The U.S. is forecasted to fall in its global rankings below nearly all high-income and some middle-income countries. Drug use disorders, high body mass index, high blood sugar, and high blood pressure are driving mortality and disability higher across the U.S. Future scenarios for health outcomes identify the states that are forecasted to gain ground, face stagnation, or grow worse. Scientific evidence underscores the urgent need to prioritize public health to prevent the economic consequences of sickness, disabilities, and premature mortality in the U.S.