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Comparing US prevention efforts to other high-income countries
Irene Papanicolas1, Tania Sawaya1, Sara N Bleich2
1Department of Health Services, Policy and Practice, Brown School of Public Health, Providence, RI, USA.
The Lancet. Public Health
|October 29, 2025
Summary
The USA has lower life expectancy due to weaker public health policies and healthcare access, despite strong clinical prevention. Improving population health requires investment in prevention and healthcare access.
Area of Science:
- Public Health
- Comparative Health Policy
- Preventive Medicine
Background:
- US life expectancy lags behind other high-income nations, with many preventable deaths.
- The contribution of prevention measures and public health policies to this disparity is unclear.
Purpose of the Study:
- To compare US prevention performance and public health policies against other high-income countries.
- To identify factors contributing to lower life expectancy in the USA.
Main Methods:
- Comparative analysis of population-based health indicators (2010-2023).
- Inclusion of USA, six high-income countries, and OECD countries.
- Assessment of healthcare system-dependent and independent prevention measures.
Main Results:
- USA has lower obesity, higher calorie intake, illicit drug use, and gun/vehicle ownership than comparators.
- US excels in clinical prevention (screening, chronic disease management) but lags in healthcare access and coverage.
- Public health policies outside the healthcare system are weaker in the USA.
Conclusions:
- US healthcare system performs well internally but faces external risks and weaker public health regulations.
- Policy makers should prioritize multi-sectoral prevention investments and improve healthcare access to enhance population health.
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