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Executive BriefForewordIntroductionNational HighlightsFindingsHealth OutcomesSocial and Economic FactorsPhysical EnvironmentClinical CareState RankingsInternational ComparisonCOVID-era Disparities SurveyAppendixMeasures TableData Source DescriptionsMethodologyState Summaries
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US Summary
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingUS SummaryComparing the health of the United States to that of other countries is an indicator of the progress the United States has made and where it has potential to improve measures of health and create healthier communities. The Organization for Economic Co-operation and Development (OECD), the data source for this section, is composed of 38 member countries, including the United States. OECD’s mission is to promote the economic development and social well-being of people worldwide. OECD collects and analyzes data from each member country on a wide range of social, economic and health-related topics.
The COVID-19 pandemic has had profound effects on global population health. Despite differences in reporting across countries, the picture is becoming clearer. Among OECD countries, more than 110 million COVID-19 infections and more than 2.1 million deaths were reported as of October 2021. According to OECD, this represented approximately 47% of all reported global COVID-19 infections and 44% of deaths at that time. Overall mortality rates were also up. In 2020 alone, more than 1.8 million excess deaths were reported in the 36 OECD countries with data. Preliminary data suggest excess deaths were high in 2021 as well. Emerging evidence suggests that the risk of infection and adverse health effects were higher in the first year of the pandemic among individuals with lower incomes or educational attainment, ethnic minorities and immigrants as well as their families across OECD countries, similar to the U.S.
Vaccinations against COVID-19 have been an important tool to protect against severe illness and death across the world, but vaccination coverage varies markedly across OECD countries. As of October 2021, the percentage of the population fully vaccinated ranged from a low of less than 40% in Colombia and Mexico to a high of 86% in Portugal. The longer-term implications of the pandemic will not be clear for some time, including the direct and indirect effects on countries’ economies and the mental and physical health of their populations.
The following analysis compares the U.S. with other OECD countries using three health measures: infant mortality, life expectancy at birth and total health spending. Data presented are from 2020 unless specified. For infant mortality, the top and bottom states from the 2022 Health of Women and Children Report were included for reference. Top and bottom states were also included for life expectancy, using data from the National Center for Health Statistics, National Vital Statistics System.
The U.S. had a higher infant mortality rate and lower life expectancy than most other OECD countries. Even the best performing U.S. states ranked poorly among member countries for the infant mortality and life expectancy measures, despite the U.S. having the highest total health spending of all OECD countries.
Infant mortality
Infant mortality accounts for deaths among children under 1 year of age. Over the past 50 years, the U.S. infant mortality rate has not improved at the same pace as that of other OECD countries.
The average rate of infant mortality among OECD countries was 4.1 deaths per 1,000 live births. At 5.4 deaths per 1,000 live births, the U.S. ranked No. 33 out of the 38 OECD countries. Estonia (No. 1) had the lowest rate in 2020, with 1.4 deaths per 1,000 live births. Mexico (No. 37) and Colombia (No. 38) had the highest infant mortality rates of OECD countries at 13.8 and 16.8 deaths per 1,000 live births, respectively. There were large racial/ethnic disparities among U.S. infants. In 2018-2019, the mortality rate was 3 times higher among Black infants at 10.7 deaths per 1,000 live births compared with Asian infants at 3.5 deaths per 1,000 live births.
According to the 2022 Health of Women and Children Report, New Hampshire was the state with the lowest infant mortality rate at 3.4 deaths per 1,000 live births, placing it on par with Hungary (also 3.4, No. 23). The state with the highest rate, Mississippi, had an infant mortality rate of 8.6 deaths per 1,000 live births, which was more than twice the OECD average.
Life expectancy
Life expectancy at birth describes how long a newborn can expect to live, on average, assuming current death rates remain the same. Life expectancy has increased over the past 50 years in all OECD countries. However, the COVID-19 pandemic has had profound global effects on life expectancy due to the high number of deaths from COVID-19 and other related causes.
In 2020, life expectancy fell in nearly all OECD countries with available data. Norway, Japan, Costa Rica, Denmark, Finland and Latvia were the exceptions. Nine countries had a decrease of one year or more; the largest decreases occurred in the U.S. (1.6 years) and Spain (1.5 years).
The average life expectancy in OECD countries was 80.5 years. The U.S. life expectancy at birth was 77.0 years and ranked No. 31 out of the 38 OECD countries, tied with the Slovak Republic (also 77.0 years) and falling between the Czech Republic (78.3 years, No. 30) and Colombia (76.7 years, No. 33).
Hawaii, the state with the highest life expectancy at 80.7 years, fell between Slovenia and Costa Rica (both 80.6 years, No. 25) and Belgium and Chile (both 80.8 years, No. 23). Mississippi, the state with the lowest life expectancy at 71.9 years, fell well below Lithuania (75.1 years, No. 38), the OECD country with the lowest life expectancy.
Total health spending
Total health spending represents the total consumption of goods and services; this includes personal health care (such as curative, rehabilitative and long-term care) and collective services (such as prevention and public health services).
Prior to the COVID-19 pandemic, per capita health spending increased in OECD countries by an average of 2.7% annually. Estimates suggest that health expenditures grew approximately 5% on average in 2020 in response to the COVID-19 pandemic, the largest increase in spending in approximately 15 years. Preliminary estimates for 2021 suggest that health spending has continued to increase at a similar pace.
The average total spending on health in OECD countries was $4,272 U.S. dollars per capita in 2020. The U.S. spent nearly three times that amount, totaling $11,859 U.S. dollars per capita. Switzerland, which spent the second most on health among OECD countries ($7,179), still spent only about two-thirds the amount the U.S. spent.
Spending on inpatient and outpatient care accounted for the largest share of the difference between the U.S. and other countries, and represented a greater share of health spending in 2018. Roughly 50% of total health spending in the U.S. came from public funds in 2017, which was much less than the OECD average of 71%.
