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Drugs push the US down in global health rankings

The United States has tumbled in the global health rankings as drugs shave years off the life expectancy.

Poor diet and inefficient healthcare also cost the US points in the Bloomberg Healthiest Country Index, which ranks 169 countries and publishes an esteemed ‘top 50’.

This year, the US fell to 35th place (from 34th in 2018), far behind peer nations like Spain (1), Italy (2), the UK (19), Canada (16), Israel (10), and Australia (7).

The US pales in comparison with other rich nations. Spain took the top spot, pushing Italy down to second place in Bloomberg’s healthiest countries ranking, with Iceland and Japan close behind. Australia is the only English-speaking country to make it into the top 10, placing seventh despite a two-place drop from fifth in 2017

The Bloomberg Healthiest Country Index took into account life expectancies, smoking rates, obesity and access to clean water. 

For the second year in a row, the US also failed to usurp Cuba, a developing country that has been rewarded for focusing on preventing disease (with disease screening, diet tweaks and exercise) rather than treating people after diagnosis. 

The US has soaring rates of heart disease driven by the ‘Western diet’ rich in saturated fats, sugar and processed meat. 

But the biggest blow has been from prescription painkillers, which created a nation of addicts and a market for the synthetic drug fentanyl, up to 100 times stronger than heroin, which has been laced into everything from street drugs to Percocet. 

In the last eight years, more than 200,000 Americans have died of drug overdoses, driving down the life expectancy from 78.8 years to 78.6. 

Spain, which is forecast to have the longest life expectancy in the world by 2040 at 86 years old, was crowned the healthiest country in the league table this year.

Currently, it falls behind Japan and Switzerland in terms of life expectancy.

But a number of factors are driving Spain up the ranks. 

It has a strong public health workforce, which delivers efficient care to women, children and the elderly – groups which often fall through the cracks of other health systems, according to the University of Washington’s Institute for Health Metrics and Evaluation. 

Spain has also aggressively driven down rates of heart disease in the last decade. And, crucially, it has a young population, unlike Japan.

Although Spaniards are avid meat-eaters, they conform to a Mediterranean diet, with fewer saturated fats and far less sugar than Americans. 

Italy slipped to the second spot. The rest of the top 10 was completed by Iceland, Japan, Switzerland, Sweden, Australia, Singapore, Norway and Israel.

The countries in the top 50 which made the biggest improvements on the previous index, in 2017, were South Korea – which rose from 24th to 17th – Estonia, which rose six places from 38th to 32nd, and Albania, which rose from 50th to 43rd.


  1. Spain
  2. Italy
  3. Iceland
  4. Japan
  5. Switzerland
  6. Sweden
  7. Australia
  8. Singapore
  9. Norway
  10. Israel 

Source: Bloomberg Healthiest Countries Index 2019 

Meanwhile, Macedonia was the biggest faller – dropping 12 places from 44th to 56th.

A separate ranking of healthy countries done last year, by educational charity the Legatum Institute, claimed Spain was the 22nd healthiest country. 

Scientists regularly publish studies praising the health benefits of the Mediterranean diet, which contains a lot of vegetables, nuts, fish and oils.

It is known to improve heart health and also believed to be good for the brain and liver, and may improve sexual function in men.    

Although the Legatum’s Institute ranking is at odds with Bloomberg’s assessment, there is crossover in the top 10 on both lists. 

Singapore, Japan, Switzerland, Sweden and Norway all feature in the 10 healthiest countries on both Bloomberg’s and Legatum’s lists. 

No African nations made it into the top 50 of today’s index, and only a handful of those in the Middle East did – Bahrain, Qatar, Lebanon, Brunei, the United Arab Emirates and Oman. 

Countries in sub-Saharan Africa – where access to clean water and sanitation are lingering issues and deadly diseases are rife – made up 27 of 30 unhealthiest countries.    

Haiti, Afghanistan and Yemen were all also among the worst performing. 

THE TOP 50 HEALTHIEST COUNTRIES IN THE WORLD (Source: Bloomberg Healthiest Country Index 2019) 
Rank Country Rank Country
1 Spain 26 Greece
2 Italy 27 Malta
3 Iceland 28 Belgium
4 Japan 29 Czech Republic
5 Switzerland 30 Cuba
6 Sweden 31 Croatia
7 Australia 32 Estonia
8 Singapore 33 Chile
9 Norway 34 Costa Rica
10 Israel 35 US
11 Luxembourg 36 Bahrain
12 France 37 Qatar
13 Austria 38 Maldives
14 Finland 39 Lebanon
15 Netherlands 40 Poland
16 Canada 41 Montenegro
17 South Korea 42 Bosnia & Herzegovenia
18 New Zealand 43 Albania
19 UK 44 Brunei
20 Ireland 45 Slovakia
21 Cyprus 46 United Arab Emirates
22 Portugal 47 Uruguay
23 Germany 48 Hungary
24 Slovenia 49 Oman
25 Denmark 50 Panama


Consuming more fruit and fish, and fewer sugary drinks and snacks, are the most important aspects of a Mediterranean diet.

Emphasis on: 

  • Fruits
  • Vegetables
  • Legumes
  • Nuts
  • Seeds
  • Whole grains
  • Fish and meat 
  • Monounsaturated fats, such as olive oil

Less of:

  • Saturated fats, like butter
  • Red meat 
  • Processed foods, like juice and white bread
  • Soda
  • Sugar 

In moderation:

  • A glass of red wine here and there is fine

How you can follow it:

  • Eat more fish
  • Squeeze more fruit & veg into every meal
  • Swap your sunflower oil or butter for extra virgin olive oil
  • Snack on nuts
  • Eat fruit for dessert 


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