The U.S. faces higher rates of preventable deaths compared to other wealthy nations, particularly from firearms, alcohol, and suicide.12 These external causes point to a weaker public health infrastructure that fails to protect the population as effectively as European systems. Despite overall improvements in global health outcomes, the U.S. has seen an increase in avoidable deaths, contrasting with declining rates in many peer countries.34 This trend underscores the need for targeted interventions and policy reforms to address these specific mortality risks and improve overall life expectancy in the United States.

Cardiovascular disease mortality rates in the United States significantly exceed those in Europe, contributing to the overall life expectancy gap. This disparity persists across wealth levels, with even affluent Americans facing higher cardiovascular mortality risks than their European counterparts12. Several factors contribute to this trend:

• Higher prevalence of obesity and related conditions in the U.S.

• Differences in dietary habits and physical activity levels

• Variations in healthcare access and preventive care

• Stress levels associated with socioeconomic factors

Recent research has shown promising results in addressing cardiovascular risks, with medications like semaglutide 2.4 mg reducing total cardiovascular events by 22% in people with established cardiovascular disease and overweight or obesity3. However, the systemic nature of the U.S.-Europe mortality gap suggests that broader policy interventions targeting lifestyle factors, healthcare accessibility, and social determinants of health may be necessary to close this cardiovascular mortality divide.

The weaker social safety net in the United States compared to European countries contributes significantly to the disparity in lifespans, even among wealthy Americans. This systemic issue affects health outcomes across all socioeconomic levels:

• Limited access to affordable healthcare: The U.S. lacks universal health coverage, leading to delayed or foregone medical care even among insured individuals due to high out-of-pocket costs12.

• Inadequate social support: European countries generally provide more comprehensive social services, including paid family leave, childcare support, and unemployment benefits, which can reduce stress and improve overall health1.

• Income inequality: The U.S. has a wider wealth gap than many European nations, contributing to health disparities and increased stress levels across all wealth brackets2.

• Work-life balance: Americans typically work longer hours with fewer vacation days, potentially impacting mental and physical health2.

• Education and prevention: European countries often invest more in public health education and preventive care, leading to better health outcomes across the population13.

These factors collectively contribute to the "systemic" issues affecting American longevity, highlighting the need for comprehensive policy reforms to address the social determinants of health and improve life expectancy across all wealth levels12.

The relationship between wealth and lifespan in the United States exhibits a stark contrast to European countries, with wealth-related health disparities being more pronounced in America. While increased wealth generally correlates with longer lifespans in both regions, the gap between the richest and poorest Americans is significantly larger than in Europe12. This disparity is so extreme that the wealthiest Americans have survival rates comparable to the poorest Europeans in countries like Germany, France, and the Netherlands13.

Key factors contributing to this wealth-mortality relationship include:

• Economic inequality: The U.S. has a wider wealth gap than many European nations, exacerbating health disparities across all socioeconomic levels2.

• Healthcare access: Despite higher healthcare spending, the U.S. system's fragmentation and lack of universal coverage lead to poorer health outcomes, even for wealthy individuals13.

• Social determinants of health: Factors such as education, environmental hazards, and stress levels disproportionately affect lower-income Americans but also impact wealthier individuals to a greater extent than in Europe12.

These findings underscore the need for systemic changes in U.S. health policy and social infrastructure to address the underlying causes of shorter lifespans across all wealth brackets13.