Why are Americans expected to die sooner than their peers in other high-income countries?
A new study published in the Journal of the American Medical Association takes a look at the question. The results are, well, not too surprising — three of the big drivers for the year analyzed, 2012, were guns, drugs, and cars.
The study looked at these causes of injury deaths, which are the three biggest causes of injury death in the US and altogether account for more than 100,000 early deaths each year in America. It compared how common these deaths are in the US versus other high-income countries — the UK, Denmark, Sweden, Japan, and eight others — with 2012 data from the US National Vital Statistics System and the World Health Organization Mortality Database.
It found that, on average, men and women in the other high-income countries can expect to live about 2.2 years longer than men and women in the US — and guns, drugs, and cars played a prominent role.
Among men, gun deaths explained 21 percent of the gap, drug overdoses 14 percent, and car crashes 13 percent. And among women, gun deaths explained 4 percent, drug overdoses 9 percent, and car crashes 6 percent.
In total, the death rate for guns, drugs, and cars was much, much higher in the US than its developed peers, as this chart shows:
"Although the reasons for the gap in life expectancy at birth between the United States and comparable countries are complex," study authors Andrew Fenelon, Li-Hui Chen, and Susan Baker wrote, "a substantial portion of this gap reflects just three causes of injury."
One of the big reasons for the gaps: policy
So why do Americans die more from these causes? There are cultural factors, but bad policy plays a role too.
With guns, the research shows that America's unusually high levels of gun ownership lead to more gun violence. Other factors, such as socioeconomic issues, contribute to violence, but guns are the one issue that makes America unique relative to other developed countries in comparable socioeconomic circumstances. (To learn more about America's gun problem, read Vox's explainer.)
"A series of specific comparisons of the death rates from property crime and assault in New York City and London show how enormous differences in death risk can be explained even while general patterns are similar," UC Berkeley's Franklin Zimring and Gordon Hawkins wrote in a breakthrough analysis in the 1990s. "A preference for crimes of personal force and the willingness and ability to use guns in robbery make similar levels of property crime 54 times as deadly in New York City as in London."
Some research also shows tightening existing gun control measures in the US would help: Studies in both Connecticut and Missouri suggested that gun licensing laws in those states helped reduce homicides and suicides.
With drugs, America is now in the middle of a harrowing opioid and heroin epidemic that's killing tens of thousands of people each year. (For an in-depth dive on this topic, read Vox's explainer.)
Academic analyses of the crisis have concluded that the US was too slow to respond to misleading advertising campaigns from opioid producers, in which they claimed that their drugs were safe and effective. Americans have suffered the consequences, getting addicted to and dying from opioid painkillers and heroin as pharmaceutical companies have massively profited.
With cars, by the 1960s European policies began encouraging walking, cycling, and public transportation. The US, meanwhile, continued to encourage sprawl and driving. The result: Americans drive much more than their European peers, and are more likely to die in crashes as a result. (To learn more about US and European transportation policy, read Ralph Buehler's great explainer at the Atlantic's CityLab.)
Even perfect policies might not fix all of these problems — Americans, after all, love their guns, drugs, and cars, and that cultural preference will likely remain strong for some time. But better policies could push the US in the right direction — and save lives.