Studies of mortality-rates and life expectancy in schizophrenia have consistently shown that the standardized mortality rate (SMR) are raised compared to the general population. In a meta-analysis (2007) of 38 studies with 22,296 deaths, all cause SMR was 2.98. SMR in a French cohort study (2009) in 3470 patients with schizophrenia, were 3.6 for men and 4.3 for women. A recent epidemiological study (2015) of a US-cohort of 1,138,853 individuals with schizophrenia, 4,807,121 million years of follow-up and 74,003 deaths, all cause SMR was 3.7 for the total population: 3.3 for men and 4.3 for women. Life expectancy, the other side of the coin of increased SMR, in this study was reduced with 28.5 years. Studies in life expectancy, the other side of the coin of increased SMR, show a substantial, if not alarming reduced life expectancy. Israel with 12.5 years and Denmark–15 years for women and 20 years for men – reported the lowest reduction in life expectancy, while Arizona reported the highest reduction of 32 years. Progress in such diverse fields as genetics, neuro-imaging, early diagnosis of (ultra) high-risk populations, CBT and rehabilitation treatment, has not improved schizophrenia SMR or life expectancy. On the contrary, in far a trend is visible, the situation tends to worsen, not to improve. After going through the barriers for optimal somatic care, both patient and health care related, we will discuss options for improvement of the level of somatic health care, at the preventive and therapeutic level.