Explanations for lagging life expectancy in the US compared to other high-income countries have focused largely on “deaths of despair,” but attention has also shifted to the role of stalling improvements in cardiovascular disease and the obesity epidemic. Using harmonized data from the US Health and Retirement Study (HRS) and English Longitudinal Study of Ageing (ELSA), we assess differences in self-reported and objective measures of health, among older adults in the U.S. and England and explore whether the differences in Body Mass Index (BMI) documented between the US and England explain the US disadvantage. Older adults in the US have a much higher prevalence of diabetes, low HDL cholesterol, and high inflammation (CRP) compared to English adults. While the distribution of BMI is shifted to the right in the US with more people falling into extreme obesity categories, these differences do not explain the cross-country differences in measured biological risk. We conclude by considering how country differences in health may have impacted the burden of Covid-19 mortality in both countries.