There are lots of reasons to envy residents of Northern Europe. Each day they get to take in raw, dramatic landscapes, stunning architecture and world-class shopping. But, more important, they know a thing or two about health and wellness.
Forbes.com has found that the region is home to some of the world’s healthiest countries, including top-ranking Iceland, Sweden and Finland.
Others that fared well include Germany, Switzerland, Australia, Denmark, Canada, Austria and the Netherlands.
“Historically, these countries had an ethic of having more of a nationalized health care system,” says Kate Schecter, a program officer for the American International Health Alliance, a nonprofit that works to advance global health by helping nations with limited resources build sustainable infrastructure. “There’s this mentality that health care should be a given right for citizens.”
Despite the fact that an estimated 47 million Americans lack health insurance, the U.S . ranked 11. Rounding out the list, were Israel, the Czech Republic, Spain and France.
Behind The Numbers
To determine our list of the healthiest places to live in the world, Forbes.com looked at the latest available health and environmental statistics for every nation, from sources such as the World Health Organization, the World Bank and the UN.
But due to incomplete data, we ranked only the 138 nations with statistics in every measure. That’s why you don’t see countries such as Monaco, Norway, Malta, Belgium, Luxembourg, New Zealand, Ireland and Andorra–all of which had a shot of cracking the top 15 were they not missing information.
The statistics we examined included estimated air pollution in world cities; the percentage of a country’s population with access to improved drinking water and sanitation; infant mortality rates; the rate of prevalence of tuberculosis; the density of physicians–generalists and specialists–per 1,000 people; undernourishment rates; and healthy life expectancies for men.
Beyond high marks for drinking water, sanitation and nourishment, which many countries achieved, Iceland and Sweden had some of the lowest levels of air pollution, infant mortality and rates of tuberculosis prevalence. They also both had the highest healthy life expectancies for men: 72 years.
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Healthy life expectancy statistics, in particular, say a lot about the welfare of a country’s inhabitants, says Yohannes Kinfu, a statistician for the World Health Organization. Those nations with the highest numbers tend also to have high gross domestic products, as well as accessible health care systems and lower rates of infectious diseases, such as HIV/AIDS.
Research has shown that long-term exposure to air pollution can affect lung function and lead to premature death. Other nations with estimated low particulate matter concentrations, according to the World Bank, include France and Australia.
Countries’ success in combating pollution is likely due to a mix of policies addressing the problem, enforcement of standards and the use of clean fuel, says Kiran Pandey, a senior environmental economist for the Global Environment Facility, an organization affiliated with the World Bank, and an author of the research. But some places, such as those located along coastlines, are simply luckier than others, since crosswinds can dilute air pollution, Pandey says.
Low infant mortality rates are indications of socioeconomic factors, such as household incomes, which can influence the kind of nutrition and health care a child receives and whether a family is knowledgeable about protection against infection, Kinfu says. The Czech Republic also had one of the world’s lowest infant mortality rates.
And while a high number of doctors located in an area might not necessarily mean its residents are healthy, due to questions of access, it’s generally a positive sign. Israel has a relatively high doctor density rate, according to the World Health Organization’s World Health Statistics 2007.
While the average resident of any of these countries might take for granted or pay little attention to something like access to health care, these factors make a healthy nation, says Jen Kates, vice president and director of HIV/AIDS Policy for the Kaiser Family Foundation, a nonprofit, private foundation focused on major U.S. health care concerns, as well as global health.
“Everyone,” Kates says, “needs to be aware that how we provide health care to people in a country is a critical issue.”
1. Iceland
Icelanders enjoy one of the world’s highest healthy life expectancies (72 for men and 74 for women), giving them plenty of time with the country’s mountains, glaciers, volcanoes, waterfalls and coastal lands. The country is also one of the world’s least polluted. Ensuring Iceland’s top position is the country’s TB prevalence (2.2 per 100,000 people) and infant mortality rate (two deaths per 1,000 live births), both the world’s lowest. The country also has one of the highest physician densities, 3.62 per 1,000 people.
2. Sweden
Sweden’s strong environmental policies helped it land the No. 2 spot on our list. Sweden’s air is clean enough to place the country in the top three. Its infant mortality rate, three deaths per 1,000 live births, and TB prevalence, 4.6 per 100,000 people, are the lowest in the world. Keeping the country from first place is its physician density (3.28 physicians per 1,000 people), relatively high worldwide but lower than the top-spot country, Iceland.
3. Finland
Thirty years ago, this low-polluting country had the highest death rate from heart disease for men (around five deaths per 1,000). This drove local governments to encourage healthy living. Fruit and vegetable intake more than doubled since then and the number of smokers has dwindled. The death rate from heart disease is now down to one, on average, for the region. The country also has one of the world’s lowest infant mortality rates, or three deaths per 1,000 live births, and a low TB prevalence, or 4.8 per 100,000 people.
4. Germany
In Germany there is no waiting for appointments, no need for referrals to see a specialist and, until recently, you didn’t even pay for your taxi ride to the hospital. All this plus state of the art facilities come at a high price. The German health care system, one of the best in the world, is also one of the most expensive. The country’s total expenditure on health is 10.6 % of its GDP and pays for one of the highest physician densities on our list, 3.37 physicians per 1,000 people. Germany’s clean air solidified its position in the top.
5. Switzerland
Switzerland spends over 11 % of its GDP on universal health coverage, the second-highest health spending per capita of all the countries considered. It has one of the world’s highest healthy life expectancies, or 71 for men and 75 for women. Its physician density, 3.61 per 1,000 members of the population, is also one of the highest on the list. Preventing the country from ranking higher is its air pollution estimate, the highest of the countries in the top five.
6. Australia
Australia’s health care system is one of the best in the world. Got a less than squeaky-clean medical history, numerous past claims or just plain old age? No worries, mate! Down under, insurance companies are required to charge policyholders the same premiums regardless of one’s status or past. Australia also received high marks for its air, among the world’s cleanest. Keeping Australia from making into the top five is its TB prevalence: 5.9 per 100,000 people.
7. Denmark
Danes pay between 42% and 59% of their incomes in taxes; about 8% of taxes goes to pay for the country’s universal health care coverage. Sadly, the Danish health care system isn’t super efficient. Long waits to see a doctor are common. The country’s physician density, 2.93 per 1,000 people, is one of the lowest on the list. Preventing the country from ranking higher but solidly placing it in the top 10 is the country’s healthy life expectancy, or 69 for males and 71 for females.
8. Canada
The Great White North has the list’s lowest number of doctors per capita, or 2.1 for every 1,000. Still, Canadians enjoy one of the world’s longest life expectancies and one of the lowest TB rates, or 3.6 per 100,000 people. A relatively high infant mortality rate, 5 deaths per 1,000 live births, also lands Canada in spot eight.
9. Austria
Austria’s ranking was negatively affected by the fumes and smog polluting its air. The country’s TB prevalence, 8.8 per 100,000 people, also kept the country from scoring higher. Austria did have a good infant mortality rate (4 deaths per 1,000 live births) and physician density (3.38 per 1,000 people) solidifying its position in the top 10.
10. Netherlands
Though the Netherlands is thought by many to offer one of the world’s highest standards of living, the country failed to crack the list’s top five. Its ranking was adversely affected by high pollution rates. The highly urbanized, densely populated nation suffers from water, air and soil contamination. Working in its favor, the country has a low TB rate, or 5.4 for every 100,000 people. The country’s healthy life expectancy, 70 for men and 73 for women, is average for the countries on the list.
11. United States
The U.S. spends over 15% of its gross domestic product on health care–with little to show for it. In 2006, almost 16% of the population lacked health insurance. Still, of the 15 countries on the list the U.S came out on top when measuring infant mortality rate. The country also has the second-highest healthy life expectancy. What’s more, air pollution is relatively low, and the U.S. boasts one of the world’s lowest TB rates.
12. Israel
Plagued by respiratory problems or concerned about clean air? Steer clear of Israel. It’s got one of the highest levels of air pollution of the countries on our list. You won’t be lacking vitamin D in this sunny country, however; it’s one of the world’s leaders in solar energy use. Also working for it: the list’s highest physician density rate, or 3.37 for every 1,000 people. Israel’s healthy life expectancy stood at 70 for males and 72 for females, average for the countries on our list.
13. Czech Republic
The Czech Republic has one of the list’s lowest healthy life expectancies–66 for men and 71 for women. The country’s less than stellar sanitation coverage and its TB prevalence rate, 10.8 per 100,000 people, prevented a higher ranking. Working in its favor? One of the world’s lowest infant mortality rates. In 1990, the number of deaths per 1,000 live births stood at 13. It’s now 3.
14. Spain
The country’s tuberculosis rate is the highest of all 15 countries, at 21.7 for every 100,000 people. Spain also has one of the highest air pollution estimates on the list. Its physician density, healthy life expectancy and infant mortality rate are average when compared with other countries on the list.
15. France
A stellar health care system and clean air landed France on the list. Working against it: the worst wastewater treatment standards of the top 15. Its tuberculosis rate–11 cases per 100,000 people, one of the highest on the list–also held it back. But there’s good news for the country’s chronically ill; France’s high physician density measurement: 3.37 per 1,000 people.