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Smaller Countries Are Becoming the Healthiest

There’s more to life than money, and economists know it. As new assessments of global living standards proliferate, attempting to gauge how healthy, happy and successful humans are depending on where they live, a pattern is slowly emerging.

There’s more to life than money, and economists know it. As new assessments of global living standards proliferate, attempting to gauge how healthy, happy and successful humans are depending on where they live, a pattern is slowly emerging.

While slight variations in data can throw up different winners, smaller countries are increasingly dominating the top of the lists while big countries with booming economies fall behind.

A new analysis, the Global Wellness Index published by investment firm LetterOne, ranks Canada as the best country out of the 151 nations evaluated. The U.S. trails far behind, coming in at 37. In a tighter ranking of G-20 nations combined with the 20 most populous countries on the planet, South Africa comes in dead last, below Ukraine, Egypt and Iraq.

Based on a basket of metrics ranging from government healthcare spending to rates of depression, alcohol use, smoking, happiness and exercise, the new index is the latest attempt by economists to evaluate the world beyond economic growth. Last month, Bloomberg’s own research named Spain the world’s healthiest country.

A common thread in both surveys, and others like them, is that the top ranks are increasingly filled with smaller countries. This may be tied to researchers developing new metrics for the modern world, measures that don’t necessarily correlate economic health with actual health—let alone wellness—at the expense of other, more nuanced barometers. 

“The old concerns about growth—that it does not include every country, or every person in growing countries—are ever present,” said Richard Davies, a former Bank of England and U.K. Treasury economist who compiled the Global Wellness Index.

Davies’ dashboard ranks Canada highly due to its good scores for blood pressure, life expectancy and government healthcare spending, but it also pays close attention to the country’s high happiness levels. South Africa, once a beacon of economic growth, scores poorly for life expectancy, alcohol use, depression and diabetes.

How Canada Tops the Wellness Charts
Canadians live long and prosper while South Africans struggle

Source: Global Wellness Index

In the overall list, several major economies struggle when ranked against smaller, healthier countries. The global top 10 includes large nations such as the Philippines and South Korea, but also finds room for Oman, Iceland, Maldives, Netherlands and Singapore.

The U.K. was ranked 15th, held back by high rates of obesity and inactivity. Big countries such as Japan, Germany, France or Italy failed to make the news survey’s global top 25, with all four faring poorly for rates of high blood pressure. Middle Eastern countries ranked relatively high due to good scores in the alcohol category.

Where to Find Health, Wealth and Happiness
Key G-20 nations fail to make top 25 of ‘wellness’ rankings

Source: Global Wellness Index

The U.S. was hampered by excessive obesity, depression, inactivity and other items, Davies said.

The Global Wellness Index focuses on ten key metrics: blood pressure, blood glucose, obesity, depression, happiness, alcohol use, tobacco use, exercise, healthy life expectancy and government spending on healthcare. Data was gleaned from standard sources including the World Health Organization’s Global Health Observatory and the United Nations, as well as the World Happiness Report and public health data. Countries are ranked from the weakest to the strongest across every metric. Any with more than one missing data point were excluded, leaving 151 in the final composite rankings.

Additionally, G-20 nations were ranked alongside the “P-20” nations with the highest populations, to produce a list that excludes small nations but covers more than 95 percent of the global population.

“While rich countries tend to lead, many emerging economies score more highly than some advanced nations. This is down to huge increases in life expectancy in these countries in recent years,” Davies said, pointing also to high rates of depression and obesity in advanced countries.

“The low scores for countries like South Africa—an economy lauded for its growth rate in the 2000s—shows that simply ranking an economy based on traditional economic metrics like GDP alone can miss important parts of the story when it comes to the well-being of a nation.”

Economies of the future may end up being judged on three levels, Davies said. Those could include traditional measures of the whole economy, such as GDP and employment rates; indicators that point to how equitable and fair a country is; and a new layer including measures of health, happiness and well-being.

“The challenge is that this top layer may be both the one the public care most about and the hardest to measure.”

— With assistance by Fergal O’Brien, and Samuel Dodge


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