The Ten Americas: How Geography, Race, and Income Shape U.S. Life Expectancy

The differences in U.S. life expectancy are so large it’s as if the population lives in separate Americas instead of one.

Nearly two decades ago, a team of researchers published the landmark “Eight Americas” study, which examined drivers of U.S. health inequities between 1982 and 2001 by dividing the U.S. population into groups based on geography, race, income, and other factors. 

A new research study, published this month by the University of Washington and the Council on Foreign Relations, revisits that landmark research project, adding two new “Americas” to account for Latino populations. 

This new study finds that U.S. life expectancy disparities have grown over the last two decades between 2001 and 2021, with the differences between the best and worst of those “Americas” increasing from 12.6 years in 2000 to 20.4 years in 2021. COVID-19 exacerbated this divide, but gaps in longevity had already been growing before the pandemic hit.  

Although U.S. health inequities had been growing since the mid-2010s, that trend accelerated with the emergence of COVID-19. The largest declines in U.S. life expectancy during the first year of the pandemic were suffered by AIAN, Black, and Latino Americans. Essential workers in the pandemic were disproportionately AIAN, Black, and Latino. These population groups were more likely to live in multigenerational households, where SARS-CoV-2 spread more easily, and were more likely to face discrimination and systemic disadvantages in accessing health care. Only a quarter of U.S. states included specific strategies to encourage vaccination in minority racial and ethnic communities in their initial COVID-19 vaccine rollout plans, despite previous research showing those communities have historical reasons to mistrust public health campaigns. 

In the second year of the pandemic, from 2021 to 2022, the health of many Americans rebounded with the arrival of effective vaccines. But some groups have still not recovered, especially the AIAN population living in the western United States and low-income Black and white Americans in the South. 

The growing extent and magnitude of health disparities in the United States is truly alarming. This research reveals that poor U.S. health is not determined by singular characteristics—age, income, race, or environment—but by their combined interactive effect. 

In particular, the declining health of the AIAN population, in the western United States and elsewhere, is a crisis. Lower rates of health insurance and chronic underfunding of the Indian Health Service are barriers to the AIAN people in this region accessing health care. Higher rates of unemployment, lower rates of educational attainment, and a devastating history of discrimination against AIAN people and cultures have contributed to higher rates of excessive alcohol consumption, tobacco use, and poor diet. Simply, AIAN voices and needs must play a greater role in U.S. political debates over health. Improvements in education and employment opportunities will likewise be essential to alleviating health disparities and fostering socioeconomic growth for AIAN communities. 

The decline in national U.S. life expectancy is not intractable. The “Ten Americas” study and those like it demonstrate that localized planning, national prioritization, and greater resource allocation is possible. Policymakers and politicians must target the needs of the most disadvantaged so that all Americans can live long, healthy lives, regardless of where they reside, their race, or their income. 

Will Merrow and Michael Bricknell created the graphics for this article.

This interactive was made possible by a generous grant from Bloomberg Philanthropies. The statements made and views expressed are solely the responsibility of the authors. The Council on Foreign Relations takes no institutional positions on policy issues and has no affiliation with the U.S. government.