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.

This is a Purple Public Health Project episode.

Dr. Itai Bavli is a Research Associate and lecturer at the W. Maurice Young Centre for Applied Ethics at the University of British Columbia, as well as the author of the Substack When Public Health Goes Wrong. His research focuses on developing a framework for understanding public health decisions and actions that have gone wrong and caused harm, with particular attention to how these errors intersect with social inequalities, medical racism, and the ties between governments and the pharmaceutical industry.

In this Purple Public Health conversation, Dr. Bavli joins Salma to discuss public health errors, which are different from medical errors but can also result in harms to the population. By exploring a wide array of examples—including the approval of Oxycontin in the US and Canada—they discuss the difference between errors of commission and errors of omission and highlight the importance of having conversations about these errors within the field. They also discuss the importance of identifying the errors versus assigning blame, the role that polarization has played in prioritizing some errors over others, the key role that transparency about errors can have on trust, and explore when has enough time passed to determine if an error has been made.

This episode will invite you to think beyond ideological, partisan, and professional lines, to understand, identify, and confront public health errors to improve the health of all.

Useful resources:

• Bavli, Itai. When Public Health Goes Wrong. Substack, accessed March 19, 2026. https://itaibavli.substack.com/
• Bavli I. When Public Health Goes Wrong: Toward a New Concept of Public Health Error. J Law Med Ethics. 2023;51(2):385-402. doi:10.1017/jme.2023.67

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.

Why does the US spend more on healthcare than other high-income countries and still have lower life expectancy?

Dr. Jose Francisco Figueroa is an Associate Professor of Health Policy and Management at the Harvard T.H. Chan School of Public Health, Assistant Professor of Medicine at Harvard Medical School, and a practicing Internist and Associate Physician at the Brigham and Women's Hospital. His research focuses on the drivers of healthcare spending and clinical outcomes and whether reforms aimed at improving healthcare quality and costs lead to better population health outcomes.

In this episode, Dr. Figueroa walks through three of his papers to build a case that is more nuanced than it first appears. The US healthcare system, it turns out, performs reasonably well on the things it controls—screening, diagnosis, chronic disease management. The problem lies outside the system: roughly 70% of the increase in avoidable deaths in the US is driven by drug use, alcohol, suicide, homicide, and traffic accidents, which are causes that clinical care cannot fix. Meanwhile, public health policies that could address those causes—such as regulations, taxes on harmful products, firearm laws—lag well behind peer countries. Also, a major policy lever of the past two decades, value-based payment reform, hasn’t moved the needle, in part because it was designed to change what happens inside the system rather than what drives people to die prematurely outside of it.

This episode will give you insights about why improving healthcare alone will not close the gap the US is currently facing. It makes the case for stronger public health infrastructure targeting the root causes of premature death.

Useful resources:

• Figueroa JF, Duggan CE, Joynt Maddox KE. Value-Based Payment in Medicare: Progress, Challenges, and Future Directions. Journal of Health Politics, Policy and Law. 2025;50(6):1059-1079. doi:1215/03616878-11995200
• Papanicolas I, Niksch M, Figueroa JF. Avoidable Mortality Across US States and High-Income Countries. JAMA Intern Med. 2025;185(5):583. doi:1001/jamainternmed.2025.0155
• Papanicolas I, Sawaya T, Bleich SN, Figueroa JF. Comparing US prevention efforts to other high-income countries. The Lancet Public Health. 2025;10(11):e988-e1000. doi:1016/S2468-2667(25)00222-1

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.