Despite being a rich nation, America makes it hard to get old—and hard to thrive if you do

Transportation policy is a key reason why. More transit isn't the (only) answer. The first of two short posts on the subject.

A paradox characterizes aging in the United States: in material terms, we are a nation rich beyond compare, and yet when we compare ourselves to other rich nations on a key social dimension—how long people live—we come up short. The reasons are numerous: a mix of culture, diet, health care, drug and gun access and other non-medical determinants of health are all factors identified by researchers that help explain why Americans have a shorter life expectancy than our counterparts in other rich countries like Canada and Japan. (Transportation safety is another reason that has been identified, on which more to come.) Journalists have seized on this as well.¹

But for Americans who do achieve old age, it is also hard to thrive. This is a more subjective concept than lifespan and thus harder to measure, but we can make some inferences. One yardstick, if you ask people what they value, is independence. Why is staying independent hard as an older adult in the United States? In a chapter I contributed to a recent book on aging—Law and the 100-Year Life: Transforming Our Institutions for a Longer Lifespan²—I argue transportation is a key factor.

This post is the first of two expanding on that chapter. This installment establishes two background facts: that America is rich and that life expectancy in other countries is longer. The companion post will bring law and policy into the mix.

I. America is Rich

A basic fact of modern life that few politicians in this populist age will advertise is that America is a very affluent society, in both global terms and relative to the recent past. There are many ways to measure this and it’s not really the focus of my chapter, but it’s helpful to understand how rich we are in order to see how perverse the gaps in U.S. life expectancy and (I argue) thriving are.

Income and Wealth in the United States

Let’s start with income: how much people earn in a given year. Between 1984 and 2024, median real US household income grew by about 40%, from about $60,000 in 1984 to about $84,000 in 2024 (all in 2024 dollars).

This measure is adjusted for inflation, so it accounts for the historically high level of price increases during the post-2020 economic regime. Further, as a median (rather than mean), it is not affected by disproportionate income growth at the high end. There are reasons to think even this rosy picture actually understates income growth.³

Affluence can also be measured in wealth rather than income. Doing so tends to emphasize the upward skew in the distribution (wealth is more skewed than income), but given the state of political rhetoric you might be surprised by how well the least well off fare on this measure.⁴

So, with the important qualification that many individuals and households—especially those in disadvantaged demographic groups—struggle financially even in the best of times, the levels of median income and wealth in the United States⁵ are very high. That’s true in historical terms and, as we’re about to see, in comparative terms.

International Comparisons

Most public health outcomes in the United States are worse than in peer nations, for example those in the OECD club of high-income countries. Notably, this is not only a function of the high level of wealth inequality in the United States. A recent study in the New England Journal of Medicine found that the wealthiest Americans have lifespans comparable to or lower than those of the poorest Europeans, with the wealthiest quartile in the U.S. positioned “similar to that in the poorest quartile in northern and western Europe.” This is all the more striking when you consider the range of unhealthy behaviors that are far more common in Europe, especially smoking. (Of course we have our own unhealthy habits.) So, while this is partly a distributional story in the U.S., even wealthy Americans are adversely affected, which suggests the depth of the issue. There are also methodological difficulties to consider which complicate direct international comparisons on the basis of household wealth⁶ and disfavor strong inferences in the area.

International comparisons of income are also challenging, but there are ways to get at the question. Here are some OECD data on a PPP basis,⁷ collated on Wikipedia.⁸ While the usual Wikipedia caveats apply (and I don’t use the table in the chapter), one thing to like about this table is that it includes the value of in-kind transfers such as the free or extremely low-cost education and health care that our rich-country peers commonly provide. These are two services you might think would help close the gap in this still economic but more holistic measure of income, given how expensive they are in the U.S. Especially in the context of a debate on policies adapted to aging, one can debate non-economic benefits, but in economic terms, even after accounting for this difference U.S. household income stands far above its peers. I was surprised by the gap down to Australia and Canada, for example.

II. American Life Expectancy Is Short

Generally, rich countries enjoy longer life expectancy. Within the universe of affluent countries, however, America lags. As of 2022, life expectancy at birth in the U.S. stood at 77.5 years, whereas in other OECD countries—including ones where household income and wealth are far lower than the U.S., like Portugal—it’s about 6%, or 4.5-5 years, higher.

Those U.S. figures reflect some modest recent improvement. As has been reported, the U.S. has seen some life expectancy growth as covid deaths have fallen. But the gap predated the pandemic and persists today. In the richest nation on earth, we enjoy a shorter life expectancy than in places that are far less fortunate materially. That’s a puzzle (albeit not exactly a neglected one among scholars) and a problem worth addressing.

Conclusion

There are multiple ways to measure the concepts discussed above, but they all point in the same direction: the U.S., despite being richer than our peers (and far richer than any other large nation), lags in life expectancy. In my next post on this topic, I’ll get into the transportation policy dimension of this issue.

I’ll also broach what I think is an underdiscussed (and admittedly squishier) concept, which might be called the older-adult thriving gap. It’s hard to stay independent as an older adult in the U.S., especially if you reach very old age. The book’s nominal focus is on centenarians, but long before reaching age 100 many people lose the ability to drive safely—that is to say, they have a shorter “driving life expectancy.” The solution, in my view, isn’t as simple as “more transit”—partly because many Americans clearly show a preference for private transport, partly because that solution would simply take too long to benefit current older adults and the giant wave of retiring Boomers. The good news is that I think market forces can, if harnessed and given more room to run, play a constructive role here. That’s not always the case, but one advantage when it is the case is speed of change relative to more state-driven changes like mandates (e.g., inclusionary zoning) or direct public provision (e.g., building more conventional transit). Subscribe to receive the thrilling solution to all these challenges—or at least a modest stab at a way to make incremental progress—next time.

1. See “America Is a Rich Death Trap” and “Tackling America's weirdly short life expectancy should be a priority.”

2. You can download the whole book for free at that link. It includes many excellent chapters on varied topics.

3. For example, household size decreased during this period—more people live alone now, and parents have fewer kids—which means that the observed 40% increase in household income goes further per household.

4. The bottom quintile of the wealth distribution, for example, currently control about $4.2 trillion in wealth. The figure is similar (a bit higher, actually) if you look at the bottom quintile of the income distribution (they currently control about $5 trillion in wealth).

5. It’s tangential to this topic, but a post I wrote on an increasingly popular wealth accumulation vehicle in the U.S.—target date funds—is here:

6. Variation in the prevalence, size, and terms of defined-benefit pensions is part of the challenge. I also would not want to be responsible for estimating the net present value of 401(k)s at the household level, given variation in asset allocation, duration of the accumulation and depletion periods, and the like. This is all the easy part, relative to, say, valuing real estate at scale. Research on the methods question goes back a ways.

7. Purchasing Power Parity (PPP) attempts to account for differences in living costs from country to country ($1 in the U.S. will not get you as far as the equivalent amount of pesos in Mexico). I think PPP leaves much to be desired in measurement and even in concept, but that’s for another day.

8. https://en.wikipedia.org/wiki/Disposable_household_and_per_capita_income