Special Report

The Healthiest (and Least Healthy) Countries in the World

Thomas C. Frohlich, Alexander Kent, Mark Lieberman

The Least Healthy Countries

10. Botswana
> Life expectancy: 47.7 (3rd lowest)
> Infant mortality rate (per 1,000 live births): 36.3 (52nd highest)
> Health expenditure per capita: $384 (80th highest)
> Unemployment rate: 18.4% (13th highest)

Botswana spent roughly $384 per person on health care in 2013, a fraction of the global spending figure, but also one of the higher expenditures compared to other unhealthy countries. Despite the relatively high health care spending, Botswana had among the world’s worst health outcomes. Life expectancy in Botswana was just 47.7 years, tied for the second-lowest in the world. This is despite having some of the elements that make for a healthy population. More than 90% of the population had access to clean water, and the country had above average immunization rates for its children. The country also had above average literacy rates and reasonably low smoking rates. In part, the poor health outcomes are due to cultural and economic factors that its health care system seems unable to cope with effectively. The HIV/AIDS epidemic in the country is severe, with roughly 25% of the population living with HIV. The country also suffers from very high levels of infant mortality and high rates of infectious diseases such as tuberculosis.

9. Equatorial Guinea
> Life expectancy: 51.2 (11th lowest)
> Infant mortality rate (per 1,000 live births): 69.3 (13th highest)
> Health expenditure per capita: $1,138 (37th highest)
> Unemployment rate: 8.0% (64th highest)

Equatorial Guinea is one of the more interesting countries among the world’s 10 unhealthiest countries. Its health care expenditure per capita of $1,138 in 2013 was above average, yet it had exceptionally poor health outcomes. The nation had one of the world’s highest infant mortality rates, which at 69.3 deaths per 1,000 live births was 13th highest in the world. It also had very low rates of child immunization. For example, it had the lowest rates of immunization for DPT of any of the 172 countries reviewed. These kinds of results raise the question: how is the money spent on health care being used? Transparency International ranks Equatorial Guinea among the most corrupt countries on the planet.

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8. Mozambique
> Life expectancy: 48.9 (6th lowest)
> Infant mortality rate (per 1,000 live births): 61.5 (18th highest)
> Health expenditure per capita: $37 (17th lowest)
> Unemployment rate: 8.3% (58th highest)

Mozambique ranked poorly across essentially all of the factors that 24/7 Wall St. considered in assessing the state of health in a country. The quality of infrastructure in the country is poor, with only 35% of the rural population having access to clean water. The country also suffers from high levels of malaria, which account for roughly 26% of hospital deaths. The health care infrastructure is poorly equipped to deal with these conditions. Per capita expenditures on health care were roughly $37 dollars in 2013, 17th lowest in the world. The country has too few doctors at 0.04 per 1,000 people. The result of such low health spending and so few doctors is very poor health outcomes. The nation’s life expectancy is sixth lowest in the world at 48.9 years, and the infant mortality rate is 18th worst in the world.

7. Haiti
> Life expectancy: 60.9 (41st lowest)
> Infant mortality rate (per 1,000 live births): 54.7 (29th highest)
> Health expenditure per capita: $53 (32nd lowest)
> Unemployment rate: 7.0% (81st lowest)

Even among the least healthy nations, Haiti ranked lower than most in several factors. When it comes to life’s basics, Haiti ranked among the lowest in access to clean water and electricity. For example, less than 75% of the country’s urban population had access to adequately clean water in 2012, the 6th lowest access level in the world. Against this backdrop, health care spending was just $53 per capita as of 2013. The poorest country in the Western Hemisphere also had some of the lowest child immunization rates in the world. The combination of poor infrastructure and economic conditions as well as poor health care spending resulted in poor health outcomes. Among these is an infant mortality rate of 54.7 deaths per 1,000 live births, the 29th highest rate in the world. Haiti is still recovering from a devastating earthquake in 2010 as well as a cholera epidemic which emerged in the aftermath of the natural disaster.

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6. Zambia
> Life expectancy: 55.4 (23rd lowest)
> Infant mortality rate (per 1,000 live births): 55.8 (25th highest)
> Health expenditure per capita: $96 (46th lowest)
> Unemployment rate: 13.3% (29th highest)

Violent conflicts can have a detrimental effect on the health of people in a country. While several of the least healthy countries have suffered from violent histories and ongoing conflicts, Zambia has been relatively peaceful. Still, the lack of resources and the weak economy likely make it difficult for Zambians to achieve better health outcomes. Zambia’s unemployment rate of 13.3% was more than double the global rate in 2013. Additionally, nearly three-quarters of the population lived in poverty in 2010, one of the higher rates compared to countries where data was available. Health spending was less than $100 per capita annually. Also, as in other countries with poor health measures, access to basic services and the infrastructure quality were severely lacking in Zambia. For example, just 18.5% of the population had access to electricity, one of the lowest percentages and considerably lower than the global figure of 83.1%.