Americans are living shorter, unhealthier lives. At the same time, the United States outspends other wealthy nations when it comes to health care, according to a new report from Commonwealth Fund researchers Roosa Tikkanen and Melinda Abrams.

The analysis, which compares the U.S. to 10 other high-income nations on health care spending, outcomes, risk factors, and quality, also finds the U.S. has the highest suicide rate. And while the U.S. spends approximately double what many other countries spend on health care, Americans’ average life expectancy is a two full years below that in similar nations. Contributing to this disparity is the comparatively high rate of premature deaths in the U.S. from conditions that are treatable with timely health care.

What will it take to improve? The authors say reducing costs, investing in primary care, addressing people’s social needs, and cutting back on unnecessary tests and procedures could all help.