death rates—made remarkable improvements.

The increase in U.S. avoidable deaths came primarily from preventable rather than treatable causes. Deaths from external factors—traffic accidents, homicides, suicides, and substance abuse—drove much of the increase, with drug-related deaths accounting for 71% of this rise.

When COVID Hit: A System Already in Trouble

COVID-19 amplified existing weaknesses. From 2019 to 2021, US states suffered far greater increases in avoidable deaths (median: 101.5 additional deaths per 100,000) than other countries (median: 25.8 additional deaths per 100,000).

States and countries that already had higher death rates before the pandemic generally fared worse during the crisis, revealing how existing systemic problems become more apparent when stressed.

Beyond direct COVID-19 deaths, the pandemic period saw increases in avoidable deaths from other causes, including heart disease and accidents. This pattern indicates that disruptions in care and other pandemic impacts further undermined population health.

The Money Paradox: Spending More, Getting Less

The disconnect between spending and outcomes raises fundamental questions about American healthcare. The U.S. already spends roughly twice as much per capita on healthcare as other high-income countries, yet this massive investment isn’t preventing deaths that modern healthcare systems should be able to address.

Researchers say our problems extend beyond clinical care. The evidence points to failures in addressing social factors that influence health outcomes. State-level policy differences—regarding healthcare coverage, reproductive health, taxation, social welfare programs, and other factors—have become more pronounced over the past decade, potentially contributing to the growing variation in outcomes between states.

Still, the fact that even the best-performing U.S. states lag behind most comparable countries shows the problem is national rather than merely regional issues. “There’s been a lot of discussion about preventable deaths in the U.S. such as drug-related deaths or suicides, which do account for a big proportion of this trend,” says lead study author Irene Papanicolas, a professor of health services, policy and practice at Brown’s School of Public Health, in a statement. “However, we found that deaths from nearly all major categories are increasing.”

Looking Forward: Beyond Traditional Healthcare Solutions

The findings emphasize that improving U.S. health outcomes will require action beyond traditional healthcare delivery. Policies affecting nutrition, harmful products, obesity prevention, gun violence, vehicle safety, and other public health measures may be as important as medical care itself.

For everyday Americans, the implications are sobering. Your chances of surviving a preventable or treatable condition are significantly better in almost any other developed country than in the United States—regardless of which state you live in or how much your state spends on healthcare.

“We’ve known for some time that life expectancy has been getting worse in the U.S., but now we can see that the country is on a different trajectory from other high-income countries,” says Papanicolas, who is also the director of the Center for Health System Sustainability. “Other countries are getting better at reducing avoidable deaths through prevention and treatment, but in the U.S., these deaths are growing.”

As life expectancy in the U.S. continues to falter while other nations progress, this research points to the need for fundamental reforms to address what has become a national health crisis affecting every state in the union.