Which countries have the healthiest populations?

Being healthy is important. Not only for individuals, because it allows people to live longer and enables them to participate in life and enjoy it to the fullest, but also for society: a healthy population is a happier, more capable and more productive population.

There are many indicators that measure people’s health. However, only a few are available for comparisons between countries and over time[1]. Two of these are life expectancy and self-perceived health. The average life expectancy of a population is widely used to provide a general indication of its health (D’Albis, Esso and Arolas 2012; Mackenbach et al. 2011). Self-perceived health is a subjective assessment of an individual’s own health and provides an indication of a person’s experienced quality of life (Idler and Benyamini 1997).

Life expectancy

In 2012, Japan had the highest average life expectancy at birth (Figure 1). Within Europe, the Spanish were expected to live the longest, immediately followed by the Italians and the French. The lowest average life expectancies were found in the Central and Eastern European countries.

Source: Eurostat (Life expectancy, 2014), OECD Statistics (Health status, 2014)

Average life expectancy increased in all countries between 1995 and 2012 (Figure 2). The increase was greatest in Estonia, Latvia and Korea, where the populations gained about an extra six months of life expectancy every year. The lowest increases were found in Sweden, Greece and Northern America, where the figures showed a yearly increase of around two months. The stronger increase in countries with lower life expectancies narrowed the gap with the countries with higher life expectancies.

Source: Eurostat (Life expectancy, 2014), OECD Statistics (Health status, 2014)

Life expectancy at birth used to be much higher for women than for men, but the gap is narrowing.

Life expectancy differs between men and women, and also by socioeconomic status. Life expectancy at birth used to be much higher for women than for men, but the gap is narrowing. This can mainly be attributed to diminishing gender differences in health risk behaviours such as smoking (OECD 2014). Furthermore, highly educated persons are likely to live several years longer and to be in better health (OECD 2013). They not only adopt a healthier lifestyle, but also have more resources in terms of income, as well as facilitating access to appropriate healthcare.

Although living longer is seen as a desirable goal, the quality of additional years increases if they can be spent in good health. In the later stages of life, most people succumb to the effects of old age and have to deal with increased disability. If disability-free life expectancy[2] increases more than life expectancy, it means that people live a greater part of their lives in better health. In the EU-28, women are likely to live more years with disability than men. So, while overall life expectancy is still greater for women, time spent free from disability is almost the same for men and women.

Self-perceived health

The prevalence of good health is highest in Western and Northern Europe, especially in Ireland, Switzerland and Sweden (Figure 3). It is least extensive in Central and Eastern Europe, with particularly low figures for Lithuania, Latvia and Croatia.

Source: Eurostat (Self-perceived health, 2014), OECD Statistics (Perceived health status, 2014), SCP treatment

On average, the prevalence of good self-perceived health was quite stable since 2005 (Figure 4). In most countries, only minor increases or decreases occurred in the estimates of good health over the past years. However, there were substantial increases in most Central and Eastern European countries, especially in the Slovak Republic, Hungary and Latvia, where the prevalence of good self-perceived health increased by almost two percentage points per year.

Source: Eurostat (Self-perceived health, 2014), OECD Statistics (Perceived health status, 2014), SCP treatment

Good health is determined by …

What makes a population healthy? The question is hard to answer because it is not uncommon to find contradictory results in the literature (Or 2000, Starfield 2002). This is due to differences in the applied models and the studied countries and time span. But there is general agreement that health is influenced by a range of factors such as personal characteristics, lifestyle, the physical, social and economic environment, culture and attitudes and the health services.

… culture and attitudes,

An analysis of changes in health[4] over the period 1990-2012 indicates that health expenditures, welfare levels and lifestyle factors account for about a third of the variation in health across countries and over time. Less than half of the variation is explained by unobserved factors such as attitudes, culture and unmeasured differences in health behaviour across countries. The remaining variation is due to other factors. For a more detailed explanation, see Chapter 3 in the full report here.

… higher levels of welfare,

A well-known fact from the literature is that health status is related to a country’s welfare level. Higher levels of welfare provide citizens with more means to improve their health such as purchasing healthy food and better housing and schooling (Mackenbach and McKee, 2013). However, several studies have shown that this relationship is complex. As for socioeconomic indicators, such as education and per-capita income, we expected to find similar associations but our analysis revealed no significant links to changes in health.

… lower levels of alcohol consumption

Smoking, alcohol consumption and obesity are well-known risk factors for the health status of individuals. Research has shown a negative relationship between these lifestyle factors and health (Or 2000). Individuals are unlikely to fully control their lifestyles because they are partly attributable to cultural factors. Our main results, based on analyses controlled for time-stable cultural factors, show that higher alcohol consumption is related to poorer health outcomes.

… and better health services.

Several indicators specify the performance of the health sector: the level of healthcare expenditures, whether financing is public or private and accessibility to the services. However, the empirical evidence on the relationship between expenditure and health is mixed (Hitiris and Posnet 1992; Grubaugh and Santerre 1994; Moreno-Serra and Smith 2011). One reason for this is that it is very hard to find a good indicator for expenditure. In our analyses, we find that a higher share of health expenditure in total government spending is associated with better health. Publicly financed health services are often associated with more equitable care. It can be argued that if a larger share of the population has access to healthcare, the population as a whole is likely to be healthier. On a local level it is found that larger public health systems perform better than smaller ones, since the fixed costs are spread out over more beneficiaries and taxpayers (Mays et al. 2006).

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