Community-led solutions that address the root causes of America’s unique longevity problem can improve health for all    

In our November 2025 data update, County Health Rankings and Roadmaps (CHR&R) refreshed several measures, including county-level mortality. This data spotlight offers a summary of notable patterns and key trends in the leading causes of death, providing context to your local data. You can navigate the interactive visuals in this data spotlight to learn more about how leading causes of death have changed in the past decade, differences across neighboring counties and what we know about prevention and harm reduction strategies that can make a difference.

Introduction  

Deaths at an early age continue to be a serious and growing concern for our country. In fact, the U.S. has a unique longevity problem. Life expectancy in the U.S. has declined since 2014 and is now the lowest among high-income countries. Within the U.S., life expectancy has consistently been lowest among racialized and marginalized communities, including American Indian/Alaskan Native, Black and rural populations. Individual behaviors (e.g., smoking, drugs, diet) explain only part of the gap and limit action on deeper structural causes.

In local communities across the U.S., the broader policy context matters more than often acknowledged. Research shows that public health systems, behaviors, and socioeconomic factors alone cannot account for the U.S. disadvantage. Underexamined drivers include state and national policies, social values, and the influence of corporations and major donors on those policies. These societal rules and power dynamics are the deeper structural causes at the root of lives lost too soon, and why some communities carry a heavier burden.

A closer look at the leading causes of death reveals opportunities for public health intervention to address immediate crises and to inform actions at the root to prevent early deaths and meaningfully improve health for all families and communities.

Key trends

• The leading causes of death over the past decade continued to include chronic conditions, such as cancer, diabetes, and heart disease, as well as injury deaths such as homicide, suicide and accidental (or unintentional) injury. Deaths due to COVID-19 impacted communities in recent years.  
• Injury deaths have been leading contributors to early mortality over the last 10 years. Injury deaths due to poisonings (e.g., alcohol and drug overdose), firearms, and car crashes remain leading contributors to deaths at early ages, and demand coordinated public health responses.  
• Since 2021, public health gains have been realized in declining injury death rates, including homicide, poisoning and motor vehicle crashes.  
• Evidence shows that policies and enforcement of laws (e.g., seat-belt mandates, impaired driving enforcement) along with health system and public health interventions (e.g., harm-reduction strategies like naloxone distribution) have contributed to these gains. These gains are largest when organizing and advocacy groups work with elected officials to cultivate political will for multi-pronged policies implemented together and sustained over time, rather than relying on education or enforcement approaches alone.  
• Socioeconomic and community investments, including economic supports, job programs, and community development, can further amplify the impact by addressing the underlying conditions that shape community health.
• Despite these gains, however, a notable and troubling trend suggests that suicide rates are not making the same progress. The number of suicide deaths has risen in recent years. 

Key trends

• Deaths at early ages — particularly injury deaths — continue to affect the length and quality of life in our communities.  
• Across the U.S., suicide rates are higher in rural areas than in urban areas. Suicide rates in rural counties were nearly twice that in large urban metropolitan counties (22.0 and 12.2 deaths per 100,000 population, respectively).
• While suicide is a leading cause of death across the U.S., rural residents face additional structural and social challenges that may exacerbate burden. Rural residents face challenges such as social isolation and mental health stigma, limited access to mental and behavioral health services, economic hardship, and limited access to broadband/internet, including telehealth services. These types of community conditions are all shaped by decision-makers’ choices on health care, broadband access, and community development, among other factors.  

Key trends

• Patterns in the method of injury death, such as firearms, poisonings, or motor vehicle crashes, and how these methods differ across age groups can inform public health interventions that can improve lives for everyone, particularly people and places most impacted.
• For youth and young adults (ages 10–24) suicide is the second leading cause of death, and the majority of these deaths are the result of firearms. In fact, youth are more likely to die by firearm than any other form of youth injury death. Firearms have been the leading method of youth suicide for more than two decades.  
• Research shows that, across states, uneven laws reflect political and structural barriers. For example, firearm regulations vary widely due to political polarization, lobbying power, constitutional framing and state preemption that limits local action. As a result, a young person’s safety depends heavily on where they live, with stronger gun safety policies consistently linked to lower suicide rates across age groups.

Public health interventions and suicide-prevention strategies that account for different needs across communities and age groups are imperative. Evidence-based solutions exist, including:  

• Harm reduction strategies can reduce overdose deaths, including interventions like syringe services programs, Naloxone education & distribution programs, Good Samaritan drug overdose laws and fentanyl test strip distribution programs.
• Firearm access regulation laws, such as child access prevention laws and firearm licensing laws can be implemented or strengthened to reduce suicides. Other policies, such as universal firearm background checks and firearm restrictions for people convicted of domestic violence are also likely to decrease gun violence. Extreme Risk Protection Order laws are an expert-suggested legal intervention to prevent suicide.
• Access to mental health services can be increased through structural interventions like mental health benefits legislation and offering telemental health services. Other systems-level interventions that can improve mental health are behavioral health primary care integration and trauma-informed health care. Strategies that focus on improving mental health, such as mobile health for mental health and crisis lines can also be important investments.

How we resource and govern the communities we live in matters. Deep-rooted inequities and local conditions shape who is most at risk of dying young.  When public health organizations work together with people directly impacted by inequities and other advocates, we can identify and implement solutions. For example, Mothers Against Drunk Driving (MADD) led nationwide community organizing that resulted in the enactment of nearly 250 traffic safety laws in a little over a decade. And until activists like the Chicago Recovery Alliance put in place bulk purchasing and distribution of naloxone, the standard intervention in the U.S. for opioid misuse was arrest and incarceration. These examples show how we can work together to identify and implement place-based solutions to create opportunities for living long and well.   

Visit What Works for Health (WWFH) to find policies and programs that are a good fit for your community priorities. Explore WWFH's curated lists of evidence-informed strategies and solutions, including Rural Health, Civic Health, and Violence Prevention and Community Safety and more!    

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Ehsani, J.P., Michael, J.P., & MacKenzie, E.J. (2023). The future of road safety: Challenges and opportunities. The Milbank Quarterly, 101(S1), 613-636. https://doi: 10.1111/1468-0009.12644

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