Progress Stalled? The Uncertain Future of Mortality in High-Income Countries

Steady and significant improvements in life expectancy have been a bright spot for human progress for the last century or more. Recently, this success has shown signs of faltering in some high-income countries, where mortality improvements have slowed or even reversed since the early 2010s. Combined with the large mortality shock of the COVID-19 pandemic, guaranteed forward progress feels less certain. We review mortality trends in high-income countries since 2000 through the COVID-19 pandemic. While deteriorating mortality in the United States has received the most attention, countries including the United Kingdom, Canada, the Netherlands, Greece, and Germany are also seeing slowdowns. Before COVID-19, these slowdowns largely reflected stalling improvements in cardiovascular disease mortality and increases in deaths from external causes in young and midlife for the worst-performing countries. We discuss prospects for the future of mortality in high-income countries, including lingering impacts of the COVID-19 pandemic, challenges and opportunities related to the obesity epidemic, and emerging reasons for both optimism and pessimism. While biological limits to increased life expectancy may eventually dominate long-term trends, human-made social factors are currently holding many countries back from already achievable best-practice life expectancy and will be key to near-term improvements.