WASHINGTON -- Americans are living longer than ever, but not as long as people in 41 other countries.
For decades, the United States has been slipping in rankings of life expectancy, as other countries improve healthcare, nutrition and lifestyles.
Countries that surpass the United States include Japan and most of Europe, as well as Jordan, Guam and the Cayman Islands.
"Something's wrong here when one of the richest countries in the world, the one that spends the most on healthcare, is not able to keep up with other countries," said Christopher Murray, head of the Institute for Health Metrics and Evaluation at the University of Washington.
A baby born in the United States in 2004 is expected to live an average of 77.9 years. That ranks 42nd, down from 11th two decades earlier, according to international numbers provided by the Census Bureau and domestic numbers from the National Center for Health Statistics.
Andorra, a tiny country between France and Spain, had the longest life expectancy, at 83.5 years, according to the Census Bureau.
It was followed by Japan, Macao, San Marino and Singapore.
The shortest life expectancies were clustered in sub-Saharan Africa, a region that has been hit hard by HIV and AIDS, famine and civil strife. Swaziland has the shortest, at 34.1 years, followed by Zambia, Angola, Liberia and Zimbabwe.
Researchers say several factors have contributed to the United States falling behind other industrialized nations. A major one, they say, is that 47 million people in the United States lack health insurance, whereas Canada and many European countries have universal healthcare.
But "it's not as simple as saying, 'We don't have national health insurance,' " said Samuel B. Harper, an epidemiologist at McGill University in Montreal. "It's not that easy."
Among the other factors researchers cite:
* Adults in the United States have one of the world's highest obesity rates. Nearly a third of those 20 or older are obese, according to the National Center for Health Statistics. "The U.S. has the resources that allow people to get fat and lazy," said Paul D. Terry, an assistant professor of epidemiology at Emory University in Atlanta. "We have the luxury of choosing a bad lifestyle as opposed to having one imposed on us by hard times."
* Racial disparities. Black Americans' average life expectancy is 73.3 years, five years less than white Americans'. Black American males have a life expectancy of 69.8 years, slightly shorter than in Nicaragua and Morocco.
* A relatively high percentage of babies born in the United States die before their first birthday, compared with other industrialized nations: 6.8 deaths for every 1,000 live births. Forty countries, including Cuba, Taiwan and most of Europe, had lower infant mortality rates in 2004. The rate for black Americans was 13.7, the same as Saudi Arabia.
"It really reflects the social conditions in which African American women grow up and have children," said Dr. Marie C. McCormick, professor of maternal and child health at the Harvard School of Public Health. "We haven't done anything to eliminate those disparities."
Another reason for the U.S. drop in the rankings is that the Census Bureau now tracks life expectancy for many more countries -- 222 in 2004 -- than it did in the 1980s.
Murray said improved access to health insurance could increase life expectancy. But he said he doubted that the United States would move up in the rankings as long as the healthcare debate was limited to insurance. He said policymakers also should focus on reducing cancer, heart disease and lung disease. He advocates stepped up efforts to reduce tobacco use, control blood pressure, reduce cholesterol and regulate blood sugar.
"Even if we focused only on those four things, we would go along way toward improving healthcare in the United States," Murray said.
© 2007 The Los Angeles Times