Why do so many more Americans die compared to Europeans?

500 000 more Americans die every year compared to equivalent economies. The death rate in America is higher for several causes of death than in Europe.

US life expectancy fell from 78.8 to 76.1 between 2019 to 2021. In all other developed countries it continued to increase.

graph showing life expectancy trends, America's going down!

According to a recent large-scale study by mortality researchers:

  • In 2020 the EU reported 5800 overdose deaths in a population of 330 million. America reported 68 000 overdose deaths in a similar population of 440 million.
  • In 2021 there were 26 000 murders in America compared to just a few hundred in most European countries with larger populations.
  • The US car crash death rate is four times that of Germany.
  • Americans are nearly twice as likely to die in fires compared to in Western Europe.
Relevance to A-level sociology

This material is relevant to global development, an option within A-level sociology.

These statistics suggest that social development does not automatically follow on from economic development. America is one of the richest countries on earth, but its social development is relatively retarded. The money made in America isn’t being used to benefit ordinary people by making the country a safer place to live!

Why is the UK’s Child Mortality Rate so High?

The United Kingdom has the highest child mortality rate in Western Europe except for Malta. The UK’s child mortality rate currently stands t 6.5 per thousand live births.

This has been the case for many years now and a recent research study into the causes has found that deprivation is the key factor which correlates with higher infant mortality rate.

Dr Karen Luyt from the University of Bristol lead the study which found that every extra 10% increase in deprivation, there is a corresponding increase in the child mortality rate.

To put it bluntly* the poorer a child is the more likely they are to die before they reach 18 years of age. (*and maybe crudely as poverty isn’t exactly the same thing as deprivation).

It’s not that being born into deprivation itself directly causes a child to be more likely to die compared to a child born into wealth, it’s the societal and lifestyle factors associated with being born into deprivation.

And the primary factor which causes higher child mortality rates is exposure to smoking.

The programme above features one interview with someone from a deprived background which illustrate how this works – she describes how she started smoking at 14, along with all her friends, and this wasn’t discouraged as her entire family smoked too.

She describes how her friends would pool their lunch money to buy cigarettes and do without lunch and sometimes use the school emergency fund not for lunch but again for cigarettes.

And then when these teenagers become adults they carry on smoking, and when some of them eventually get pregnant, around 6% of them continue smoking into pregnancy, and it’s that which increases the likelihood of child mortality.

(The link between smoking during pregnancy and damaging the foetus is well established).

There have been government intervention programmes to try and help people quit smoking but they are less successful in poorer areas where more people smoke as it’s simply harder to quit when more people around you in your daily life are smoking.

And not to mention cuts to government pubic health funding recently which mean many of these quit smoking programmes have been cut back.

This issue was the investigation of a recent News Night study which you can view on YouTube:

NB – the first half of the video is about the issue of smoking, the second half mainly consists of politicians lying about their commitments to improving public health funding.

Relevance to A-level sociology

This provides yet more evidence of the consequences of inequality in society, and the harmful effects of deprivation in particular, and it’s a useful update to topic of death rates, which have long been declining in rich countries, but this reminds us that even in rich countries like Britain the death rate can be relatively high in deprived areas.

If we look at the agenda of the report it’s also interesting that ‘deprivation’ is the main cause of high child death rates and yet the whole video is about the lifestyle issue of smoking – this might be an example of agenda setting from a Marxist point of view – shifting the emphasis away from the broader issue of inequality to the ‘lifestyle’ factor of smoking.

Finally, it’s a good example of quantitative data analysis – with a research team talking data from the public health database and correlating this with other factors such as the deprivation index. This is is research broadly in line with Positivist tradition.

The coronavirus class-divide

Those in working class jobs are about two to three times more likely to die of covid-19 related deaths compared to those in middle class jobs.

The Office for National statistics allows you to look at the latest figures for covid-19 infections and covid-19 related deaths, and one of the aspects of the death rate it focuses on is how it varies by occupation.

The covid-related death rate is three times higher among men working in elementary and service occupations (the working classes) compared to those working in professional and managerial occupations (the upper middle classes)

The class difference in the covid related death rate isn’t quite as large for women – those in ‘working class’ jobs are only around twice as likely to die as those in professional jobs…

OK so I’m being quite crude in my measurements of social class, but nonetheless, this is yet more evidence of social class inequality in the UK

Why are the working classes more likely to die from Covid-19?

This article from The Conversation sums it up nicely:

Referring to the ‘coronavirus class divide’ (there’s a not so nice new concept for you!) the answer is very simple:

Working class jobs are the kind of jobs you have to be physically present to be able to do – cleaning, care work, taxi-driving, food and accomodation services – you simply have to be ‘out there’ away from home and you are more likely to be interacting with people.

And thus you are more exposed to the virus if you are working in a manual, working class job:

While if you’re in a managerial or professional role, it is much easier for you to work remotely, to work from home, or if you must go into your workplace, it is easier for you to maintain social distance by shielding yourself in an office or at your individual work station.

The figures for stay at home work, post lockdown, are much higher for those in middle class jobs:

So there is even a class divide when it comes to your chances of contracting and dying from covid-19

Relevance to A-level sociology

This can be used as a rather depressing update to the ‘death rate’ topic which is part of families and households, or the ‘health’ topic within global development.

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Explaining the long term decrease in the death rate

economic growth, improved living standards, technological advances and improved public health all help explain the declining death rate.

The death rate is the number of deaths in relation to the number of people in a population. It is normally measured per hundred thousand or per thousand people.

The death rate is also known as the mortality rate.

The crude mortality (or death) rate in England and Wales was approximately 10/1000 in 2021. This has decreased significantly since 1840 when the death rate was approximately 23/1000.

What is the long term trend in the death rate?

The long term decrease in the death rate, England and Wales, 1840 to 2020.
  • The death rate has halved in the last century, declining from 23/1000 in 1840 to 10/1000 today.
  • The death rate decreased most rapidly between 1840 and 1830.
  • Since 1930 the death rate has declined overall, but at a slower rate.
  • There were spikes in the death rate during WW1 and WW2 (not shown on the graph below). See the data source (1) for details.
  • The death rate has increased since 2010, when the Tory government came to power.

NB the Census cites the death rate per 100 000 of the population. To get the death rate per 1000 you simply divide the above figures by 100!

How did Coronavirus affect the death rate?

There were more deaths in England and Wales due to the Coronavirus Pandemic especially in 2020 and 2021 (2)

graph showing increase in death rates for males and females, England and Wales.
  • The age standardised death rate for males increased from 1079 per thousand in 2019 to 1236 per thousand in 2020
  • The age standardised death rate for females increased from 798 per thousand in 2019 to 894 per thousand in 2020.

The death rates now seem to be coming back down to what they were before the Pandemic. The overall long term trend is towards a declining death rate, and this is what this post will focus on.

Why has the death rate declined?

There are three major reasons for the long term decline in the death rate:

  1. Economic growth and improved living standards resulting in declining infant mortality and increased life expectancy.
  2. Medical advances such as improved immunisation and better survival rates from ‘diseases of affluence’ such as heart disease.
  3. Social policies and improved public health. Such as the establishment of the NHS and pollution laws.

In the first part of the century, most of this decrease was due to fewer children dying of infectious diseases, later on in the century, the continued decline is due to people living longer into old age.

The major causes of death have changed: from mainly being due to preventable, infectious diseases in the early part of the century to ‘diseases of affluence’ such as heart disease and cancers today.

There are considerable variations in life expectancy by gender and social class – people in the poorest parts of Glasgow die before 60, in the wealthiest parts of the UK (e.g. Kensington) life expectancy is nearer 90.

Economic growth and improving living standards

There are number of ways in which this had led to a decline in the death rate:

  • better food and nutrition (which in turn is related to better transport networks and refrigeration) which has meant that children are better able to resist infectious diseases, reducing the infant and child mortality rates. This is estimated to account for 50% of the decline in the death rate.
  • Better quality housing – Better heating and less damp, means less illness.
    Smaller family sizes – as people get richer they have fewer children, which reduces the chances of disease transmission.
  • More income = more taxation which = more money for public health services.
  • Evaluation – It’s worth noting that not all people have benefited equally from the above advances. The wealthy today have longer life expectancy than the poor, who still suffer health problems related to poverty.
  • Evaluation – In terms of food and nutrition, obesity is now becoming a serious problem – more food doesn’t necessarily mean better nutrition.

Medical Advances

  • Mass immunisation programmes limited the spread of infectious diseases such as measles.
  • Important in improving survival rates from ‘diseases of affluence’ such as heart disease and cancers.
  • Only really significant since the 1950s.
  • Evaluation – It’s easy to fall into the trap into thinking that modern medicine is the most important factor in improving life expectancy, it isn’t – economic growth, rising living standards and improvements in public health are more important.

Social Policies

  • The setting up of the NHS.
  • Health and safety laws – which legislate so that we have clean drinking water, food hygiene standards and safe sewage and waste disposal.
  • The clean air act and other policies designed to reduce pollution.
  • Health and Safety laws at work.
  • Evaluation – These are largely taken for granted, but they are important!

Other factors

  • There is greater knowledge and concern about health today
  • The decline of manual work means work is less physical and exhausting and less dangerous.

Analysis points

Two important related trends are the declining in infant mortality and the increase in life expectancy.

Declining Infant Mortality

The decline in infant mortality has broadly mirrored the declining death rate:

Increasing life Expectancy

Much of the decrease in the death rate has been due to increasing life expectancy.

Life expectancy isn’t increasing as fast today as it did between 1840 and 1850. This partly explains why the death rate has remained at around 10/1000 for the last several decades. People simply aren’t living that much longer!


  • 3/4s of the decline between the 1850s and 1970 was due to the reduction of infectious (fairly easily preventable) diseases such as Cholera, and improved nutrition accounts for half of this reduction. In these early years
  • More recently, the decrease in the death rate has been due to improving survival rates from heart disease and cancers.
  • The declining death rate is not necessarily all good – in the last decades we have witnessed a declining death rate and a declining birth rate – and so we now have an ageing population, which requires society to adapt in order to meet the different demands of differently structured population.
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Related Posts

This topic is part of the demography aspect of the families and household module within A-level sociology.

A closely related topic with some overlapping themes is Explaining changes to the Birth Rate

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(1) Office for National Statistics (2021) Annual deaths and mortality rates, 1838 to 2020 (provisional).

(2) Office for National Statistics (2021) Deaths registered in England and Wales: 2021 (refreshed populations)

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