The Richest Americans Still Die Earlier Than the Poorest Europeans

What if the billionaire tech mogul with access to concierge doctors and the latest wellness trends has a shorter lifespan than a retired factory worker in France? It sounds counterintuitive yet that is exactly what the data shows.

A sweeping study of nearly 74,000 adults across the United States and Europe has revealed a stark reality: Americans, even at the very top of the wealth ladder, are dying younger than Europeans at the very bottom. The gap isn’t a matter of a few months it stretches into years of life lost, despite America’s staggering investment in healthcare and its reputation as one of the wealthiest nations on earth.

Once upon a time, the U.S. and Europe were nearly neck and neck in life expectancy. But since the 1980s, the lines have diverged. European life expectancy has steadily climbed, while the U.S. began slipping behind so much so that by 2014, the American trend reversed entirely, inching downward. Today, Americans live on average six years less than Europeans, a divide that no amount of personal wealth seems able to close.

The unsettling truth is that wealth in the U.S. buys advantages, but not immunity from the broader forces shaping public health. This raises a profound question: what are Europeans doing differently that allows their poorest to outlive America’s richest?

The Study That Turned Heads

The research at the heart of this debate was published in The New England Journal of Medicine and examined nearly 74,000 adults between the ages of 50 and 85. About 19,000 of the participants were American, while the remaining 54,000 came from 16 European countries, grouped into northern and western, southern, and eastern regions. Tracked from 2010 to 2022, the study offered one of the most comprehensive comparisons of wealth and mortality ever conducted across the Atlantic.

The results were striking. Wealth did reduce the likelihood of dying sooner in both the U.S. and Europe, but the extent of the benefit varied sharply. Overall, the wealthiest quartile in each region had about a 40% lower risk of death compared with the poorest quartile. Yet when the researchers compared across regions, the picture shifted dramatically: wealthy Americans had higher mortality rates than their European counterparts, and in many cases, even higher than the poorest Europeans in northern and western countries. In numerical terms, America recorded an overall death rate of 6.5 per 1,000 people, while northern and western Europe reported just 2.9 per 1,000.

Dr. Irene Papanicolas, lead author of the study and director of the Center for Health System Sustainability at Brown University, described the findings as both surprising and troubling. “We were expecting to find greater inequity in the U.S.,” she noted. “But what was surprising was how the richest in the U.S. compared to the richest in Europe.”

Why More Spending Doesn’t Equal Better Outcomes

One of the most baffling aspects of America’s longevity gap is that it persists despite the nation spending more on healthcare than any other country in the world. In 2022, U.S. healthcare spending reached nearly $13,000 per person, almost twice the average of other wealthy nations. Yet this enormous investment has not translated into longer lives. Instead, Americans die younger, experience higher rates of chronic illness, and face greater health inequalities than Europeans who spend far less.

The explanation lies not only in how much is spent, but in how those resources are distributed. Unlike Europe, where universal healthcare systems ensure that doctor visits, hospital care, and preventive screenings are accessible to all, the U.S. system relies heavily on employer-based insurance and private providers. This leaves millions uninsured or underinsured, forcing many to delay treatment, skip prescriptions, or forgo care altogether due to cost. Even wealthy Americans, though better protected, still face a fragmented system where access to consistent, affordable care is far from guaranteed.

The consequences show up starkly in mortality statistics. For example, while the wealthiest Americans do enjoy better survival than the poorest, their advantage is diluted by the inefficiencies of the system itself. As Dr. Steven Woolf, professor of family medicine and population health at Virginia Commonwealth University, explained, European countries have built safety nets that shield people from catastrophic health risks, while in the U.S., “when they go through tough times, it doesn’t just threaten their finances it threatens their health.”

This paradox underscores a deeper reality: in America, health outcomes are more tightly bound to personal wealth than in Europe. A wealthy individual in Boston or Los Angeles may gain years of life from private healthcare, but not nearly as many as their counterpart in Berlin or Amsterdam. In fact, the study showed that personal wealth “buys” more additional years in the U.S. than in Europe, but that advantage is undermined by a baseline that is already lower to begin with.

Social and Lifestyle Drivers of Longevity

While access to healthcare explains part of America’s longevity gap, it is far from the whole story. The forces cutting U.S. lives short extend into daily life what people eat, how they work, the stress they endure, and the social supports (or lack thereof) that shape resilience over time.

• Diet and Chronic Illness
  One of the clearest differences lies in diet. Americans consume more ultra-processed foods than any other wealthy nation, and the results are visible in national health statistics. The U.S. has the highest obesity rate among OECD countries, with more than 42% of adults classified as obese, compared to just 15–20% in many European countries. This excess weight is linked to higher risks of diabetes, cardiovascular disease, and certain cancers conditions that shorten lifespans and increase healthcare costs.
• Stress, Loneliness, and Mental Health
  Beyond physical health, psychosocial stressors play a profound role. Financial insecurity is more common in the U.S., where a sudden job loss or medical bill can devastate a household. Chronic stress has well-documented links to heart disease, immune dysfunction, and depression. Loneliness is another factor: a 2023 report from the U.S. Surgeon General described widespread social isolation as a “public health epidemic,” with risks comparable to smoking 15 cigarettes a day. In Europe, stronger social safety nets — from unemployment benefits to elder care programs buffer citizens from some of these pressures, reducing the toll of stress on health.
• Education and Opportunity
  Education also influences longevity, shaping employment prospects, income, and health literacy. In Europe, free or heavily subsidized higher education expands opportunity and reduces inequality. In contrast, American families often take on crushing debt to access the same opportunities, adding another layer of financial stress that can ripple through health outcomes.
• The Power of Social Policy
  Taken together, these factors highlight how longevity is less about individual choices than the environments in which people live. As Dr. Atheendar Venkataramani of the University of Pennsylvania observed, “the set of stressors that are harming the health of Americans is very widespread, to the point where even being wealthy or rich, you’re not going to be able to escape them.” From what lands on the dinner plate to whether someone can afford to take time off work when ill, the social fabric profoundly shapes the arc of people’s lives.

Wealth Gaps and Health Gaps

The study revealed that the relationship between wealth and survival is far sharper in the U.S. than in Europe. The richest Americans are significantly less likely to die than the poorest, but the size of this gap far exceeds what is seen across the Atlantic. In northern and western Europe, redistributive policies help narrow disparities, so that being poor does not automatically condemn someone to dramatically worse health. By contrast, in the U.S., wealth and survival are deeply intertwined.

Part of this comes down to the broader economic structure. The U.S. has one of the highest levels of income inequality among developed nations. Decades of wage stagnation, combined with rising costs for housing, education, and healthcare, have left large segments of the population struggling to meet basic needs.

Research consistently shows that inequality itself independent of absolute poverty erodes public health. Communities with wide income gaps experience higher rates of chronic disease, mental illness, and premature death, regardless of average income.

In Europe, safety nets lift the health “floor” for everyone. Universal healthcare, subsidized education, unemployment protections, and housing assistance do not eliminate inequality, but they prevent health outcomes from diverging so sharply along class lines. As Dr. Martin McKee, professor of European public health, has noted, strong social safety nets “benefit not just the poor, but the middle class as well.” In other words, collective investment raises the baseline for all citizens, softening the extremes of wealth’s impact on life expectancy.

What Europe Is Doing Differently

If the wealthiest Americans cannot buy their way to longer lives, the natural question is: what are Europeans doing differently? The answer lies less in individual behavior and more in collective policy.

Universal Healthcare as a Foundation
Across much of Europe, healthcare is treated as a right rather than a privilege. Systems in countries like France, Germany, and the Netherlands guarantee access to care regardless of income, often with little or no out-of-pocket cost. Preventive care from routine screenings to vaccinations is widely available, catching health problems before they spiral into life-threatening conditions. This universal foundation ensures that health outcomes are not dictated by employment status or the depth of one’s wallet.

Comprehensive Social Safety Nets
Europe also invests heavily in social supports that indirectly extend lives. Subsidized housing, elder care programs, and unemployment benefits provide stability during life’s inevitable downturns. While these policies don’t eliminate poverty, they shield individuals from the kind of financial crises that in the U.S. often cascade into health crises skipped doctor visits, untreated conditions, or chronic stress.

Education and Employment Protections
Many European countries offer free or heavily subsidized higher education, which not only improves economic opportunity but also enhances health literacy and lifelong well-being. Employment protections, including paid leave and stronger worker rights, help reduce stress and give people the ability to recover from illness without fear of losing income or insurance.

Raising the Baseline for All
The effect of these policies is not limited to the poor. As Dr. Martin McKee, professor of European public health, has observed, robust welfare systems “benefit not just the poor, but the middle class as well.” By raising the baseline of health security across the population, Europe ensures that longevity is less dependent on personal wealth. In practice, this means the poorest European pensioner can expect to outlive not only their American counterpart, but often even America’s wealthy elite.

What’s at Stake for America

The gulf in longevity between Americans and Europeans is not an abstract research finding it is part of a broader story of American decline in public health. Fifty years ago, the U.S. and its European peers enjoyed similar life expectancies. But starting in the 1980s, the trajectories began to split. European countries steadily gained years of life, while U.S. progress slowed, then reversed. Since 2014, life expectancy in America has actually declined, a rare and alarming trend among wealthy nations.

Today, Americans live on average six years fewer than Europeans. That gap represents millions of years of life lost each decade, and it touches every family, regardless of wealth. For policymakers, the message is urgent: the nation is falling behind not only in abstract health metrics but in the lived experience of its people.

The consequences of inaction extend beyond mortality statistics. A population that dies younger also lives sicker, with higher rates of chronic illness, disability, and economic dependency. These patterns strain healthcare systems, depress productivity, and widen social fractures. As Dr. Steven Woolf of Virginia Commonwealth University has warned, recent political moves to weaken federal health agencies and scale back public health programs risk pushing the country “in the opposite direction of what you would want to do to make America healthy again.”

Turning the Longevity Gap into a Wake-Up Call

The paradox revealed by this research is difficult to ignore: in the United States, wealth buys comfort and privilege, but not necessarily more years of life. The fact that some of the poorest Europeans are outliving America’s wealthiest underscores a truth we are often reluctant to face health is not merely the product of individual choices or personal fortune. It is shaped by the systems in which we live: healthcare access, social supports, economic security, and the policies that bind them together.

For decades, the U.S. has poured staggering sums into healthcare, yet Americans continue to live shorter, sicker lives than their peers abroad. What Europe demonstrates is that collective investment in preventive care, education, housing, and social safety nets can lengthen and enrich lives across the board. These benefits ripple outward: they reduce stress, narrow inequality, and ultimately create societies where longevity is less tied to personal wealth and more to shared well-being.

The challenge for America is not whether it can afford reform it already spends more than enough but whether it can reimagine health as a common good rather than a commodity. Until then, the richest Americans will continue to find themselves outlived by Europeans who, though less wealthy, live in systems that prioritize health for all.

The choice ahead is clear: will America continue down a path where money fails to buy life, or will it choose policies that make longer, healthier lives an attainable reality for everyone?