US: Preventive Healthcare - National Policies

Life expectancy at birth (years), 2021: 76.4 years
Maternal mortality ratio (per 100,000 live births), 2023: 17
Under-five mortality rate (per 1000 live births), 2023: 6.5
Neonatal mortality rate (per 1000 live births), 2023: 3.4
Tuberculosis incidence (per 100,000 population), 2023: 3.1
Probability of dying from any of CVD, cancer, diabetes, CRD between age 30 and exact age 70 (%), 2021: 13.7%
Suicide mortality rate (per 100,000 population), 2021: 15.6
Diphtheria-tetanus-pertussis (DTP3) immunization coverage among 1-year-olds (%), 2023: 94%
Measles-containing-vaccine second-dose (MCV2) immunization coverage by the locally recommended age (%), 2023: 95%
Pneumococcal conjugate 3rd dose (PCV3) immunization coverage among 1-year olds (%), 2023: 84%
Human papillomavirus (HPV) immunization coverage estimates among 15 year-old girls (%), 2023: 52%
Prevalence of stunting in children under 5 (%), 2024: 4.2%
Prevalence of wasting in children under 5 (%), 2015-2024: 0.1%
Prevalence of overweight in children under 5 (%), 2024: 9.7%
Prevalence of anaemia in women aged 15-49 years (%), 2023: 15.0%

Source: World health statistics 2025: monitoring health for the SDGs, Sustainable Development Goals. Tables of health statistics by country and area, WHO region and globally. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.

Life expectancy at birth, 2021: 76.4 years
Infant mortality, deaths per 1,000 live births, 2021: 5.4
Maternal mortality rate, deaths per 100,000 live births, 2020: 21.1
Congestive heart failure hospital admission in adults, age-sex standardized rate per 100,000 population, 2021: 357
Asthma and chronic obstructive pulmonary disease hospital admissions in adults, age-sex standardized rate per 100,000 population, 2021: 137

Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.

Neonatal Mortality Rate, 2021: 2
Infant Mortality Rate, 2021: 3
Under-5 Mortality Rate, 2021: 3
Maternal Mortality Ratio, 2020: 5

Note: “Under-5 mortality rate – Probability of dying between birth and exactly 5 years of age, expressed per 1,000 live births.
“Infant mortality rate – Probability of dying between birth and exactly 1 year of age, expressed per 1,000 live births.
“Neonatal mortality rate – Probability of dying during the first 28 days of life, expressed per 1,000 live births.”
“Maternal mortality ratio – Number of deaths of women from pregnancy-related causes per 100,000 live births during the same time period (modelled estimates).”

Source: United Nations Children’s Fund, The State of the World’s Children 2023: For every child, vaccination, UNICEF Innocenti – Global Office of Research and Foresight, Florence, April 2023.

“Despite spending more on health care than every other high-income country, the US had comparably higher avoidable mortality, which includes deaths that can be avoided through timely prevention and access to high-quality health care. This study, which disaggregated US mortality rates across individual states and 40 EU and OECD countries, observed 5 key findings.

“First, between 2009 and 2019, avoidable mortality increased in all US states, while decreasing in most comparator countries. The increase in US states was observed in both preventable and treatable mortality, with external causes of death and circulatory system diseases contributing the most. The stark contrast in prepandemic trends in US states vs comparator countries suggests that there are concerning broad and systemic issues at play.

“Second, from 2009 to 2019, the study observed variation in avoidable mortality widening across US states and narrowing in comparator countries. Among comparator countries, those in Eastern Europe improved significantly, albeit having the highest rates of avoidable mortality at baseline in 2009. While the study was unable to determine what accounted for these differences, there were many changes in the policy landscape across these regions that warrant further investigation, such as accession of countries to the EU, which may have led to more policy convergence, particularly around social and economic policies. Conversely, in the US, the growing heterogeneity of state-level policy decisions across this period could have differentially impacted avoidable mortality across states (eg, adoption of Medicaid expansion across states and growing divergence in other areas, such as abortion rights, firearm legislation, and public welfare benefits).^5,28

“Third, with the onset of the COVID-19 pandemic, all countries experienced an increase in avoidable mortality between 2019 and 2021, reversing the downward trend observed in the prior decade. However, US states still fared worse than most of the observed countries. In US states, avoidable mortality continued its upward trend, albeit at a higher relative increase from the trend in the prior decade, and only some northeastern states and Hawaiʻi had insignificant increases. During this time, avoidable mortality significantly increased for only some Eastern European countries and Chile. The greatest increases in avoidable mortality were also observed in countries and states with higher baseline avoidable mortality, which could indicate that the prior performance of a state or country on population health is associated with its capacity to respond to health care shocks or emergencies. Increases in avoidable mortality, while mostly related to COVID-19 deaths, also occurred in deaths from other causes. This could represent some combination of factors, including (1) a continuation or exacerbation of a secular trend in avoidable deaths preceding the pandemic (eg, in overdose deaths, which increased between 2020-2021), (2) an increase in non–COVID-19 deaths related to disruptions in health service delivery, or (3) an increase in COVID-19 deaths miscoded as other deaths. More work should investigate the extent to which differences in underlying demographics, especially socioeconomic status and the adoption of social and health policies across states and countries, influenced the observed population health outcomes during this period.^9,29

“Fourth, avoidable mortality in the US appears to have been disproportionately driven by preventable mortality, which is influenced by socioeconomic factors and public health policy. This underscores the necessity for a multisectoral approach to improve US population health. For example, policies promoting access to healthy foods, limiting exposure to harmful products, and combating obesity can significantly reduce the risk and incidence of chronic diseases.^30–36 Legislative measures addressing gun violence can lower injury-related deaths.^7,37 Regulations on motor vehicle safety can prevent collisions and deaths.^38–40 These broader determinants of health require coordinated efforts across various sectors and highlight that improvements in preventable mortality can extend far beyond the realm of clinical care.

“Fifth, the study observed a consistent, negative, and significant association between health spending and avoidable mortality for comparator countries, but no statistically significant association within US states. While the analysis cannot say anything about the direction of the association, several other studies have shown that higher health spending in the US is likely the product of higher prices, which might explain why the study did not observe greater expenditures to be associated with lower avoidable mortality rates.^41–43 However, this could also indicate that the US spends more because its population is sicker. While the study cannot determine the underlying mechanisms, the lack of a significant association between health spending and health care outcomes in the US raises questions about the US health care system’s overall efficiency.”

Source: Papanicolas I, Niksch M, Figueroa JF. Avoidable Mortality Across US States and High-Income Countries. JAMA Intern Med. Published online March 24, 2025. doi:10.1001/jamainternmed.2025.0155

“Moreover, our cause-specific analyses indicated that mental and behavior disorders and drug and alcohol induced death contributed to 21.2% of late maternal deaths. A similar analysis from the United Kingdom and Ireland suggested that psychiatric causes led to almost a quarter of late maternal deaths during 2009 to 2014.²⁰ Maternal anxiety and depression are the most common complications of childbirth.²¹ According to the American Psychological Association, the prevalence of depression ranges from 8.5% to 11.0% during pregnancy and from 6.5% to 12.9% during the first year post partum.²² It is critical to address mental health needs as part of efforts to reduce pregnancy-related death.

“In the US, homicide, suicide, and drug overdose are the leading causes of pregnancy-associated death, which include pregnancy-related death and death from incidental causes while pregnant.^23–25 Although the current analysis does not analyze maternal death from incidental causes, published data show that intimate partner violence during pregnancy is an important cause of maternal death.²⁶ Moreover, recent US statistics indicate a noteworthy increase in pregnancy-associated homicides in 2020.²⁷ Traditionally, pregnancy-associated deaths from incidental causes have not been considered in maternal deaths, so we did not include them in our estimates. Yet, these deaths are important public health concerns.²⁸

“The current analysis confirmed cardiovascular disease as an important cause of pregnancy-related death. Pregnancy can affect the cardiovascular system, leading to cardiovascular disease (eg, hypertensive disorder), aggravating underlying conditions (eg, pulmonary arterial hypertension), or cause-specific disease (eg, peripartum cardiomyopathy).²⁹ Some of these causes, such as hypertensive disorder, are considered a direct cause of maternal death, while others are categorized as disorders related to pregnancy (eg, venous complications or thrombosis). In the current analysis, more than 20% of maternal deaths were directly attributable to hypertensive disorder and disorders related to pregnancy, emphasizing the importance of cardio-obstetric care during and after pregnancy.

“Although cancer has not been considered a direct cause of pregnancy-related death, cancer was the second leading contributor of late maternal death in the US, associated with almost 20% of the deaths. Cancer is the leading cause of death in the general population, although pregnancies complicated by cancer are potential threats to maternal well-being. Published US data suggested that more than 70% of pregnancy-associated cancers were diagnosed during the first year post partum.³⁰ Increasing maternal age leads to higher cancer risks and highlights the importance of greater awareness regarding the occurrence and recurrence of cancer during pregnancy and the postpartum period. Maternal deaths due to cancer can be due to excess incidence during pregnancy (eg, breast cancer risk is elevated during and shortly after pregnancy³¹) or could be due to voluntary or involuntary changes in treatment while pregnant. Our study period straddled the several years of the COVID-19 pandemic. Although COVID-19 itself would not be coded as a pregnancy-related cause of death, its impact on maternal health and disruptions to the health care system likely contributed to the increased pregnancy-related mortality rates, particularly in 2021.”

Source: Chen Y, Shiels MS, Uribe-Leitz T, et al. Pregnancy-Related Deaths in the US, 2018-2022. JAMA Netw Open. 2025;8(4):e254325. doi:10.1001/jamanetworkopen.2025.4325

“Among a random sampling of US EDs [Emergency Departments], nearly all offered at least one preventive health service, many currently have the resources to offer more, and only a minority of directors expressed the belief that preventive health services should not be offered in the ED setting. The results represent an increase in both the overall proportion of EDs offering at least one preventive health service and the median number of services offered per ED since 2008–2009. ⁴ This finding is consistent with recent work demonstrating that EDs are providing a growing amount of chronic and preventive care in the US. ¹ ^, ² A component of the results might be explained by the high proportion of responders from critical access hospitals and the unique mission these EDs have within their local communities. Reassuringly, adjustment for critical access hospitals did not materially alter the observed temporal difference.

“Although we are unable to comment on the underlying reasons why (or why not) a particular ED offers a particular preventive health service, the reasons are likely multifactorial. Services that are mandated or strongly encouraged, compared to services that are neither, are likely more often offered. Further, services that are less time- and resource-intensive (eg, a series of screening questions compared to checking a hemoglobin A1c or performing a HIV antigen/antibody test) are also more likely to be offered. A component likely also depends on both the ED and its available resources, and the unique needs of the patient populations served in these EDs.

“The observed changes occurred in the setting of the recent unwinding of Medicaid’s continuous enrollment provision, with the prospect that millions of Americans will lose—or have already lost—Medicaid coverage. ³ This loss will likely translate into increased rates of ED utilization for both emergent and non-emergent (eg, chronic and preventive) care across the country. Given the staffing, crowding, and boarding crises in EDs, which were exacerbated by the COVID-19 pandemic, ED resources are expected to be further strained. ⁹“

Source: Bennett CL, Kit Delgado M, Pasao M, Espinola JA, Boggs KM, Camargo CA Jr. Preventive Health Services Offered in a Sampling of US Emergency Departments, 2022-2023. West J Emerg Med. 2024;25(5):823-827. doi:10.5811/westjem.18488

“From 1975 to 2020, an estimated 5.94 million cancer deaths were averted from the combination of prevention, screening (for interception and early detection), and treatment advances (Table 2). Across all interventions combined, prevention and/or screening were estimated to account for 80% of cancer deaths averted (4.75 million), with tobacco control for lung cancer alone contributing 3.45 million of the 4.75 million deaths. The contribution of prevention and/or screening to cancer deaths averted varied across cancer sites. Prevention of lung cancer due to tobacco control accounted for 98% of lung cancer deaths averted and screening accounted for 100% of cervical cancer deaths averted. Prevention and/or screening accounted for 79% and 56% of deaths averted for colorectal and prostate cancers, respectively. In contrast, given the development of very effective therapies for breast cancer over this period, screening was estimated to account for a minority, about 25%, of female breast cancer deaths averted and therapies accounted for the remaining deaths averted. Less than half of total cancer deaths in the absence of all interventions (scenario 1) were averted for each cancer site (Table 2).”

Source: Goddard KAB, Feuer EJ, Mandelblatt JS, et al. Estimation of Cancer Deaths Averted From Prevention, Screening, and Treatment Efforts, 1975-2020. JAMA Oncol. Published online December 05, 2024. doi:10.1001/jamaoncol.2024.5381

“Approximately 19.7% of children and adolescents ages 2 to 19 years in the United States have a body mass index (BMI) at or above the 95th percentile for age and sex, based on Centers for Disease Control and Prevention (CDC) growth charts from 2000.¹⁷^,¹⁸ BMI percentile is plotted on growth charts, such as those developed by the CDC, which are based on U.S.-specific, population-based norms for children age 2 years or older.¹⁷^,¹⁹ The prevalence of high BMI increases with age and is higher among Hispanic/Latino, Indigenous American, and non-Hispanic Black children and adolescents and children from lower-income families.¹⁷^,¹⁸

“The USPSTF identified high-priority gaps to expand the evidence in interventions for high body mass index BMI in children and adolescents, inclusive of populations disproportionately affected:

“• Research is needed on long-term health outcomes (at least 2 years) and the benefits of behavioral and pharmacotherapy interventions.

“• Research is needed on long-term (at least 2 years) psychosocial harms (e.g., quality of life) of pharmacotherapy.

“• Research is needed on the benefits and harms of healthy lifestyle or weight-neutral interventions in children and adolescents with a high BMI.

“• Research is needed on the best timing for interventions for weight management.

“• Research is needed on the maintenance of weight loss after behavioral interventions and assessment of long-term (>5 years) benefits and harms.

“• Research is needed on the best practices for weight-related discussions with children and adolescents and their families.

“• Research is needed on the biochemical adaptations to weight loss in children and adolescents that may promote weight regain.”

Source: Nicholson WK, Silverstein M, Wong J. 14th Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services: Commemorating 40 Years of Making Evidence-Based Recommendations for Preventive Services [Internet]. Rockville (MD): U.S. Preventive Services Task Force (USPSTF); 2024 Nov.

“Iron deficiency is the leading cause of anemia during pregnancy.²⁷ According to National Health and Nutrition Examination Survey data from 1999 to 2006, the overall estimated prevalence of iron deficiency during pregnancy is near 18% and increases across the three trimesters of pregnancy (from 6.9% to 14.3% to 28.4%).²⁸ An estimated 5% of pregnant persons have iron deficiency anemia.²⁷^,²⁸ In the United States, there are disparities in the prevalence of iron deficiency anemia by race, ethnicity, and social factors (e.g., socioeconomic status, nutritional status, and food insecurity).²⁷^,²⁸ The aim of routine screening or iron supplementation for treatment of iron deficiency and iron deficiency anemia during pregnancy is to improve maternal and infant health outcomes.

“The USPSTF needs research to address high-priority gaps and expand the evidence in screening and supplementation for iron deficiency and iron deficiency anemia during pregnancy, inclusive of populations disproportionately affected:

“• Research is needed in pregnant persons with iron deficiency and iron deficiency anemia to assess whether changes in maternal iron status (e.g., because of supplementation or treatment for screen-detected populations) improve maternal and infant health outcomes in settings relevant to U.S. primary care clinical practice.

“• Research is needed to assess the benefits and harms of screening (e.g., with hemoglobin, hematocrit, or ferritin values) for iron deficiency and iron deficiency anemia during pregnancy on maternal (e.g., quality of life or need for transfusion) and infant (e.g., low birth weight or preterm birth) health outcomes.

“• Research is needed to assess the benefits and harms of treatment (e.g., oral or intravenous iron) in asymptomatic, screen-detected populations with iron deficiency and iron deficiency anemia during pregnancy on maternal and infant health outcomes in settings relevant to U.S. primary care clinical practice.

“• Research is needed to assess the benefits and harms of routine iron supplementation in asymptomatic pregnant persons without known iron deficiency or iron deficiency anemia on maternal and infant health outcomes.

“• Research is needed to assess the relationship between social determinants of health and risk factors for iron deficiency and iron deficiency anemia, including but not limited to nutritional status, screening services, access to iron-rich foods, and access to prenatal care and timely healthcare in populations disproportionately affected by iron deficiency/iron deficiency anemia during pregnancy.”

“Child maltreatment, which includes child abuse and neglect, can have profound effects on health, development, survival, and well-being throughout childhood and adulthood.¹⁰^,¹¹ The prevalence of child maltreatment in the United States is uncertain and likely underestimated.¹⁰ In 2021, an estimated 600,000 children were identified by Child Protective Services (CPS) as experiencing abuse or neglect and an estimated 1,820 children died of abuse and neglect.¹²“

“The USPSTF [US Preventive Services Task Force] was established in 1984 to systematically review the scientific evidence for clinical preventive services and make recommendations for primary care clinicians. To fulfill its mission to improve health by making evidence-based recommendations for preventive services, the USPSTF routinely highlights the most critical evidence gaps for making actionable preventive services recommendations. This includes calling attention to areas where evidence is lacking for populations that are disproportionately affected by health conditions.”

US: Preventive Healthcare - Morbidity, mortality, preventable hospitalization, tuberculosis, suicide, wasting in children, overweight in children, hypertension, obesity - National Policies - World Health Systems Facts

World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other OECD member nations.

Page last updated June 12, 2025 by Doug McVay, Editor.