By Dr. Devaki Lindsey Berkson

In 2020, the COVID-19 pandemic led to the largest decline in U.S. life expectancy since World War II. Yet, prior to the pandemic, the U.S. was already experiencing a decrease in life expectancy, unlike any of its peer nations with comparable Gross Domestic Product (GDP) per capita.

Contributing Factors

Among many factors contributing to this long-term trend are infant and maternal mortality.

Infant mortality: The U.S. ranks 33 out of 36 nations, according to the Organization of Economic Cooperation and Development (OECD). Compared to countries with a similar GDP, the U.S. infant mortality rate is much higher. France and the U.K., for example, have 3.8 deaths per 1,000 live births. In contrast, in the U.S., there are 5.9 infant deaths per 1,000 live births a year (this is more than 21,000 infant deaths annually).

Maternal Mortality: The U.S. is the only industrialized nation globally with rising maternal mortality. Approximately 700 American women die each year during pregnancy, childbirth or subsequent complications.

Chronic diseases: The Centers for Disease Control and Prevention reports that in 2018, 51.8% of U.S. adults had at least one chronic condition, and 27.2%, almost one-third of Americans, had multiple chronic conditions.

U.S. life expectancy has dropped to 76.1 years, its lowest since 1996. Our country has been at a life expectancy disadvantage since the 1950s. It has only gotten worse since then.

A recent study published in the American Journal of Public Health shows more than 50 countries have surpassed the U.S. in life expectancy since the 1930s.

Yet, we pay more for health care than any other country. In 2021, the U.S. spent 17.8% of gross domestic product (GDP) on health care, nearly twice as much as the average OECD country. 

Health spending per person in the U.S. was nearly two times higher than in the closest country, Germany, and four times higher than in South Korea.

Overall the U.S. has:

  • lowest life expectancy at birth,
  • highest death rates for avoidable or treatable conditions,
  • highest maternal and infant mortality,
  • some of the highest suicide rates,
  • highest rate of people with multiple chronic conditions and an obesity rate nearly twice the OECD average,
  • most COVID-19 related deaths, though we do not know the exact number.
  • violent crime rates (homicide, rape and robbery) several times higher than the averages for reporting European countries.
  • Additionally, Americans see physicians less often than people in most other countries and have among the lowest rate of practicing physicians and hospital beds per 1,000 population.

Still, America is a land of opportunity. We can work hard and make money, this is still true.

I love my country. I’m America through and through.

Abraham R. Berkson, my hero of a Dad, fought four years on the front lines of World War II and two years in Korea. I remember his words well about all that.

But America is not a healthy country anymore. You must fight for the health of yourselves and your family and your patients. You may need our medicine, but you also have to be protected against potential harm by our medicine.

How our health care is presently unfolding in many domains is not working. I am not talking about ER medicine or orthopedic surgery, but birthing, dying and chronic care.

How our old folks age is shocking. There is so much to do to slow this down and make the end of life so much better. Yet our medicine does not do these things.

Life Expectancy

The U.S. began seeing dramatic increases in life expectancy in the early 20th century, mainly a result of public health advances such as sanitation.

This growth continued into the ’50s, with U.S. life expectancy ranking 12th highest in the world. That growth rate began declining in 1955, and by 1968, the U.S. had fallen to 29th.

The decline began much earlier, in the 1950s.

What was going on in the 1950s that initiated this?

The American Heart Association (AHA) began to recommend the fateful low-fat diet in their Dietary Fat Recommendations 1957–2015. Putting down fat over sugar.

By the way, the AHA is still trying to get LDL cholesterol lower and lower and lower. They are using statins more and more and more. Remember, your brain, eyeballs and cell membranes, are mainly made up of cholesterol.

The life expectancy growth rate rebounded in 1974, then decelerated again in 1983. Our current life expectancy rate of 76.1 is the lowest it has been since 1996.

Fifty-six countries surpass the U.S. in life expectancy since 1950.

By 2019, the U.S. ranked 40th among countries – lower than Lebanon and Albania.

Countries that don’t necessarily have all the support systems, infrastructure and policies that exist in higher-income countries are still outperforming the U.S.

State to State

Within the U.S., life expectancy varies from state to state.

For example, Hawaii, New York and a few other high-performing states have the same life expectancy as some of the healthiest countries in the world.

In the past decade, U.S. deaths, especially in Southern states, have soared from a wide range of diseases and conditions, including diabetes, suicide, stroke and unintentional injuries, such as drug and alcohol overdoses. (As I travel through the country these past several years on many airplanes, I see such food differences in various states, such as much more comfort and junk food in Southern states).

A 2020 Commonwealth Fund study concluded that the U.S. has the highest rate of avoidable deaths in the world.

This was measured as “premature deaths from conditions that are considered preventable with timely access to effective and quality healthcare.” The title of the article says it all: U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes.

Agile Thinking

Many docs are arrogant that their way of health care is the right and best and only way.

They look down on functional medicine, nutritional interventions, hands-on interventions and assessment of gut and nutrient status.

There is a growing bias against hormonal therapies.

Keep all this in mind when trying to figure out your own health care path.

Don’t let yourself be browbeat into doing what doesn’t feel right. You must be educated to realize what feels right or not. Without diving into some educational materials yourself, you take what any health care professional tells you as gospel.

There should not be only one way of looking at how you got ill, and how – now – to get you well.


  • Be an agile thinker.
  • Knowledge is power.
  • You must take your health care into your own hands.
  • Assemble a team of allies to help you stay well.
  • Navigate through life with the best possible outcomes for YOU.

Don’t become a sad statistic but a soaring unstoppable healthy human, even in today’s messy, toxic world.

Dr. Berkson is a functional medicine specialist at Naples Center for Functional Medicine focusing on hormones, anti-aging and medical nutrition. Learn more about her here.


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