Special Report

The Healthiest (and Least Healthy) Countries in the World

5. Guinea-Bissau
> Life expectancy: 52.5 (14th lowest)
> Infant mortality rate (per 1,000 live births): 77.9 (7th highest)
> Health expenditure per capita: $30 (13th lowest)
> Unemployment rate: 7.1% (83rd highest)

Like several other least healthy countries, especially those in Africa, Guinea-Bissau was crippled by a relatively recent civil war, and continues to suffer from violence in the region. While a high birth rate can be positive for a nation, Guinea-Bissau’s high birth rate of nearly 38 births per 1,000 people may be related to other, less healthy behaviors. Like in other West African nations, for example, it may mean people are failing to use contraceptives even when having a child is not desired. This can also lead to higher vulnerability to infectious diseases. The annual health expenditure of $30 per capita was especially low, even among several of the least healthy countries. By contrast, global annual health spending was more than $1,000 per capita. Lack of resources may account for the lack of doctors and facilities. For every 20,000 people in Guinea-Bissau there was only about one doctor in 2010, a fraction of the global ratio of physicians to people.

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4. Mauritania
> Life expectancy: 59.9 (36th lowest)
> Infant mortality rate (per 1,000 live births): 67.1 (15th highest)
> Health expenditure per capita: $52 (31st lowest)
> Unemployment rate: 31.0% (the highest)

Consumption of alcohol in Mauritania was just 0.1 liters per capita in 2010, the lowest level of all countries reviewed. This could be due in part to the country’s large Muslim population, but also to the fact that Mauritanians are likely unable to afford such habits. In 2013, 31% of the country’s labor force was unemployed, the highest unemployment rate worldwide and more than five times the global rate of 6%. The life expectancy at birth of less than 60 years was also among the lower figures compared to other countries. The term “unhealthy” may be an understatement for Mauritania, as large portions of the country are either at risk of death or currently living in slavery. The country abolished slavery in 1981, long after every other country in the world had already done so. And according to the Global Slavery Index, Mauritania has the highest incidence of slavery in the world.

3. Yemen, Rep.
> Life expectancy: 61.6 (45th lowest)
> Infant mortality rate (per 1,000 live births): 40.4 (45th highest)
> Health expenditure per capita: $71 (38th lowest)
> Unemployment rate: 17.4% (15th highest)

Like several other countries with the worst health indicators, Yemen has been the center of several violent conflicts. Just four years after the Republic of Yemen was formed in 1990, a civil war devastated the country. The ensuing displacement of country residents, strained political climates, and war-torn public infrastructure largely account for Yemen’s near-bottom position on this list. Less than half of the country’s population had access to electricity in 2010, one of the lowest proportions worldwide. And with only about one doctor per 5,000 residents, physicians were likely nearly impossible to access in times of need. The data available likely does not even capture the current state of poor health in the country. In February, rebels deposed the president, prompting multiple countries led by Saudi Arabia to bomb Yemen, resulting in further devastation.

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2. Central African Republic
> Life expectancy: 47.7 (2nd lowest)
> Infant mortality rate (per 1,000 live births): 96.1 (3rd highest)
> Health expenditure per capita: $18 (4th lowest)
> Unemployment rate: 7.6% (71st highest)

The Central African Republic faces some of the same issues that its northeast neighbor Sudan faces. Central African Republic spent an annual $18 per capita on health, less than all but three other countries. The country has high infant mortality rates at birth, and among children under five, as well as the fourth highest death rate in the world. Less than one-quarter of children in the area were vaccinated against measles and DPT — diphtheria, pertussis (whooping cough), and tetanus — both the worst and second-worst shares, respectively, in the world. About 28% of Central African Republic residents are considered obese, one of the higher rates in the world. As in other unhealthy nations, the literacy rate of less than 37% was among the lowest percentages worldwide.

1. Sudan
> Life expectancy: 60.1 (39th lowest)
> Infant mortality rate (per 1,000 live births): 51.2 (33rd highest)
> Health expenditure per capita: $115 (53 lowest)
> Unemployment rate: 15.2% (22nd highest)

Sudan’s ranking as the country with the worst health outcomes in the world comes on the heels of more than a decade of turmoil and violent crisis. The country has been embroiled in conflict in western Darfur since 2003. The conflict has resulted in more than 200,000 deaths. Sudan continues to struggle with the inflow of refugees from nearby Ethiopia, Eritrea, Chad, Central African Republic, and South Sudan. The inflow is taxing Sudan’s resources and infrastructure, particularly after South Sudan’s secession in 2011 split the country and its oil reserves. Perhaps as a result, the country spends the equivalent of just $115 per capita on health, just slightly more than 10% of the global average expenditure. Sudan is near the bottom in almost every health measure. With a population of almost 38 million, Sudan is the most populous of the 10 countries with the worst health outcomes.