Yet money still can’t buy Americans a European lifespan. A Brown University study published last year in the New England Journal of Medicine found that Americans die sooner than Europeans at every level of wealth, and that the richest Americans fare no better than the poorest people in much of Western Europe.

“The plot twist is that even the wealthiest quartile of Americans does not have better outcomes than most of northern and Western Europeans,” says Sara Machado, a research scientist at Brown’s Center for Health System Sustainability. “That was unexpected and counters a lot of the narrative that we’re used to.”

What the Brown study found

The researchers tracked more than 73,000 adults ages 50 to 85 in the U.S. and 16 European countries, starting in 2010 and following them for about a decade, using data from the U.S. Health and Retirement Study and Europe’s SHARE survey.

The wealthiest people in northern and western Europe had a mortality rate about 35% lower than the wealthiest Americans. Survival among America’s richest quartile was statistically equivalent to that of the poorest quartile in countries like France, Germany, and the Netherlands.

Across the board, people in continental Europe died at rates about 40% lower than Americans over the study period, according to Brown. In southern Europe, death rates were about 30% lower.

Wealth still matters within each country. “We found that where you stand in your country’s wealth distribution matters for your longevity, and where you stand in your country compared to where others stand in theirs matters, too,” Machado says.

Why money doesn’t close the gap

The U.S. spent an estimated $14,775 per person on health care in 2024, nearly $7,000 more than the average comparable wealthy country, according to the Peterson-KFF Health System Tracker. Those countries averaged a life expectancy of 82.7 years, 3.7 years longer than the U.S. Fortune has reported on why U.S. health care costs run about twice those of peer nations.

The spending doesn’t buy universal access. About 26.7 million Americans went uninsured for all of 2025, Census data shows, and about 2.6 million fewer Americans had ACA marketplace plans in early 2026 than in early 2025.

“Fixing health outcomes is not just a challenge for the most vulnerable – even those in the top quartile of wealth are affected,” says Machado.

Lifestyle plays a role. Americans tend to have less healthy diets and a more sedentary lifestyle, and heart disease and cancer remain the two leading causes of death nationally. The researchers noted that smoking and rural living, both tied to poorer health, were more common in the U.S.

Europe is also home to two of the so-called blue zones, Sardinia in Italy and Ikaria in Greece, where longevity is credited to activity, diet, rest, and strong social ties, though some researchers dispute the claims.

When Fortune first reported on the study, senior author Irene Papanicolas pointed to higher U.S. rates of avoidable deaths from firearms, alcohol, and suicide; higher cardiovascular mortality; and a thinner social safety net, with health coverage tied more closely to employment.

Inequality compounds it. The U.S. has a far wider gap between rich and poor than Europe, a divide that Creative Planning CEO Peter Mallouk recently warned is unsustainable.

“Our previous work has shown that while wealth inequality narrows after 65 across the U.S. and Europe, in the U.S. it narrows because the poorest Americans die sooner and in greater proportion,” explains Papanicolas, a professor of health services, policy, and practice who directs Brown’s Center for Health System Sustainability.

What researchers say comes next

The recent gains in U.S. longevity came largely from the end of the pandemic, and a drop in overdose deaths and suicides also occurred in 2024, according to the CDC. Those gains have not closed the gap with Europe.

“If we want to improve health in the US,” explains Papanicolas, “we need to better understand the underlying factors that contribute to these differences – particularly amongst similar socioeconomic groups – and why they translate to different health outcomes across nations.”

“There is a lot of it that is a collective issue,” Machado agrees. “But I would say to individuals that you really need to think about your retirement—about when you’re going to retire, how you’re going to retire, and how you can be happy as a person that has retired.”

Machado adds, “If you look at other countries, there are better outcomes, and that means we can learn from them and improve. It’s not necessarily about spending more — it’s about addressing the factors we’re overlooking, which could deliver far greater benefits than we realize.”