United States – Health Issues

What are the most common health issues and diseases in the United States?

The leading health conditions afflicting Americans include heart disease, cancer, chronic lower respiratory diseases, obesity, Alzheimer’s disease, diabetes, substance use disorders, influenza, kidney disease, and a range of mental health conditions. These aren’t simply prevalent — they are frequently fatal. CDC mortality figures show heart disease claiming roughly 681,000 lives each year, followed by cancer at around 613,000, unintentional injuries at 222,000, and stroke at more than 162,000.

Coronary Artery Disease (CAD) is the predominant form of heart disease in the US, arising when fatty deposits accumulate in arterial walls and reduce blood flow to the heart, potentially triggering chest pain and eventual cardiac failure. Approximately 108 million American adults — close to one in three — live with high blood pressure, which ranks among the foremost risk factors for developing heart disease.

Eight of the ten leading causes of death in the United States are chronic, non-communicable conditions. Across multiple disease categories, the US records higher illness rates than comparable wealthy nations. Though newly diagnosed cancers most often involve the breast or prostate, cancer fatalities are predominantly driven by lung, colorectal, and pancreatic malignancies. Cancer rates in the US run 15% above the average seen in peer nations — reaching 367.0 per 100,000 people in 2022, against a comparable-country average of 320.3 per 100,000.

Research consistently identifies the southeastern United States as a region of especially elevated chronic disease burden, shaped by pronounced socioeconomic disadvantage, lower median household incomes, and considerable obstacles to healthcare access. Expats settling in different parts of the country — whether in the urban Northeast or the rural South — will likely encounter distinctly different health environments and varying levels of care availability.

Addressing the rising tide of chronic illness is widely seen as dependent not only on medical intervention, but on behavioural change and the broader social determinants of health. For incoming expats, grasping these dynamics matters both for their own health management and for understanding the cultural context of healthcare they will be entering.

Is the United States considered a healthy country? How do health outcomes compare internationally?

US life expectancy climbed to 79 years in 2024 — the highest figure ever recorded in the country’s history. Heart disease held its position as the number one cause of death, though the associated mortality rate fell by roughly 3% for the second consecutive year. Despite these positive signals, the United States continues to fall markedly short of comparable wealthy nations when it comes to overall population health.

Life expectancy at birth in the US stood at 78.4 years in 2023, while the figure for comparable countries averaged 82.5 — a gap of 4.1 years that has proven stubbornly persistent. The EU’s preliminary 2024 figure of 81.7 years further underscores the disparity. What makes this especially striking is the scale of American healthcare investment: the US devotes a far greater share of GDP to healthcare than any peer nation, yet achieves notably worse outcomes — raising fundamental questions about equity, affordability, and systemic efficiency.

The Commonwealth Fund’s 2024 Mirror, Mirror report assessed health outcomes across ten high-income countries, evaluating how effectively each nation’s healthcare system keeps its population healthy and prevents premature death. The US performed worst across the board — Americans had the shortest lifespans and the highest number of deaths that could have been avoided with timely, effective care. No other country in the comparison matched the US rate of preventable and treatable mortality.

An analysis by the Johns Hopkins Bloomberg School of Public Health identified preventable causes — among them heart disease, drug overdoses, gun violence, and road traffic fatalities — as the primary drivers behind the roughly three-year life expectancy shortfall between the US and comparable nations. The US overdose death rate stands at 31.6 per 100,000, more than three times the rate of 9.3 per 100,000 recorded in England and Wales. Firearm-related homicides and suicides account for 13.3 per 100,000 deaths in the US, versus just 0.1 per 100,000 in England and Wales.

Life expectancy varies considerably from state to state within the US, though even the best-performing states fall below the average for comparable nations. For the most current data, readers can consult the WHO country health profile for the United States and the CDC National Center for Health Statistics.

What infectious diseases or environmental health risks should expats be aware of in the United States?

The US is an expansive, geographically varied nation, and the profile of infectious disease risk shifts meaningfully depending on location, climate zone, and time of year. Although the country maintains a well-developed public health infrastructure, several infectious and environmental hazards deserve consideration before you arrive.

In 2024, the CDC recorded 16 measles outbreaks — a sharp increase from just four in 2023 — driven largely by gaps in vaccination coverage linked to declining immunisation rates in certain communities. Pertussis (whooping cough) also resurfaced with force, with case counts in late 2024 running more than six times higher than in the same period of the previous year. Expats arriving from countries with robust routine immunisation programmes should verify that their vaccination records are current — particularly for measles-mumps-rubella (MMR), pertussis, and influenza.

CDC data indicates that the 2023–2024 flu season resulted in more illnesses and deaths than the season before it, with paediatric flu fatalities (200 deaths) surpassing the previous record for a non-pandemic year. Annual influenza vaccination is readily available throughout the US and is strongly encouraged for residents of all ages.

Vector-borne diseases are a genuine concern in multiple regions. Lyme disease, transmitted through tick bites, is well established across the northeastern and upper Midwestern states. West Nile virus, carried by mosquitoes, circulates across much of the continental US during the warmer months. Dengue fever has been reported in southern states and US territories. Those venturing into the western mountain states should be aware of hantavirus risk. Rocky Mountain Spotted Fever — misleadingly named — is actually most prevalent across the South and East.

Air quality constitutes a meaningful environmental health concern in certain parts of the country. Industrial zones, wildfire-affected western states, and densely populated urban centres can all experience periods of significantly degraded air quality, posing particular risks to people with respiratory or cardiovascular conditions. The US Environmental Protection Agency (EPA) provides a real-time air quality index at AirNow.gov. Anyone living with asthma or chronic lung conditions should keep a close eye on local readings. Tap water is generally safe in most urban settings, though quality can be inconsistent in some rural communities or older urban areas with ageing distribution infrastructure; checking with local authorities is always a sensible precaution.

Most travellers entering the US face no mandatory vaccination requirements, though certain visa categories — particularly immigrant visas — require a medical examination and proof of specific immunisations. Expats should consult their home country’s official travel health authority as well as the CDC Traveler’s Health pages for recommended vaccines and current health advisories both before departure and after settling in.

Is smoking common in the United States, and what are the laws around it?

Around 10.8% of American adults smoked cigarettes as of 2023 — the lowest figures ever recorded, though meaningful disparities remain across demographic and geographic groups. This marks a dramatic long-term reduction from rates that surpassed 40% during the 1960s. Even so, tobacco use continues to be responsible for approximately 480,000 deaths in the US every year.

E-cigarettes first emerged as the most widely used tobacco product among young Americans in 2014 and have retained that status through 2024, despite some recent decline in use among high school students. Vaping among younger age groups remains a pressing public health concern. At the federal level, the US Food and Drug Administration (FDA) serves as the primary regulatory authority over tobacco and nicotine products.

Individual states and municipalities have enacted tobacco control measures of varying scope, resulting in considerable geographic and sociodemographic unevenness in how well communities are protected from tobacco-related harm. Adults in Midwestern and Southern states smoke at higher rates than their counterparts in the Northeast and West; the so-called “Tobacco Nation” states report smoking rates more than 40% above the national norm.

The 2026 State of Tobacco Control report found that only 13 states and Washington D.C. received top marks for the comprehensiveness of their smokefree workplace laws. The practical experience for expats can therefore differ substantially depending on where they live. States such as California, Massachusetts, and New York have enacted broad smokefree protections covering workplaces, restaurants, bars, and many outdoor settings. Meanwhile, several southern and midwestern states maintain weaker or more fragmented protections. Compared to countries like the UK or Australia — which operate nationwide indoor smokefree legislation — the US framework is considerably more decentralised and inconsistent. Expats should take time to understand the specific rules in their state and city.

By 2024, two US states and nearly 200 local jurisdictions had banned the sale of menthol cigarettes and other flavoured tobacco products. The federal minimum age for purchasing tobacco products is 21, established under the Tobacco 21 legislation enacted in December 2019. The legal minimum purchasing age for alcohol is likewise 21.

Is obesity or poor diet a significant health concern in the United States?

Obesity represents one of the most pressing public health challenges in the United States, affecting roughly 2 in 5 adults and 1 in 5 children, and is widely described as an epidemic. Internationally, the figures stand out starkly: the US records the highest proportion of obese adults among comparable high-income nations, at 41% in 2023. The obesity rate is more than double the average for peer countries — in 2022, 42.0% of US adults were classified as obese, compared to an average obesity rate of 17.8% across comparable nations.

As the most prevalent chronic condition in the country, obesity significantly raises an individual’s risk of developing an array of additional health problems, including hypertension, type 2 diabetes, and asthma. The financial toll is enormous — obesity and its associated complications account for over 20% of annual healthcare expenditure in the United States. For expats arriving from countries with stronger traditions of food regulation, clear labelling requirements, and controls on portion sizes, the American food environment can require a considerable adjustment.

The typical American diet is heavily shaped by the widespread availability of ultra-processed foods, generous portion sizes, and a deeply embedded fast-food culture. While fresh produce and whole foods are accessible in most parts of the country, they can be costly and harder to find in lower-income or remote communities — areas frequently described as “food deserts.” A range of structural factors compound the obesity problem, among them chronic stress, food insecurity, and limited time and opportunity for physical activity.

Various federal and state initiatives address nutrition and physical activity, including the CDC’s Overweight and Obesity programme and the USDA’s MyPlate nutrition guidance. Lower-income households may be eligible for support through the Supplemental Nutrition Assistance Program (SNAP) or the Women, Infants and Children (WIC) programme. Expats who have lived under more tightly regulated food systems — particularly in parts of Europe with stricter controls on additives, labelling, and food marketing — may find notable differences in product formulations and the broader food culture they encounter.

What are the mental health attitudes and services like in the United States?

Mental health has become an increasingly prominent subject of public conversation in the United States, and societal attitudes have shifted substantially over recent decades. Therapy and counselling carry a degree of cultural normalisation in American life — particularly in cities and professional circles — that is greater than in many other countries. Nevertheless, stigma persists in certain communities and regions, and structural barriers such as cost and provider availability remain genuinely significant obstacles.

Mental health conditions rank among the most widespread health issues affecting the American population. Unlike countries with national health services — such as the NHS in the UK or universal systems across much of Scandinavia — the US does not offer a single public healthcare programme covering everyone. As a result, access to mental health treatment is largely determined by health insurance status, which for most working-age people means either an employer-provided plan or a privately purchased policy. Without adequate insurance, therapy and psychiatric care can be prohibitively expensive out of pocket.

Public mental health services do exist, delivered primarily through community mental health centres, Federally Qualified Health Centers (FQHCs), and state-funded programmes. The federal government’s Substance Abuse and Mental Health Services Administration (SAMHSA) operates a national helpline (1-800-662-HELP) and an online treatment locator. The 988 Suicide and Crisis Lifeline provides free, round-the-clock confidential crisis support to anyone in the country.

For expats, the level of mental health care available depends greatly on their insurance arrangement. Many employer-sponsored plans include mental health benefits, and the Mental Health Parity and Addiction Equity Act (MHPAEA) legally requires that mental health coverage be broadly equivalent to coverage for physical health conditions. Even so, identifying in-network providers and keeping costs under control can be a persistent source of frustration. The rapid growth of telehealth has made mental health support more accessible, particularly for those in rural or underserved locations, and often at more manageable cost.

The stresses inherent in relocation — including isolation, culture shock, linguistic or cultural adjustment, and professional upheaval — can place expats at elevated risk of mental health difficulties. Seeking support proactively, rather than waiting until a crisis develops, is strongly recommended. Many larger cities have established expat communities, international cultural associations, and therapists with internationally diverse training who can offer more familiar frames of reference.

Are there any health risks specific to expats living in the United States?

Relocating to the United States brings with it a number of health-related challenges that are worth anticipating well in advance. The most consequential practical issue for the majority of expats is learning to navigate an American healthcare system that operates on fundamentally different principles from most universal public health models. Without adequate insurance coverage, even routine medical consultations can be surprisingly costly, and emergency treatment can generate bills of staggering proportions.

Expats from countries where a single government-funded system covers all residents — analogous to how Medicare functions for older Americans or how the NHS operates in the UK — may be unprepared to find that most working-age people in the US rely on employer-sponsored plans, individually purchased market policies, or government programmes such as Medicaid (serving lower-income individuals) or Medicare (for those aged 65 and over). Arranging solid, continuous insurance coverage before setting foot in the country is an essential first step.

Climate adaptation is another practical consideration that should not be underestimated. The US encompasses an extraordinary range of climates — from the subtropical humidity of Florida and the Gulf Coast, to the arid heat of the Southwest, to the severe winters of the Midwest and New England, to the high-altitude environments of states like Colorado, where Denver lies above 1,600 metres. Those unaccustomed to high elevations may experience altitude-related symptoms, while extreme heat and cold events present genuine health hazards for the unprepared.

Dietary change is a frequently reported experience among expats arriving in the US. The food environment — defined by large serving sizes, heavily processed convenience foods, and a strong culture of eating out — can lead to gradual but significant weight gain or nutritional imbalances if newcomers are not attentive to shifts in their eating patterns. Registering promptly with a primary care physician (PCP) after arrival is highly advisable. A PCP can carry out baseline health checks, review and update vaccination records, manage any pre-existing conditions, and coordinate referrals to specialists within your insurance network.

Expats should also take time to understand the opioid crisis, which has left a profound mark on communities across the country. Drug-related fatalities have surged in recent years as the crisis has deepened. For those managing chronic pain, it is worth knowing that opioid-based medications may be prescribed with greater frequency than would be typical in other countries, and understanding safe use and disposal practices is important.

Practical steps for protecting your health as an expat in the US include:

1. Secure comprehensive health insurance before or immediately upon arrival — check whether your employer provides a plan, or explore options at healthcare.gov (the federal health insurance marketplace).
2. Register with a primary care physician as soon as possible and obtain a referral network for specialist care.
3. Bring a full medical history, current prescriptions (with generic drug names, as brand names differ by country), and vaccination records from your home country.
4. Update vaccinations as recommended by the CDC, particularly for influenza, COVID-19, and any travel-related vaccines relevant to your region.
5. Check local air quality, water quality, and any regional disease alerts specific to the state and city you are moving to.
6. Familiarise yourself with local emergency services (911) and the nearest hospitals and urgent care centres.

Where can expats find reliable health information and services in the United States?

The US offers an extensive array of authoritative public health resources, and expats are strongly encouraged to turn to official government and institutional sources rather than depending on informal online communities or commercial health platforms. Key resources include:

• Centers for Disease Control and Prevention (CDC) — The country’s principal national public health agency, covering disease surveillance, vaccination recommendations, environmental health, and travel health guidance.
• U.S. Department of Health and Human Services (HHS) — The federal body overseeing national health policy, including Medicare, Medicaid, and a range of public health initiatives.
• National Institutes of Health (NIH) — The world’s foremost biomedical research institution, offering a substantial library of accessible health information for members of the public.
• Substance Abuse and Mental Health Services Administration (SAMHSA) — An essential resource for mental health and substance use support, including a national helpline and an online treatment locator.
• HealthCare.gov — The federal marketplace through which individuals can purchase health insurance under the Affordable Care Act (ACA).
• FoodSafety.gov — Official food safety guidance from the US government.
• AirNow.gov — Live air quality data searchable by zip code across the entire country.
• World Health Organization (WHO) — International health data encompassing US country profiles and global disease alerts.

It is worth keeping in mind that health guidelines, vaccination requirements, insurance rules, and public health advisories are subject to change. Expats should verify all specific figures, fees, and health requirements with official sources both before leaving for the US and once they have arrived. Your home country’s official travel health authority — such as the UK’s TRAVAX or NATHNAC, or their equivalents in other nations — is an equally important pre-departure reference for health guidance relevant to the US.

After arrival, many large employers, universities, and international organisations provide Employee Assistance Programmes (EAPs) that incorporate health advisory services. International health insurance providers often maintain dedicated support lines for policyholders living abroad. Local expat communities and international associations can also prove valuable as sources of candid, practical advice on how to navigate the American health system day to day.

Frequently Asked Questions About Health Issues in the United States

Do I need health insurance to live in the United States as an expat?

Although the federal individual mandate penalty for being uninsured no longer applies, going without health coverage in the US represents a serious financial exposure. Medical bills in the absence of insurance can be extraordinarily high — a single emergency room visit can easily cost thousands of dollars. Most expats in employment will be covered through a workplace plan; those who are not can compare and purchase plans through the federal marketplace at healthcare.gov, or may wish to investigate international expat health insurance options. Arranging coverage before your first day in the country is strongly recommended.

What vaccinations should I get before moving to the United States?

No vaccines are mandatory for entry into the US for the majority of non-immigrant visa holders, but the CDC advises all US residents to be current on routine immunisations including MMR (measles, mumps, rubella), annual influenza, COVID-19, tetanus-diphtheria-pertussis (Tdap), and varicella (chickenpox). Those applying for immigrant visas must complete a medical examination and provide evidence of a prescribed vaccination schedule. Consult the CDC Traveler’s Health pages and your home country’s travel health authority for the most up-to-date recommendations.

Is the tap water safe to drink in the United States?

In most US cities and towns, tap water undergoes treatment and is considered safe to drink, regulated by the Environmental Protection Agency (EPA) under the Safe Drinking Water Act. That said, quality can be inconsistent in municipalities with older pipe networks (as the Flint, Michigan situation demonstrated), and some rural properties drawing on private wells fall outside federal regulatory coverage. If you have any doubts, contact your local water supplier or review the water quality reports that municipalities are required to publish.

Are there dangerous animals or insects I should be aware of in the United States?

Several creatures in the US can pose genuine health risks. Ticks are prevalent across many regions and can transmit Lyme disease and Rocky Mountain Spotted Fever. Mosquitoes carry West Nile virus during the warmer months. Venomous snakes, including rattlesnakes, are found across the Southwest, and black widow and brown recluse spiders inhabit certain states. Applying insect repellent, dressing appropriately for wooded terrain, and thoroughly checking for ticks after time outdoors are all sensible precautions.

How do I find a doctor as an expat in the United States?

Locating a primary care physician (PCP) typically starts with your health insurance plan, since most insurers require you to select a provider within their network to minimise costs. Your insurer’s website will include a searchable provider directory. If your employer has an Employee Assistance Programme (EAP), that can also point you toward referrals. Major university health systems frequently offer services tailored to international patients. If you are not yet insured, Federally Qualified Health Centers (FQHCs) charge fees on a sliding scale based on income and can be located at findahealthcenter.hrsa.gov.

Is mental health care easily accessible for expats in the United States?

The availability of mental health care in the US is largely determined by your insurance coverage. Those with solid employer-sponsored plans will generally be able to access therapy and psychiatric services, though identifying in-network providers and keeping up with co-payments can be an ongoing challenge. Telehealth platforms have expanded considerably and can be especially helpful for expats in less densely populated areas or those who prefer practitioners with an international background. The 988 Suicide and Crisis Lifeline is free, completely confidential, and staffed around the clock for anyone in the country.

Does the United States have any particular issues with air pollution or environmental health?

Air quality varies widely across the US. Urban centres frequently experience elevated levels of pollution, particularly from vehicle exhaust. Western states including California, Oregon, and Washington have been increasingly battered by severe wildfire seasons that drive air quality deterioration across enormous areas, sometimes affecting communities hundreds of miles from the flames. People with asthma, COPD, or cardiovascular disease should regularly consult the EPA’s AirNow.gov tool before heading outdoors.

What is the opioid crisis, and does it affect everyday life in the United States?

The opioid crisis describes the epidemic of addiction to and misuse of both prescription opioid painkillers and illicit opioids such as fentanyl, which has driven a steep and sustained climb in overdose deaths across the US over the past two decades. Its effects are felt in communities from rural Appalachia to major metropolitan areas. For expats, a key practical consideration is that opioid-based medications may be prescribed for pain management with greater frequency than would typically be the case in other countries; understanding safe usage and proper disposal is therefore important. Naloxone (Narcan), the emergency medication that reverses opioid overdoses, is now available without a prescription at most pharmacies across the country.