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But those gains appear to be stalling. Life expectancy in the United States did not increase between 2010 and 2018: in both years, it was 78.7 years. The peak of 78.9 came in 2014, and the nation has struggled to reclaim it since. In fact, it then dropped sharply during the pandemic (78.8 in 2019 to 76.4 in 2021) and has only partially recovered (78.4 in 2023)
This plateau arrived despite unprecedented investment. In 2023, research and development spending in the pharmaceutical industry exceeded $300 billion globally, more than double the $137 billion spent in 2012.
Not All Movement Is Equal
The BMJ Medicine study followed 111,000+ participants for more than 30 years. Here are the associations with all-cause mortality (highest vs. lowest activity category):
17% lower
HR 0.83 (0.80 to 0.85). Most accessible activity studied.
15% lower
HR 0.85 (0.80 to 0.89). Benefits appeared to level off at moderate volumes.
14% lower
HR 0.86 (0.84 to 0.89). Sharp early benefit, then gradual leveling.
13% lower
HR 0.87 (0.82 to 0.91). Benefits appeared to level off at moderate volumes.
13% lower
HR 0.87 (0.80 to 0.93). Continued association at higher intensity.
11% lower
HR 0.89 (0.85 to 0.94). Non-linear association observed.
10% lower
HR 0.90 (0.87 to 0.93). Benefits appeared to level off early.
4% lower
HR 0.96 (0.93 to 0.99). Modest association; non-linear pattern.
The variety bonus
Participants who reported the widest variety of activities had 19% lower all-cause mortality than those with the least variety, even after adjusting for total activity. Variety was independently associated with lower mortality.
How to read this: For most activities, percentages compare participants vs. non-participants. For walking and climbing stairs (*), the comparison is highest vs. lowest quartile among all participants. Bar length is scaled to the largest risk reduction shown.
Observational study with self-reported activity. Most activities showed statistically significant associations; swimming did not. Source: Han et al., BMJ Medicine (2026). DOI: 10.1136/bmjmed-2025-001513
The productivity math has become troubling: the number of new molecular entities approved annually per billion US dollars of inflation-adjusted investment has halved roughly every nine years since 1950, a phenomenon researchers have dubbed “Eroom’s Law,” Moore’s Law in reverse.
So what does move the needle on mortality? Walking. A study published this week in BMJ Medicine, drawing on over 111,000 participants tracked for more than 30 years, found that fast walking as little as 15 minutes a day was associated with nearly a 20% reduction in total mortality.
That’s not to say that pharma R&D is not having an impact. Pharma R&D is working: just not where the deaths are accumulating. CDC analysis of the 2014-2017 life expectancy decline shows cancer and heart disease mortality continued to improve. The losses came from elsewhere: drug overdoses, suicide, liver disease, unintentional injuries.
In other words, the industry is winning the molecular battles. But it’s losing ground to problems that aren’t molecular: the decline in life span coincides with not only the opioid crisis, and in previous years, the COVID-19 pandemic. Other contributors include lifestyle problems. Ultraprocessed foods grew from 53.5% of calories in 2001 to about 57% in 2018.
Walking, it turns out, sits at that intersection. It addresses metabolic dysfunction, cardiovascular health, and, emerging research suggests, mental health outcomes tied to the “deaths of despair” that have dragged down U.S. longevity. The BMJ study found that variety of exercise types is associated with lower mortality even when total physical activity is held constant
