Australia offers lessons for increasing Americans’ life expectancy

Despite being home to some of the world’s most dangerous animals, Australia has been the most successful English-speaking country in terms of life expectancy for three decades. Among other high-income English-speaking countries, the Irish have seen the biggest increases in life expectancy, while Americans have come in last since the early 1990s, according to a team of sociologists led by a Penn State researcher.

The team published their results in the journal BMJ open.

“One of the lessons we can learn as Americans from looking at countries that are comparable in life expectancy is where the frontier of better outcomes lies,” said Jessica Ho, associate professor of sociology and demography at Penn State and lead author of the study. “Yes, our outcomes are poor, but this study shows what we can aim for. We know these gains in life expectancy are achievable because other major countries have already achieved them.”

The researchers compared life expectancy in the United States, Canada, Ireland, the United Kingdom, Australia and New Zealand using data from the Human Mortality Database and the World Health Organization Mortality Database between 1990 and 2019. They analyzed the data by sex, age and 18 individual and comprehensive categories of causes of death, including cancers, drug and alcohol-related deaths, firearms and motor vehicle collisions.

They also looked at life expectancy in each country to identify geographic inequalities in life expectancy by region.

The researchers found that Australians had the longest life expectancy at birth over the study period, with women living nearly 4 years longer and men 5 years longer than their American counterparts. The Irish showed the greatest gains in life expectancy, with men’s life expectancy increasing by about 8 years and women’s by more than 6.5 years. Americans had the shortest life expectancy at birth, with women living on average nearly 81.5 years and men on average nearly 76.5 years in 2019.

The United States also has some of the largest geographic inequalities in life expectancy compared to other countries, the researchers found. Women and men in California and Hawaii have some of the highest life expectancies at birth, with women averaging 83 to 83.9 years and men averaging 77.5 to 78.4 years. States in the U.S. Southeast had some of the lowest life expectancies at birth of any subnational region studied, with women averaging 72.6 to 79.9 years and men averaging 69.3 to 74.4 years.

“One of the main reasons why American longevity is so much shorter than in other high-income countries is that our young people are dying at higher rates from largely preventable causes of death, such as drug overdoses, car accidents and homicide,” said Ho, who is also an associate at Penn State’s Social Science Research Institute.

In middle age, between ages 45 and 64, some of these causes persist, such as high drug- and alcohol-related death rates, Ho said, adding that Americans also experience higher rates of death from cardiovascular disease.

“Some of these may be related to sedentary lifestyles, high rates of obesity, poor diet, stress and a history of smoking,” she said. “It is likely that these unhealthy behaviors are putting Americans at a disadvantage in terms of health and vitality.”

Australia offers the United States a model for improving life expectancy, Ho added. Like the United States, Australia is vast in land area and has a comparable history of personal vehicle ownership. The two countries have some cultural similarities, including a historically greater use of firearms. However, Australia has implemented a number of policies in recent decades, including gun law reforms, that have helped propel the country to the top of the life expectancy rankings.

“The study shows that a comparable country like Australia far outperformed the United States in controlling its young adult mortality,” Ho said. “The country has very low rates of gun deaths and homicides, lower levels of drug and alcohol use, and better chronic disease outcomes, the latter of which is linked to lifestyle factors, health behaviors and health care performance.”

Ho said policies such as investing in public transportation infrastructure, adding roundabouts and reducing the number of large cars on the road could reduce the number of traffic deaths in the United States. Increased support for programs to reduce drug addiction and reduce barriers to treatment and overdose prevention could help reduce drug-related deaths, she said. And a strong combination of public health efforts, access to health care and community interventions to encourage healthier lifestyles and the use of preventive medicine could reduce cardiovascular disease deaths, she added.

“Australia is a model of how Americans can improve and achieve not only longer life expectancy, but also lower geographic inequality in life expectancy,” Ho said.

Rachel Wilkie, a doctoral student at the University of Southern California, also contributed to this research.