Health and Me

Tanya Dutt

Not Just COVID, 1.5 Million More Lives Were Lost After The Pandemic Than Expected

As the world collectively exhaled a sigh of relief in 2022, thinking the worst of the COVID-19 pandemic had come and gone, a covert crisis stealthily took hundreds of thousands more lives in America. Rather than rebounding toward pre-pandemic levels, U.S. death rates have remained obstinately elevated, accounting for over 1.5 million "missing Americans" during 2022 and 2023—fatalities that could potentially have been avoided if our country had been comparable to other affluent nations on health outcomes. This quiet excess wave of mortality reveals deeply ingrained national shortcomings well beyond the range of any given infectious illness.

Scientists from Boston University and the University of Minnesota analyzed U.S. official death records and those from 21 other high-income countries—Australia, Canada, France, Japan, the United Kingdom, and others—over 43 years from 1980 to 2023. During that period, the U.S. incurred almost 15 million excess deaths against peer nations, which means Americans died at rates much higher than what would be predicted if we followed their lower death trends.

In 1980, the U.S. actually performed better than its contemporaries, saving approximately 42,000 lives. By 1990, it had chalked up about 89,000 excess deaths. The count rose to 355,000 in 2000 and 409,000 in 2010. At the peak of the pandemic, excess deaths ballooned to 1 million in 2020 and 1.1 million in 2021. Even as COVID-19 declined, the U.S. lost 820,000 excess lives in 2022 and 705,000 in 2023.

This long-term trend indicates not a fleeting anomaly but a prolonged public health crisis. "Imagine the lives saved, the grief and trauma prevented, if the U.S. simply performed at the average of our peers," says lead author Jacob Bor, associate professor of Boston University's School of Public Health. "One in every two U.S. deaths before age 65 is probably preventable. Our failure to do something about it is a national scandal.

<h2>Are People Under-65 at Higher Risk?</h2>

Perhaps the most alarming finding is that in 2023, nearly 46% of deaths among Americans under 65 could have been prevented were our mortality rates on par with other high-income nations. In a country that prides itself on medical innovation and economic prowess, young and middle-aged adults are dying from conditions that, elsewhere, are managed far more effectively.

An important proportion of these deaths are motivated by deep-seated noncommunicable and social-environmental causes: drug overdoses, firearms violence, motor vehicle crashes, and avoidable cardiometabolic disease. "These trends preceded the pandemic and went unstopped thereafter," says University of Minnesota's Elizabeth Wrigley-Field. "The 700,000 surplus American deaths in 2023 are precisely what you'd expect from previously increasing trends, even if there'd never been a pandemic."

<h2>What Is Reason Behind This Excess Mortality?</h2>

The American overdose epidemic, driven by opioids, methamphetamine, and increasingly by powerful synthetic opioids such as fentanyl, continues to be a major cause of premature mortality. Whereas peer countries have introduced harm-reduction policies—expanded naloxone distribution, supervised injection sites—the United States has grappled with adopting these data-driven policies at scale.

Homicide and gun-related fatalities have exploded in recent decades. Other rich nations, however, have witnessed declines in violent crime and road traffic deaths due to draconian gun-control policies, safer car regulations, and vigorous road-safety campaigns.

Heart disease, diabetes, and obesity are responsible for a significant proportion of preventable deaths. Compounding factors—disproportionate access to medical care, food deserts, and socioeconomic inequalities—exacerbate these conditions among vulnerable groups.

Senior researcher Andrew Stokes refers to the stark policy distinctions: "Other nations demonstrate that investing in universal health care, robust safety nets, and evidence-based public health policies results in longer, healthier lives." The U.S., however, has:

Fragmented Healthcare: Close to 30 million Americans lack insurance, and millions more underinsured, with obstacles to preventive health care and management of chronic diseases.

Weak Social Safety Nets: Family pay leave, unemployment benefits, and poverty assistance in the United States are far behind those in Europe, Canada, and Australia.

Political Polarization: Government distrust and partisan gridlock have interfered with coordinated actions to deal with health crises, ranging from overdose response to pandemic readiness.

Even worse, the planned federal reductions to Medicare, Medicaid, and public health funding could further expand the gap. The recently House-approved legislation, as part of a possible second Trump administration agenda, would contract health programs at the very time that strong support is needed more than ever. "Severe reductions to public health, safety net programs, and federal health data could result in a further expansion of health disparities—and increasing numbers of excess—and entirely preventable—deaths," warns Bor.

<h2>Reversing America's Excess Death Crisis</h2>

In spite of the grim fact of excess mortality in America, solutions are not new nor out of reach. Other nations, such as Canada, the U.K., and France, have shown that universal healthcare, be it through single-payer or hybrid models, can provide near-universal coverage for primary and preventive care. This kind of complete coverage greatly reduces deaths from treatable causes, which serves as a reminder of the value in a system emphasizing early intervention over crisis management.

Equally, harm reduction strategies have been strikingly effective in nations like Australia and a number of European countries. In these nations, there has been increased access to addiction treatment, overdose reversal medicines with lifesaving properties, and safe-use centers, which have worked together to decrease overdose death in a noticeable manner. These initiatives are a realistic and humane response to drug use, centering on reducing harm and supporting recovery over punitive policies.

Prevention of injury and violence deaths is yet another critical element. Seat-belt laws, graduated licensing of teenage drivers, and strict gun control have been shown to prevent car accident fatalities and violence caused by guns. These evidence-based and public safety policies provide a clear plan to mitigate avoidable deaths in the United States.

But applying these solutions at home will take political will, institutional capacity, and societal consensus. The cost of not acting has already been staggering more than 1.5 million excess deaths in the last two years alone. If the U.S. keeps on its present course, the numbers could go even higher.

To turn around this trend, America needs to spend significantly on public health infrastructure. Disease surveillance should be made stronger, data need to be made more transparent, and community health centers should be extended to cover more areas in order to build a more resilient healthcare system. These initiatives not only will ready the country for crises ahead but also improve daily health outcomes.

Increasing access to care is also paramount. Progress toward universal coverage—or at least the removal of financial obstacles that keep individuals from accessing timely preventive and primary care—could have an enormous impact on decreasing early death. Healthcare access should be a right tied neither to employment nor income but to basic human needs.

In addition, adopting evidence-based policies must become the standard rather than the exception. Harm reduction, injury prevention, and targeted interventions for chronic illnesses like heart disease and diabetes must be prioritized. These are not radical ideas; they are proven strategies with measurable success rates in comparable countries.

As Bor insists, “We have the tools and the knowledge. What we lack is the collective resolve to act.”

The 1.5 million lives lost in 2022 and 2023 are not mere statistics—they are mothers, fathers, siblings, and friends whose deaths were avoidable. While the pandemic was a tragic catalyst, the underlying causes of excess mortality run much deeper than any single virus. Confronting this crisis requires acknowledging that America’s health system and social policies have long failed to protect large swaths of its population.

Ultimately, catching up to, or exceeding, the health achievements of our peer nations is not only a matter of national pride or global reputation. It is a moral obligation, requiring us to deploy science, policy, and empathy to ensure that the next generation of Americans lives longer, healthier lives.

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As the world collectively exhaled a sigh of relief in 2022, thinking the worst of the COVID-19 pandemic had come and gone, a covert crisis stealthily took hundreds of thousands more lives in America. Rather than rebounding toward pre-pandemic levels, U.S. death rates have remained obstinately elevated, accounting for over 1.5 million "missing Americans" during 2022 and 2023—fatalities that could potentially have been avoided if our country had been comparable to other affluent nations on health outcomes. This quiet excess wave of mortality reveals deeply ingrained national shortcomings well beyond the range of any given infectious illness.Scientists from Boston University and the University of Minnesota analyzed U.S. official death records and those from 21 other high-income countries—Australia, Canada, France, Japan, the United Kingdom, and others—over 43 years from 1980 to 2023. During that period, the U.S. incurred almost 15 million excess deaths against peer nations, which means Americans died at rates much higher than what would be predicted if we followed their lower death trends.In 1980, the U.S. actually performed better than its contemporaries, saving approximately 42,000 lives. By 1990, it had chalked up about 89,000 excess deaths. The count rose to 355,000 in 2000 and 409,000 in 2010. At the peak of the pandemic, excess deaths ballooned to 1 million in 2020 and 1.1 million in 2021. Even as COVID-19 declined, the U.S. lost 820,000 excess lives in 2022 and 705,000 in 2023.This long-term trend indicates not a fleeting anomaly but a prolonged public health crisis. "Imagine the lives saved, the grief and trauma prevented, if the U.S. simply performed at the average of our peers," says lead author Jacob Bor, associate professor of Boston University's School of Public Health. "One in every two U.S. deaths before age 65 is probably preventable. Our failure to do something about it is a national scandal.Are People Under-65 at Higher Risk?Perhaps the most alarming finding is that in 2023, nearly 46% of deaths among Americans under 65 could have been prevented were our mortality rates on par with other high-income nations. In a country that prides itself on medical innovation and economic prowess, young and middle-aged adults are dying from conditions that, elsewhere, are managed far more effectively.An important proportion of these deaths are motivated by deep-seated noncommunicable and social-environmental causes: drug overdoses, firearms violence, motor vehicle crashes, and avoidable cardiometabolic disease. "These trends preceded the pandemic and went unstopped thereafter," says University of Minnesota's Elizabeth Wrigley-Field. "The 700,000 surplus American deaths in 2023 are precisely what you'd expect from previously increasing trends, even if there'd never been a pandemic."What Is Reason Behind This Excess Mortality?1. Substance Use and OverdoseThe American overdose epidemic, driven by opioids, methamphetamine, and increasingly by powerful synthetic opioids such as fentanyl, continues to be a major cause of premature mortality. Whereas peer countries have introduced harm-reduction policies—expanded naloxone distribution, supervised injection sites—the United States has grappled with adopting these data-driven policies at scale.2. Violence and InjuryHomicide and gun-related fatalities have exploded in recent decades. Other rich nations, however, have witnessed declines in violent crime and road traffic deaths due to draconian gun-control policies, safer car regulations, and vigorous road-safety campaigns.3. Cardiometabolic DiseaseHeart disease, diabetes, and obesity are responsible for a significant proportion of preventable deaths. Compounding factors—disproportionate access to medical care, food deserts, and socioeconomic inequalities—exacerbate these conditions among vulnerable groups.Why the U.S. Lags Behind?Senior researcher Andrew Stokes refers to the stark policy distinctions: "Other nations demonstrate that investing in universal health care, robust safety nets, and evidence-based public health policies results in longer, healthier lives." The U.S., however, has:Fragmented Healthcare: Close to 30 million Americans lack insurance, and millions more underinsured, with obstacles to preventive health care and management of chronic diseases.Weak Social Safety Nets: Family pay leave, unemployment benefits, and poverty assistance in the United States are far behind those in Europe, Canada, and Australia.Political Polarization: Government distrust and partisan gridlock have interfered with coordinated actions to deal with health crises, ranging from overdose response to pandemic readiness.Even worse, the planned federal reductions to Medicare, Medicaid, and public health funding could further expand the gap. The recently House-approved legislation, as part of a possible second Trump administration agenda, would contract health programs at the very time that strong support is needed more than ever. "Severe reductions to public health, safety net programs, and federal health data could result in a further expansion of health disparities—and increasing numbers of excess—and entirely preventable—deaths," warns Bor.Reversing America's Excess Death CrisisIn spite of the grim fact of excess mortality in America, solutions are not new nor out of reach. Other nations, such as Canada, the U.K., and France, have shown that universal healthcare, be it through single-payer or hybrid models, can provide near-universal coverage for primary and preventive care. This kind of complete coverage greatly reduces deaths from treatable causes, which serves as a reminder of the value in a system emphasizing early intervention over crisis management.Equally, harm reduction strategies have been strikingly effective in nations like Australia and a number of European countries. In these nations, there has been increased access to addiction treatment, overdose reversal medicines with lifesaving properties, and safe-use centers, which have worked together to decrease overdose death in a noticeable manner. These initiatives are a realistic and humane response to drug use, centering on reducing harm and supporting recovery over punitive policies.Prevention of injury and violence deaths is yet another critical element. Seat-belt laws, graduated licensing of teenage drivers, and strict gun control have been shown to prevent car accident fatalities and violence caused by guns. These evidence-based and public safety policies provide a clear plan to mitigate avoidable deaths in the United States.But applying these solutions at home will take political will, institutional capacity, and societal consensus. The cost of not acting has already been staggering more than 1.5 million excess deaths in the last two years alone. If the U.S. keeps on its present course, the numbers could go even higher.To turn around this trend, America needs to spend significantly on public health infrastructure. Disease surveillance should be made stronger, data need to be made more transparent, and community health centers should be extended to cover more areas in order to build a more resilient healthcare system. These initiatives not only will ready the country for crises ahead but also improve daily health outcomes.Increasing access to care is also paramount. Progress toward universal coverage—or at least the removal of financial obstacles that keep individuals from accessing timely preventive and primary care—could have an enormous impact on decreasing early death. Healthcare access should be a right tied neither to employment nor income but to basic human needs.In addition, adopting evidence-based policies must become the standard rather than the exception. Harm reduction, injury prevention, and targeted interventions for chronic illnesses like heart disease and diabetes must be prioritized. These are not radical ideas; they are proven strategies with measurable success rates in comparable countries.As Bor insists, “We have the tools and the knowledge. What we lack is the collective resolve to act.”The 1.5 million lives lost in 2022 and 2023 are not mere statistics—they are mothers, fathers, siblings, and friends whose deaths were avoidable. While the pandemic was a tragic catalyst, the underlying causes of excess mortality run much deeper than any single virus. Confronting this crisis requires acknowledging that America’s health system and social policies have long failed to protect large swaths of its population.Ultimately, catching up to, or exceeding, the health achievements of our peer nations is not only a matter of national pride or global reputation. It is a moral obligation, requiring us to deploy science, policy, and empathy to ensure that the next generation of Americans lives longer, healthier lives.

not just covid, 1.5 million more lives were lost after the pandemic than expected

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