People with schizophrenia die a mean of 15 years younger than the general population,1 a gap that has not improved over time and may be worsening.2 Over the past decade, this statistic has become a catalyst for efforts to improve the physical health and longevity of populations with schizophrenia and other serious mental illnesses across the globe.3 Given the extensive body of literature documenting the problem of excess mortality in schizophrenia, surprisingly little is known about the mechanisms that underlie it. The causes of mortality listed on death certificates for people with schizophrenia are similar to those seen in their communities. In developing countries, people with serious mental illnesses most commonly die of infectious diseases.4 In developed countries, deaths among individuals with schizophrenia are most likely to be because of cardiovascular disease, reflecting its high base prevalence and mortality burden in the broader population.5 But knowing these immediate causes of death provides only limited actionable information. To address the mortality gap for people with schizophrenia, we need to better understand the modifiable risk factors contributing to these excess deaths.