Americans wait for care at a three-day free medical fair in Appalachia.
Photo: John Moore/Getty

New data released by the Institute for Health Metrics and Evaluation and reported by Bloomberg shows that the U.S. is expected to fall in global life expectancy rankings over the next few decades. In 2016, the U.S. ranked 43rd among 195 nations, with an average life expectancy of 78.7 years. That’s already pretty weak for the richest country on Earth, but don’t worry—things are going to get even worse.

According to the data, by 2040, Americans life expectancy will increase by only 1.1 years, to 79.8. Meanwhile, our global rank will drop 21 spots, leaving us in 64th place.

Other nations are on pace to make massive gains in that time. China is expected to rise in rank from 68th to 39th, while Spain is expected to take the number one spot, currently held by Japan.

So why is America doing so poorly? There are a lot of explanations, mostly related to health.

From Bloomberg:

The top five health drivers that explain most of the future trajectory for premature mortality are high blood pressure, high body mass index, high blood sugar, tobacco use, and alcohol use, Foreman said. Air pollution ranked sixth.

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Many of those factors are linked to stress, which, as Jeffrey Pfeffer argues in his book, Dying for a Paycheck: How Modern Management Harms Employee Health and Company Performance—and What We Can Do About It, is driven in large part by Americans poor work conditions. America is also the only industrialized nation without some form of universal healthcare coverage.

These numbers, though bleak, aren’t set in stone. “The future of the world’s health is not pre-ordained, and there is a wide range of plausible trajectories,” Dr. Kyle Foreman, the study’s lead author, told Bloomberg. “But whether we see significant progress or stagnation depends on how well or poorly health systems address key health drivers.”