The United States life expectancy of 77.8 years at birth is a year shorter than the overall figure in Western Europe, and three to four years lower than that of Norway, Switzerland, and Canada. Over the past two decades, the country's rank in life expectancy has dropped from 11th to 42nd in the world. The infant mortality rate of 6.37 per thousand likewise places the United States 42nd out of 221 countries, behind all of Western Europe. Approximately one-third of the adult population is obese and an additional third is overweight; the obesity rate, the highest in the industrialized world, has more than doubled in the last quarter-century. Obesity-related type 2 diabetes is considered epidemic by health care professionals.
The U.S. adolescent pregnancy rate, 79.8 per 1,000 women, is nearly four times that of France and five times that of Germany. Abortion, legal on demand, is highly controversial. Many states ban public funding of the procedure and restrict late-term abortions, require parental notification for minors, and mandate a waiting period. While the abortion rate is falling, the abortion ratio of 241 per 1,000 live births and abortion rate of 15 per 1,000 women aged 15–44 remain higher than those of most Western nations.
The U.S. health care system far outspends any other nation's, measured in both per capita spending and percentage of GDP. The World Health Organization ranked the U.S. health care system in 2000 as first in responsiveness, but 37th in overall performance. The United States is a leader in medical innovation. In 2004, the nonindustrial sector spent three times as much as Europe per capita on biomedical research.
Unlike in all other developed countries, health care coverage in the United States is not universal. In 2004, private insurance paid for 36% of personal health expenditures, private out-of-pocket payments covered 15%, and federal, state, and local governments paid for 44%. In 2005, 46.6 million Americans, 15.9% of the population, were uninsured, 5.4 million more than in 2001. The main cause of this rise is the drop in the number of Americans with employer-sponsored health insurance. The subject of uninsured and underinsured Americans is a major political issue. A 2009 study estimated that lack of insurance is associated with nearly 45,000 deaths a year. In 2006, Massachusetts became the first state to mandate universal health insurance. Federal legislation passed in early 2010 will create a near-universal health insurance system around the country by 2014.