By some estimates, hundreds of thousands of Americans die each year who would still be alive if the United States had the mortality rates of other wealthy countries. What makes this even more unsettling is that it wasn't always this way. In the mid-twentieth century, Americans actually lived longer than their counterparts in other rich nations. Something changed, and it's been getting worse for over four decades.

Dr. Andrew Stokes is an associate professor of global health at the Boston University School of Public Health. A demographer and sociologist by training, he founded the Uncounted Lab, a research initiative focused on mortality that official statistics miss, whether from pandemics, chronic diseases, or public health emergencies.

Dr. Stokes joins Salma to discuss what excess mortality reveals about who is dying in America and why. The conversation is anchored in the "Missing Americans" concept, which estimates how many US deaths each year would have been averted if the country simply matched the mortality rates of its peers. They trace why the US mortality disadvantage has grown steadily since the early 1980s, how the Covid-19 pandemic both exposed and deepened it, and why the burden has fallen disproportionately on Americans without a college degree, driven less by the "deaths of despair" narrative that dominates headlines and more by cardiovascular diseases. The conversation closes with GLP-1 drugs and the need to celebrate progress while still looking for structural interventions to prevent and mitigate the impact of obesity in the US.

This episode offers a new lens for analyzing preventable mortality in the United States and for thinking through what it can take to address it.

Useful resources:

• Bor J, Raquib RV, Wrigley-Field E, Woolhandler S, Himmelstein DU, Stokes AC. Excess US Deaths Before, During, and After the COVID-19 Pandemic. JAMA Health Forum. 2025;6(5):e251118. doi:10.1001/jamahealthforum.2025.1118
• Bor J, Stokes AC, Raifman J, et al. Missing Americans: Early death in the United States—1933–2021. Galea S, ed. PNAS Nexus. 2023;2(6):pgad173. doi:10.1093/pnasnexus/pgad173
• Paglino E, Wrigley-Field E, Stokes AC. Diverging Mortality Trends by Educational Attainment in the US. JAMA Health Forum. 2025;6(6):e251647. doi:10.1001/jamahealthforum.2025.1647
• Stokes AC. Public health should embrace GLP-1 drugs without abandoning obesity prevention. STAT. November 28, 2025. https://www.statnews.com/2025/11/28/weight-loss-drugs-obesity-prevention-importance/

Host: Dr. Salma Abdalla Editors: Catalina Melendez Contreras Marketing: Kinkini Bhaduri Music: Eden Avery / Melting Glass from Epidemic Sound https://www.epidemicsound.com/track/2fqOXWpHab/

The views and opinions expressed by the guest in this episode do not necessarily reflect those of their institution, the funders, or the podcast team.