Areas with the shortest expected life spans are largely in the South. Ali Mokdad says researchers know some of the reasons.

ALI MOKDAD: "Less education, less income in some of these rural counties, more likely to be smokers, more likely to be obese. They don't have health insurance, or they don't have adequate access to health care, and the quality of medical care is not as good as well."

In the United States, many public health matters are local responsibilities. Restrictions on public smoking, for example, differ from community to community. Some communities have more bicycle paths and other chances for physical activity, or more places to buy fresh fruits and vegetables.

ALI MOKDAD: "A long-term investment in their community to increase physical activity and improve diet are needed in this country.”

The study appears in the journal Population Health Metrics. Journal editor Chris Murray says at least one finding was unexpected.

CHRIS MURRAY: "It's a real surprise to us in the study that women are faring so much worse than men."

Around the country, American women still live longer than men by five to eight years. But their international ranking has been falling since the nineteen nineties. Dr. Murray says women are increasingly taking risks with their health.

CHRIS MURRAY: "Women are now smoking more. The obesity epidemic in women is greater than in men. Progress in tackling blood pressure is much worse in women."