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Illustration: Eniola Odetunde/Axios

From high levels of obesity and opioid addiction to inequities in access to care, America's pre-existing conditions make the country an easy target for COVID-19, as well as future pandemics that could cripple the United States for decades to come.

Why it matters: One of the best ways the country could prepare for future threats — and boost its economy — is to improve Americans' overall health.

What's happening: An analysis published this week by researchers at Columbia University's National Center for Disaster Preparedness found at least 130,000 of America's 212,000 COVID-19 deaths so far would have been avoidable had the U.S. response been in line with that of other wealthy countries.

  • Just how badly the U.S. has botched COVID-19 has been covered in detail by Axios and others.
  • That failure is even more glaring when you consider that just last year the U.S. was ranked as the country most prepared for a pandemic, according to the Global Health Security Index.

What that index didn't take into account — and what has compounded months of governmental failures — is that even before COVID-19 arrived on its shores, the U.S. was an unusually sick country for its level of wealth and development.

By the numbers: That much was shown by the Global Burden of Disease (GBD) project, a massive database of what kills and sickens people around the world, which published its latest figures for 2019 in The Lancet last week.

  • Mortality for mothers and children under 5 is 6.5 per 1,000 live births in the U.S., compared to 4.9 for other wealthy countries.
  • Healthy life expectancy — the number of years people can expect to live without disability — is 65.5 years in the U.S., more than two decades fewer than in Japan.
  • Overall life expectancy in the U.S. hasn't risen since 2010, in part because of a 16.7% increase in the number of deaths due to cardiovascular disease since that year.
  • 65,700 Americans died of drug overdoses in 2019, more than double the number in 2010. Those deaths account for more than half of all drug overdose fatalities worldwide and held down life expectancy in the U.S.
  • High blood pressure, obesity and metabolic disorders are all on the rise in the U.S.

Context: Lancet Editor-in-Chief Richard Horton has called COVID-19 a "syndemic" — a synergistic epidemic of a new and deadly infectious disease and numerous underlying health problems. The U.S. is squarely in the heart of that syndemic.

What they're saying: "COVID-19 has illustrated and exacerbated the underlying inequities in America," says Rajiv Shah, the president of the Rockefeller Foundation.

Be smart: Improving overall public health is an investment worth making.

  • A report from McKinsey earlier this month estimated that poor health costs the U.S. economy about $3.2 trillion a year, but by deploying existing approaches to improve health and prevent disease, the U.S. could cut its disease burden by one-third by 2040.
  • For every $1 invested in targeting population health, the U.S. stands to gain almost $4 in economic benefit, and altogether health improvements could add up to a 10% boost to U.S. GDP by 2040.

Without dedicated interventions, the overall U.S. disease burden is expected to increase by 20% as an older population becomes more vulnerable to age- and lifestyle-related diseases.

What to watch: If the Supreme Court, with likely new justice Amy Coney Barrett, strikes down the Affordable Care Act, it would make it harder for many Americans to get health insurance.

The bottom line: There is no excuse for the way the U.S. has mishandled COVID-19, but the seeds of this catastrophe were planted well before the novel coronavirus arrived on American shores.

Go deeper

Updated 21 hours ago - Politics & Policy

Highlights from Biden and Harris' first joint interview since the election

Joe Biden. Photo: Mark Makela/Gettu Images

President-elect Joe Biden and Vice President-elect Kamala Harris sat down with CNN on Thursday for their first joint interview since the election.

The big picture: In the hour-long segment, the twosome laid out plans for responding to the pandemic, jump-starting the economy and managing the transition of power, among other priorities.

What COVID-19 vaccine trials still need to do

Illustration: Sarah Grillo/Axios

COVID-19 vaccines are being developed at record speed, but some experts fear the accelerated regulatory process could interfere with ongoing research about the vaccines.

Why it matters: Even after the first COVID-19 vaccines are deployed, scientific questions will remain about how they are working and how to improve them.

Romney: Trump's lack of leadership on COVID-19 is "a great human tragedy"

Sen. Mitt Romney and President Trump. Photo: Alex Wong/Getty Images

GOP Sen. Mitt Romney (Utah) told CNN Thursday that President Trump's lack of leadership during the coronavirus pandemic is "a great human tragedy."

Driving the news: Trump has largely stayed silent on the country's worsening pandemic in recent weeks, even as the U.S. experienced a record daily death toll and hospitalizations surpassed 100,000 for the first time. Instead, the president has focused much of his public commentary on pushing baseless claims of widespread election fraud.