Countries With the Healthiest Cultures and Health Policies

The countries with the best overall approach to public health, in terms of both public policy and individual lifestyle choices, are Monaco, Liechtenstein and Japan₁. These countries are worth emulating. And, although often through no fault of the average citizen, the worst countries are Angola, Somalia and S. Sudan₁.

42 datasets are used to calculate points for each country, including multiple decades of data on its average life expectancy, its alcohol consumption rate, its fertility rate, its smoking rate, its suicide rate, its food aid and health contributions and WHO compliance, the prevalence of overweight adults, obesity rate, its adolescent birth rate, delivery rate of infant DTP immunizations, delivery rate of 7x Infant Immunizations 2011-2015 and childhood mortality. The regions with the best average results per country are Scandinavia, Europe and The Mediterranean₁, whereas the worst are Micronesia, Africa and Melanesia₁.

1. The Criteria: Health
2. Overall Results by Country
3. Overall Results by Region
4. The Social and Moral Development Index
5. Links

1. The Criteria: Health

1.1. Life Expectancy

#1990s #2000s #2010s #demographics #health #hong_kong #immigration #japan #life_expectancy #longevity #population

Increasing longevity, and subsequent aging, is a long-term trend around the world₃. Global life expectancy is now over 70; since 2000 it has risen by 6.3 and in 2019 achieved 73.1 years₄, as part of a global trend towards better health_5,6, and due to huge portions of the world being gradually lifted out of poverty. It also reflects overall improvements to cultural health, including diet, health services systems, attitudes to exercise and well-being, and also family structure and caring. For decades, Japan was well-known for having the highest average life expectancy₇, until the top spot was taken by Hong Kong. The regions with the best life expectancy are Europe (78.4), The Middle East (75.2) and Asia (73.2)₂ and the worst, by some way, is Africa (62.8)₂.

One effect of rising longevity is the 'demographics crisis'; where an increasing portion of the population is old and retired, putting pressure on services and taxes₈. The solution is for aging countries to import younger workers from elsewhere; over time, as birth rates stabilize, geriatric care improves the length of the working life, and population growth calms, this situation will stabilize.

For more, see:

• "Life Expectancy and Longevity" by Vexen Crabtree (2020).

The United Nations Human Development Report contains data on the Life Expectancy at Birth. Life expectancy stats are sometimes skewed by taking into account immigration, so that much of the time stats are compiled of natural-born inhabitants only.

Life Expectancy By Global Region:

Note that these are values for the average country, not averages by total regional population.

1.2. Alcohol Consumption

#alcohol #health #sociology

There is nothing wrong with drinking modest and sensible amounts of alcohol but fitness, physical health, mental health and long-term health all suffer as a result of medium- or heavy- drinking₁₀ and the health risks to the baby when pregnant mothers drink₁₁ are well-known. Aside from the effects on the individual, alcohol misuse impacts on entire economies₁₂ via increased health service costs, policing costs and lost days' work. Worldwide, alcohol misuse is "among the top five risk factors for disease, disability and death" and is a "cause of more than 200 disease and injury conditions in individuals, most notably alcohol dependence, liver cirrhosis, cancers and injuries"₁₃. "In 2012... 5.9% of all global deaths, were attributable to alcohol consumption"₁₄. Deaths from chronic alcohol misuse have been rising for decades, and so has violence, abuse, vandalism and crime all associated with alcohol over-use. The aggression and crime associated with alcohol in some Western countries infringes on the human rights of those who want nothing to do with such behaviour. Many of the social effects of alcohol are psychological and cultural; i.e., people don't have to behave criminally or destructively whilst drunk - it is a culturally learned behaviour. Experiments have shown that behaviour can be controlled: Those who do not wish to behave badly whilst drunk, will not do so.

For more, see:

• "Alcohol: The Social & Medical Effects and How to Combat Misuse" by Vexen Crabtree (2015).

Alcohol Consumption By Global Region:

Note that these are values for the average country, not averages by total regional population.

1.3. Fertility Rate

#birth_control #demographics #fertility #health #overpopulation #population #yemen

The fertility rate is, in simple terms, the average amount of children that each woman has. The higher the figure, the quicker the population will grow, although, to calculate the rate you also need to take into account morbidity - the rate at which people die. If people live healthy and long lives and morbidity is low, then, 2.0 approximates to the replacement rate (two new children for each set of parents who die), which would keep the population stable. If all countries had such a fertility rate, population growth would end. The actual replacement rate in most developed countries is around 2.1, once you take mortality into account₁₆. The highest fertility rate ever detected in a single year was in Yemen in 1985, at 8.86.₁₇

For more, see:

• "The Population of the Earth" by Vexen Crabtree (2019).

In order to calculate the points for each country, I had to pick an optimum fertility rate, and then detract points as countries strayed from it. I have opted for the round figure of 2.0, slightly lower than the replacement rate, because the population right now is too high, therefore, the best fertility rate is probably one that will see a gradual decline in population numbers, at least for a few hundred years. The decline cannot be fast however, as this tends to create severe economic problems. So, any country that is either below 2.0 or above 2.0 loses points.

Fertility Rate By Global Region:

Note that these are values for the average country, not averages by total regional population.

1.4. Smoking in the 2020s

#cancer #democracy #health #smoking

Cigarettes are the most lethal consumer product on the planet, responsible for over 7 million deaths annually₂₁ and therefore the biggest preventable cause of disease in the world₂₂. A billion people smoke₂₃. The tobacco industry has resisted with misinformation and well-funded public-relations campaigns, opposing and undermining health measures wherever it can; if defeated, firms continue the same abuses in other countries₂₄. The industry has such rich and influential lobbies that most governments find it difficult to make progress in curbing smoking rates.

If you smoke, you are more likely to drink. If you smoke or drink, you are also more likely to do drugs. Only 15% of men in the highest professional classes smoke, but 42% of unskilled workers do₂₅. Smoking is higher amongst those who are already in trouble: single mothers smoke at 55%, most homeless do and practically all drug addicts do₂₅. Smoking during late pregnancy reduces the IQ of babies by an average of 6.2 points₂₆ and causes increased antisocial behaviour. Aside from the financial cost to taxpayers and the health costs to individuals, indirect negative economic effects result from increased rates of disease and sick days lost from work₂₁.

For more, see:

• " The Side Effects of Smoking. Which Countries Smoke Most?" by Vexen Crabtree (2025).

Smoking in the 2020s By Global Region:

Note that these are values for the average country, not averages by total regional population.

1.5. Suicide Rate in the 2010s

#2000s #2010s #belgium #finland #health #japan #mental_health #suicide

Suicide as a human behaviour is recorded in the texts of the most ancient civilisations. Almost universally, successful male suicide rates are much higher than female rates. However, female suicide attempts are more frequent than male attempts.

Countries with high suicide rates are a mixture between those riddled with organized criminal gangs, under-developed countries, and, highly developed countries. There are cultural and situational effects at work that persist in the long-term: nothing seems to lower the high suicide rates in Japan, Belgium and Finland. And some of the countries with the lowest rates are not well developed. It seems there is no correlation between suicide rates and things like development, prosperity and national engagement in human rights. Note that some countries such as Switzerland that allow assisted dying, the actual cause of the death is recorded as 'cancer' and not 'suicide', making their statistics more useful (and not distorted) when trying to gauge national problems such as SAMDI is doing.

For more, see:

• "Accepting Assisted Suicide: A Focus on UK Law" by Vexen Crabtree (2012).

Data is from the World Health Organisation, "for countries with high-quality vital registration systems [... tge WHO uses] data submitted by member states [with] adjustments made where necessary (e.g., for under-reporting of deaths, unknown age and sex, and ill-defined causes of death). For countries without high-quality death registration data [estimates] are calculated using other sources, including household surveys with verbal autopsy, sample or sentinel registration systems, and special studies. These estimates represent WHO's best calculations, using standard categories, definitions, and methods to ensure cross-country comparability"₂₈.

A minimum rate of 1 in 100,000 was decided for this data in SAMDI, to allow for philosophical suicides that are a matter of free will, and not from mental illness or social malaise. Hence, any country reporting less than 1 was rounded up to 1, to protect the scoring system from under-reporting despite the steps taken by the WHO. In total, this only effected 3.3% of the 4040 data points across the two decades used in the SAMDI data.

Suicide Rate in the 2010s By Global Region:

Note that these are values for the average country, not averages by total regional population.

1.6. Food Aid, Health Contributions & WHO Compliance

The Good Country Index's criteria on Contributions to Health and Wellbeing include the following:

1. Food aid: Food aid funding (according to WFP) relative to the size of the economy.

2. Pharmaceutical exports: Exports of pharmaceuticals (according to ITC) relative to the size of the economy.

3. Voluntary excess donations to the WHO: Voluntary excess contributions to World Health Organisation relative to the size of the economy.

4. Humanitarian aid donations: Humanitarian aid contributions (according to UNOCHA) relative to the size of the economy.

5. International Health Regulations Compliance: International Health Regulations Compliance (according to WHO).

Food Aid, Health Contributions & WHO Compliance By Global Region:

Note that these are values for the average country, not averages by total regional population.

1.7. Overweight Adults

#health #obesity

This data is specifically from the 1970s, before the obesity epidemic superceded its importance. It was a precursor, showing which countries were losing the ability to make informed, disciplined lifestyle choices, letting corporate advertising and bad practice influence decisions and removing the ease of choosing to eat healthily.

Overweight Adults By Global Region:

Note that these are values for the average country, not averages by total regional population.

1.8. Adult Obesity

#genetics #health #obesity #physical_fitness #public_health

About one third of the global population is overweight or obese₃₂. It's more serious than simply being overweight and causes a range of systemic health conditions including the development of Type 2 diabetes_33,34, muscle and bone degradation including osteoarthritis₃₃, cardiovascular disease (i.e. heart disease)₃₃, substantial disability₃₃, cancers (endometrial, breast and colon)₃₃, the acceleration of the ageing process₃₅ and decreased life expectancy_33,35. Health systems have to routinely cope with resultant complications, and cultural changes are having to be made₃₆, impacting on transport, resources and workplaces, with measurable effects on national economies, diverting time and resources away from other issues. In 2000, it was the world's most costly epidemic₃₆, and has continued to get worse across all regions of the world every decade since₃₇; from 2000 to 2019 diabetes has caused a 0.14-year slowdown in the increase in healthy life expectancy₃₈.

The causes are lifestyle and culture_39,33, not genetics_40,41. Causes are processed foods, low levels of physical exercise, over-indulgence, poor choices in food products and poor knowledge of nutrition. Health experts have warned that there is no medical solution: prevention is the only possible route to reduce the cost of obesity₄₂ but the situation is made much worse by well-funded advertising campaigns by food manufacturers selling cheap mass-produced food. Even many so-called "health foods" contain well over recommended limits of fat, salt and sugar₄₃ and a range of popular fad diets capitalize on miseducated consumers to buy into costly and nonsensical schemes that falsely promise quick results₄₄.

For more, see:

• "The Modern Obesity Epidemic" by Vexen Crabtree (2025).

Adult Obesity By Global Region:

Note that these are values for the average country, not averages by total regional population.

1.9. Adolescent Birth Rate

#health #parenting #population

In a world with over 7.5 billion people on it (doubling already within the author's life), quality is more important than quantity. Teenage pregnancies cause "significant health, social and economic impacts"₄₆. The statistics given here from the "Human Development Report" by United Nations (2017)₄₇ show the birth rate in women aged 15-19 - it was estimated that between 2015 and 2020, 62 million babies were born to mothers aged 15-19 years₃. Unfortunately, although children of a younger age also go through pregnancy, statistics are not widely available.

Adolescent Birth Rate By Global Region:

Note that these are values for the average country, not averages by total regional population.

1.10. Infant DTP Immunizations

#children's_health #health #vaccines

Vaccination offers reliable protection against many serious infectious diseases, preventing suffering, long-term complications and permanent disabilities₅₀, and save 3.5 million to 5 million deaths per year from diseases such as diphtheria, tetanus, pertussis, measles and influenza₅₀. Where uptake is high, targeted diseases can be dramatically reduced and sometimes nationally eliminated. The World Health Organisation emphasizes that an effective national implementation of easy access to vaccines is vital for public health₅₁. Yet access is often unequal; people in urban or wealthier households do well, while less-educated and disadvantaged groups have the lowest uptake rates₅₂. Successful disease prevention through vaccination is not exclusive to rich or highly-developed countries, and can be achieved anywhere.

The Western world suffers from enduring misinformation about vaccines₅₃. In recent decades, this is associated with the thoroughly discredited research of Dr Andrew Wakefield, who stimulated the UK tabloid press to run long misinformed and sensationalist campaigns linking vaccines to autism. He lost his medical license and moved to the USA, where he led a surge in vaccine misinformation. Reduced uptake is allowing measles and mumps epidemics to return across several Western countries.₅₄. After 3681 cases of measles in 2024, the UK lost its WHO measles-elimination status. The USA in late 2025 recorded 2242 measles cases, with three deaths - for the first time in over ten years, and is also on the verge of losing its elimination status, especially after major outbreaks in 2025-2026, centered on Texas. In the Netherlands in 1999, 2300 cases occurred in a community "philosophically opposed to vaccination", resulting in deaths₅₅. Ireland saw a surge to 1500 cases in the year 2000 including three deaths₅₆, and Italy suffered three deaths too₅₅. For developed countries to see these preventable diseases return on this scale is embarrassing, reflecting a loss of cultural wisdom.

For more detail on immunizations and the statistics used for this data, see the full page: " Immunizations: International Statistics on Vaccines and the Autism Scare" by Vexen Crabtree (2026).

Infant DTP Immunizations (2020s) By Global Region:

Note that these are values for the average country, not averages by total regional population.

1.11. 7x Infant Immunizations (2011-2015)

#health #vaccines

7x Infant Immunizations (2011-2015) By Global Region:

Note that these are values for the average country, not averages by total regional population.

1.12. Infant Mortality

#health

Mortality rate, under-5 (per 1,000 live births) from 1960s to 2023. If a country only had one or two data points in a decade, it's average was not calculated for that decade.

Infant Mortality (2020s) By Global Region:

Note that these are values for the average country, not averages by total regional population.

2. Overall Results by Country

#health #human_development

The overall scores are simply an average of each countries' position in all of the data sets that make up this category. Countries only receive a ranking if they have at least 11 different data points across the data sets. The overall results for each country are listed alongside their position in the Social and Moral Development Index.