US Has Highest Infant, Maternal Mortality Rates Despite the Most Health Care Spending

The United States has the highest infant and maternal mortality rates of any high-income country while also spending the most on health care, according to a report released Tuesday by the Commonwealth Fund.

The report evaluated US healthcare spending, outcomes, status and usage in comparison to Australia, Canada, France, Germany, Japan, the Netherlands, New Zealand, Norway, South Korea, Sweden, Switzerland and the United Kingdom. In addition, the efficiency of the US health care system was compared to the Organization for Economic Co-operation and Development (OECD) average of the 38 high-income countries for which December 2022 data was available.

Of all countries in 2020, the United States had the highest infant mortality rate with 5.4 deaths per 1000 live births, which is significantly higher than the 1.6 deaths per 1000 live births in Norway, which has the lowest mortality rate.

Maternal mortality in the US in 2020 was more than three times that of most other high-income countries, with nearly 24 (23.8) maternal deaths per 100,000 live births.

The authors gave some reasons for the danger of giving birth in the United States, including:

  • Insufficient prenatal care
  • High cesarean rate
  • Poverty, which contributes to chronic diseases such as obesity, diabetes and heart disease

The United States has a lower life expectancy and much worse health outcomes than other countries, even though the country spends two to four times as much on health care as most other high-income nations. In 2021, the United States spent 17.8% of gross domestic product on healthcare, nearly double the OECD country average.

The average life expectancy in OECD countries is 80.4 years, while in the United States it is 77 years overall, although racial and ethnic differences skew the figures in different directions. For black Americans, life expectancy is 74.8 years; for American Indians or Alaskan Natives, it is 71.8 years. The life expectancy of white Americans is 78.8 years, lower than that of Hispanic Americans (81.9 years) and Asian Americans (85.6 years).

Other results: health insurance, health status, preventable deaths, bodily injury deaths

Every country in the study guarantees all residents state or public health insurance, except for the United States, where 8.6% of the population had no health insurance in 2021.

The obesity rate in the US (42.8) was almost double the OECD average (25); Obesity drives chronic diseases such as diabetes, high blood pressure and cancer. Accordingly, US citizens had the highest rates of chronic diseases, with 3 in 10 in 2020 reporting suffering from 2 or more conditions such as asthma, diabetes, depression, heart disease and others.

The United States also had the highest rate of preventable deaths, nearly 350 per 100,000, compared to the OECD average of 225 per 100,000.

The United States also has the highest rate of deaths from physical assault, including gun violence, at 7.4 deaths per 100,000 people. That number is at least seven times higher than any other high-income country except New Zealand and well above the OECD average of 2.7.

Researchers also found the highest death rate from COVID-19 in the United States compared to similar countries. Between January 22, 2020 and January 18, 2023, there were more than 3000 deaths per 1 million COVID-19 cases.

The authors identified three reasons for the differences that make the United States an outlier compared to other high-income countries: unaffordable coverage, high costs, and limited access to effective primary care to better prevent and manage chronic conditions.

They said the Inflation Reduction Act will help older Americans and is “a step in the right direction,” but more needs to be done to help the United States catch up with other countries.

The report had some limitations, as researchers noted that the impact of the COVID-19 pandemic has likely worsened health outcomes and may persist. They also said they could not categorize the data by race and ethnicity.

It is recommended that future global racial and ethnic data be collected so that policymakers can make cross-country comparisons and see how health outcomes compare in vulnerable and historically neglected groups.


Gunja MZ, Gumas ED, Williams II RD. US Health Care Global Perspective, 2022: Accelerating Spending, Deteriorating Outcomes. Letter of Emission (Commonw Fund). Published online January 31, 2023. doi:10.26099/8ejy-yc74

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