In many ways, America is richer than most (if not all) other countries. But a new study tears a huge hole through that illusion. Americans are not better off than their counterparts; even the richest Americans are much unhealthier than you’d expect. In fact, their odds of survival are no better than the poorest Europeans, revealing a national crisis that seeps through every income bracket.
“There’s something systemic that’s happening that affects every American,” said Irene Papanicolas, senior author of the study and professor of health services, policy, and practice at Brown, in an interview with Fortune.
Money doesn’t buy health
A team of researchers at Brown University’s School of Public Health published a sweeping analysis in the New England Journal of Medicine, comparing over 73,000 adults aged 50 to 85 across the United States and 16 European countries.
The study divided participants into four wealth quartiles. In every tier — from the poorest to the richest — Americans had higher mortality rates than Europeans. Already, that’s concerning. But it gets even worse.
In Western and Northern Europe — countries like Germany, Switzerland, and the Netherlands — the richest people had mortality rates roughly 35% lower than the richest Americans. Even more startling, the study found that the wealthiest Americans had life expectancies similar to the poorest Europeans in those same regions.
“So they’re not just doing worse than the richest quartile. They’re statistically equivalent to the poorest quartile in that region,” said Papanicolas.
Wealth is supposed to buy health in America — but it doesn’t. This counters a common assumption: it’s only the lower-income groups in the US that suffer bad health outcomes. Instead, the findings reveal a broader national failure — one that affects Americans across the socioeconomic spectrum.
A Systemic Problem, Not a Personal One
So what’s behind this surprising disparity?
There’s no simple answer. The researchers point to a confluence of cultural, behavioral, and systemic factors. America’s fragmented healthcare system, patchy access to social services, and high rates of preventable deaths all contribute to this problem. The fact that healthcare is so expensive is also a big problem.
Compared to Europeans, Americans face higher rates of cardiovascular disease, firearm deaths, alcohol-related deaths, and suicide. These external causes are major drivers of early mortality. And while the U.S. spends more on health care per capita than any other country, those dollars don’t seem to be buying longer lives.
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Europeans, particularly in Western and Northern countries, benefit from more robust social safety nets — health care isn’t tied to employment, education is more equitably distributed, and income gaps are narrower. These structures, the researchers suggest, buffer individuals from the stress and risk factors that chip away at American lifespans.
In Southern Europe, where countries like Spain and Italy combine high life expectancy with lower health spending, the survival gap was also evident. Southern Europeans in the study had death rates 30% lower than their American counterparts.
Another key finding: the illusion of narrowing inequality with age in the U.S. is partly a statistical mirage. As poorer Americans die younger, the surviving population skews wealthier and healthier. That survivor effect gives a misleading picture of improvement.
“In the U.S. [wealth inequality] narrows because the poorest Americans die sooner and in greater proportion,” Papanicolas said.
The US model isn’t working
America’s life expectancy has been declining even before the COVID-19 pandemic, which further widened health gaps. By 2019, life expectancy in the U.S. stood at 78.8 years, compared to 84 years in Switzerland and Spain. And in Canada — a country culturally and economically similar to the U.S. — it was 82.3.
If the richest Americans are dying younger than Europeans across all income levels, the implication is clear: something in the American way of life is cutting lives short — even for those who seem to have every financial advantage.
The researchers are cautious about prescribing exact solutions but agree on one thing: the current U.S. model is not working.
“If you look at other countries, there are better outcomes, and that means we can learn from them and improve,” said Machado.
This study, comprehensive in scope and sobering in tone, suggests the American health crisis is a warning about a broader societal failure. And that failure, the data show, spares no one.