I'll be in Zurich next month for The Economist's Healthy Europe conference, where we'll get to grips with a tough question: how, in a context of financial crisis, to reform Europe's healthcare systems to cope with an ageing population and the rising burden of chronic (physical and mental) disease.
In advance of the meeting, I wanted to know which is Europe's healthiest country. I googled, and learnt who lives the longest, who smokes least, where obesity is lowest, who cycles most… but nothing that put it all together and made a judgement call on which country was healthiest.
I'm delighted, therefore, to reveal the findings of a ground-breaking new survey, specially commissioned (by me, from me) to determine which European country is the healthiest. Take a guess now, and read on to see if you were right.
The first thing was to decide which metrics mattered. I'll start with what I didn't include. I ignored life expectancy. Just because people live longer, it doesn't imply that society as a whole is healthier; perhaps we simply do a better job of keeping frail people alive. I also disregarded number of doctors per 1,000 population. I looked at the WHO figures and saw that the UK has 2.7 doctors/1,000, Finland has 2.9, Switzerland has 4.0, Greece has 6.2…). Fewer doctors could be a result of fewer resources, but it could also point to less need. The figures in isolation don't reveal anything.
Similarly, I ignored % of GDP spent on healthcare (World Bank figures here). Finland, often lauded as having a fine system, spends 8.9% of GDP on healthcare. The US spends 17.9%. Efficiency and effectiveness of spending is clearly what matters.
Here, then, are the metrics I decided on. Combined, they give us a good picture.
1. Obesity rates. The biggest public health challenge of our times and the focus of The Economist's recent special report. Norway and Italy have the lowest rates in Europe.
2. Smoking rates. OECD figures here, the Swedes smoke the least. Lung cancer accounts for the greatest number of cancer deaths among men in every country, except one – unsurprisingly, it's Sweden.
Those were obvious metrics to include, but there were others that seemed equally compelling.
3. Household net-adjusted disposable income. Poor people are less healthy than the rich, who eat healthier diets and spend more time doing leisure activities. On the wealth/health axis, Luxembourg was top, Greece bottom.
4. Unemployment rates. There is good Gallup analysis of how health habits differ between the employed and the unemployed. The unemployed are 68% more likely to smoke than those with full time jobs. There is a stark north-south European split here.
5. Walking and cycling rates. Data from Rutgers University shows that the Swiss are great walkers, the Dutch committed cyclists. They've included the US figures for comparison, presumably for comedic purposes.
6. Work-life balance, from the OECD Better Life Index. As they say in their report, "the amount and quality of leisure time is important for people’s overall well-being, and can bring additional physical and mental health benefits". The Danes take first prize, the UK does appallingly.
7. Happiness. There's plenty of evidence that happiness and health overlap. The new economics foundation measure "experienced well-being", or how happy people are with the way their lives are going. The Danes are happiest, Bulgarians most miserable.
8. Sleep (hours per night) is increasingly recognized as one of the pillars of good health. OECD data shows the French sleep the most.
9. Sunshine duration (hours per year). Vitamin D plays a huge part in boosting the immune system but equally, we're more likely to get outside and exercise on a sunny day. The Greeks and the Iberians do well.
For the last piece in the puzzle, I got creative:
10. FIFA ranking. Hear me out. Watching successful athletes inspires many (kids and adults) to take up sport. Football being the people's sport in Europe, I contend that how well a country's football team is doing has profound implications for health and well-being. Or I could put it another way; Scotland's rapid decline in the global hierarchy sickens me.
So there you have them, the ten key metrics of the Dougal Index. Having studied the data, here are the results. The two healthiest countries in Europe are:
1. The Netherlands
2. Denmark
Sweden and Norway were tied for third place, while Germany, Belgium, Spain, Switzerland and Luxembourg all scored well. The UK trailed a long way behind, earning below-average marks on almost all metrics.
What do these results imply for the question I posed at the outset, namely how Europe should respond to the threat of an ageing, dependent population? One response might be, "it's the economy, stupid", emphasizing the health/wealth axis. As a nation gets wealthier, it gets healthier, but the opposite applies too. Any government looking to boost GDP, competitiveness and employment rates should be cracking down hard on smoking, trying to get people eating healthily and investing in bike lanes and cycle schemes. Ministers of Finance should be lobbying hard for these measures; left in isolation, health ministries won't be able to reduce the health inequalities that drag the poor performing countries down.
Our Zurich meeting (June 20th) should be a productive one; please contact me if you'd like to attend. Similarly, I'd welcome any thoughts you have on the relative healthiness of European countries, on metrics I should have included (alcohol consumption per capita?) or on practical measures society can take to improve public health and well-being. Please contribute your ideas via the comments box below.
All the best,
Dougal
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of The Economist Intelligence Unit Limited (EIU) or any other member of The Economist Group. The Economist Group (including the EIU) cannot accept any responsibility or liability for reliance by any person on this article or any of the information, opinions or conclusions set out in the article.
