5. Democratic Republic of the Congo
> Life expectancy: 59.2
> Infant mortality rate: 72.0 (per 1,000 live births)
> Health expenditure per capita: $32
> GDP per capita: $810
For years, the Democratic Republic of Congo has been one of the most war-torn nations on Earth. As is usually the case with highly unstable, impoverished nations, a structured, adequate health care system is effectively non-existent. Total health expenditure per capita in the DRC is just $32 per person, nearly the lowest of any country on record. Health expenditure in the United States, in contrast, is $9,403 per capita, about 291 times that of the African nation, and the global average health care spending is $1,271 per person per year.
The DRC’s life expectancy is less than 60 years, and it has one of the higher death rates per capita. As is often the case with nations with severe health issues, the birth rate is arguably unsustainably high as it may strain the country’s already limited resources. There are 43 births in the DRC per 1,000 people annually, the fifth highest rate in the world.
> Life expectancy: 55.9
> Infant mortality rate: 82.6 (per 1,000 live births)
> Health expenditure per capita: N/A
> GDP per capita: N/A
There are 83 deaths of infants younger than 1-year-old for every 1,000 live births in Somalia, the third highest infant mortality rate in the world and nearly triple the global infant mortality rate. Additionally, life expectancy at birth in the East African country is just shy of 56 years, or about 16 years shorter than the global average. Health outcomes would likely improve with greater access to modern conveniences. Currently, just 32% of the population have access to clean water, and fewer than 20% have access to electricity.
Like many of the least healthy countries, Somalia is growing rapidly, putting additional strain on already scarce resources. In the last year, Somalia’s population grew by 2.9%, more than double the global population growth during that time of 1.2%.
> Life expectancy: 53.6
> Infant mortality rate: 72.4 (per 1,000 live births)
> Health expenditure per capita: $276
> GDP per capita: $3,917
An estimated 82% of Lesotho’s population have access to clean water, the largest share of any country on this list. Despite the stronger public works infrastructure compared to other countries on this list, Lesotho still faces a major public health crisis.
HIV is incurable and one of the leading causes of death worldwide. In Lesotho, one in every four residents age 15-49 is HIV positive, the second highest rate of any country considered. Partially because of the high HIV incidence rate, life expectancy in Lesotho is just 53.6 years, or 18.3 years below the global average.
2. Central African Republic
> Life expectancy: 51.4
> Infant mortality rate: 88.5 (per 1,000 live births)
> Health expenditure per capita: $25
> GDP per capita: $721
Life expectancy at birth in the Central African Republic is just 51.4 years, the lowest of any country in the world. One of the world’s least healthy countries, CAR is also one of the poorest. Annual GDP per capita in the landlocked sub-Saharan country is just $721, nearly 23 times less than the average global GDP per capita. A lack of access to basic amenities further underscores the abject poverty in CAR. Just 68.5% of the population have access to clean water, and only 12.3% have electricity.
People born in the CAR are less likely to make it to their first birthday than those in any other part of the world. There are 89 infant deaths for every 1,000 live births annually, more than double the global infant mortality rate of 31 per 1,000.
1. Sierra Leone
> Life expectancy: 51.4
> Infant mortality rate: 83.3 (per 1,000 live births)
> Health expenditure per capita: $224
> GDP per capita: $1,883
Some 1,360 mothers die during childbirth for every 100,000 live births in Sierra Leone, the highest maternal mortality rate in the world. Additionally, the country’s life expectancy at birth of 51.4 years is the second lowest in the world and nearly 21 years shorter than the global average. Inadequate utilities and government services partially explain the country’s poor health outcomes. Just 63% of the population have access to clean water, and only 13% have electricity. Unhealthy behaviors likely also play a role. An estimated 60% of men in the country smoke, nearly the highest smoking rate of any country in the world.
Like most of the countries with the worst health outcomes, Sierra Leone is poor. The country’s GDP per capita of $1,883 is about $60,000 less than the U.S. GDP per capita.