A typical American born today can expect to live 78.8 years. While the U.S. life expectancy is better than in many parts of the world, it is three to five years shorter than the majority of developed nations. Further, despite spending far and away the most in the world on health care, the United States still trails many developed nations in other health measures as well.

In order to assess the overall state of a country’s health, 24/7 Wall St. reviewed a host of indicators reflecting the health of the population, access to care, and measures of the economy, which is often directly tied to health outcomes. The healthiest country this year was the small European nation of Luxembourg. South Sudan, meanwhile, is the least healthy country.

The least healthy countries in the world tend to perform poorly not just in a few health indicators, but in most measures of health. Infant mortality rates in these nations, for example, are all at least six times the U.S. rate. Maternal mortality rates are even worse. Tuberculosis is essentially a non-factor in most of the developed world — in the United States, there are just 3.1 new incidents of the disease each year for every 100,000 residents. In Lesotho, the rate is 852 per person for every 100,000 residents.

Click here to see the most healthy countries in the world.

Click here to see the least healthy countries in the world.

Combined, these negative health conditions result in extremely low life expectancies for the populations of the least healthy countries. While a typical American is expected to live 78.8 years, a person born in the Central African Republic is more likely than not to die before the age of 50. In nine of the 10 healthiest countries in the world, life expectancy is at least 80 years and as high as 83.3 years in Japan.

Countries that tend to perform well by some measures of health tend to rank well by most measures because of the link between socioeconomic factors and health. The healthiest countries tend to be relatively wealthy, have a robust economy and stable population growth, and provide access to basic amenities and care. The least healthy countries, on the other hand, tend to be the opposite: they are extremely poor, have a high population growth rate, and the population often lacks access to basic amenities — from clean water to health care.

In particular, it appears relative affluence in a country almost always results in a healthier population. Only one of the 10 healthiest nations, Japan, ranks outside of the 20 wealthiest nations based on GDP per capita. The two wealthiest countries in the world by this measure, Luxembourg and Qatar, are also the two healthiest countries. Income allows residents access to better health care options, to healthier eating and exercise facilities, and to higher education — which in turn allows them to make healthier choices.

Of course, greater spending itself does not guarantee better health outcomes. The United States, which ranks as the fourteenth-healthiest country in the world, spends $9,146 each year on health care, roughly $2,800 more than the next highest spender, Luxembourg.

The quality of a nation’s infrastructure and health care system is also closely related to its overall health. Doctors are far more available in the healthiest countries than in the least healthy ones, for example. The majority of the healthiest nations have among the highest rates of physicians per capita. Austria, for example, has 4.8 doctors for every 1,000 people, which is roughly double the U.S. concentration and which dwarfs the concentration in the least healthy countries. In Mozambique, for example, there are 0.04 physicians for every 1,000 residents.

Click here to read our methodology.

These are the most (and least) healthy countries in the world.

10. Netherlands
> Life expectancy: 81.1 years
> Infant mortality rate (per 1,000 live births): 3.2
> Health expenditure per capita: $5,601
> Unemployment rate: 6.9%

The Netherlands is one of the healthiest countries in the world by several measures. The country has among the lowest rates of infant mortality and maternal mortality, as well as extremely low rates of tuberculosis — a disease that is rare in the West but still a serious concern in parts of the world. Someone born in the country can expect to live to 81.1 years, longer than in the majority of countries and 2.3 years on longer than the typical American. Like most nations with healthy populations, the Dutch spend among the most on health care. The country’s total health spending of $5,601 per person is fifth highest in the world. Like most countries with healthier populations, the Netherlands has a government-sponsored health care system, and citizens are automatically covered for long-term and nursing care, although they must purchase their own plan for basic services.

9. Germany
> Life expectancy: 81.0 years
> Infant mortality rate (per 1,000 live births): 3.1
> Health expenditure per capita: $4,812
> Unemployment rate: 5.0%

Like most advanced industrial countries, Germans enjoy the basic amenities that contribute to a healthy population, including such clean water and universal access to electricity. Germans are also much more likely to be able to access health care than residents in most nations, as there are 3.9 physicians for every 1,000 residents, more than in nearly every country in the world. Possibly a result of this widespread access, Germany also spends more than most nations on health care, at $4,812 per person. Unchecked population growth can result in health and public administration problems. Germany’s expected birth rate is just 8.5 births for every 1,000 people each year, and the country’s population is growing at one-quarter the rate of many less healthy nations.

8. Austria
> Life expectancy: 80.9 years
> Infant mortality rate (per 1,000 live births): 2.9
> Health expenditure per capita: $4,885
> Unemployment rate: 5.0%

Austria, like its neighbor Germany, has one of the healthiest populations in the world. Safe childbirth is often an indicator of how healthy a country’s population is and of the quality of its medical system. In Austria, the infant mortality rate is a relatively low 2.9 deaths per 1,000 live births, and the maternal mortality rate is also relatively low at 4.0 deaths for every 1,000 live births. In the United States, which still compares favorably to many countries, the corresponding rates are 5.6 and 14.0 deaths per 1,000 live births, respectively. One potential detriment to the Austria’s health is the high smoking rate among adults. An estimated 35.9% of the country’s women and 37.4% of the country’s men smoke, each higher than most countries. Like most nations with healthier populations, Austria has a socialized health care system. Citizens and visitors alike are able to access basic free care as needed.

7. Singapore
> Life expectancy: 82.3 years
> Infant mortality rate (per 1,000 live births): 2.1
> Health expenditure per capita: $3,578
> Unemployment rate: 3.0%

The geographically small but densely populated island nation of Singapore is home to approximately 5.5 million people who are among the healthiest in the world. The population’s good health is likely tied to the nation’s robust economy. Singapore thrives as a major trade and commerce center, and the nation boasts one of the highest GDPs per capita in the world. Just 3% of the nation’s workforce is unemployed, lower than in all but a handful of nations. Wealth typically translates to greater access to better health care, which likely explains the nation’s life expectancy of 82.3 years, the sixth longest in the world.

6. Switzerland
> Life expectancy: 82.7 years
> Infant mortality rate (per 1,000 live births): 3.4
> Health expenditure per capita: $6,187
> Unemployment rate: 4.5%

Higher health spending alone does not always translate to a healthier population, but most of the healthiest nations in the world tend to spend more on health care. Switzerland is no exception, with average health expenditures of $6,187 per person annually. While that is still nearly $3,000 less than the U.S. per capita figure, it remains one of the highest health expenditures in the world. As one of the most affluent nations in the world, the Swiss can afford to spend as much as they do on health. The nation’s GDP per capita of $58,149 is higher than that of all but a handful of countries. Health care coverage, while provided by private companies, is nearly universal in Switzerland. Citizens are required to have at least basic coverage, but the government subsidizes costs to prevent individuals from spending more than 10% of their incomes.

5. Iceland
> Life expectancy: 83.1 years
> Infant mortality rate (per 1,000 live births): 1.6
> Health expenditure per capita: $3,646
> Unemployment rate: 5.0%

Iceland is a relatively small and isolated nation with a population of roughly 328,000. The country’s economy is robust, however, with a GDP of $44,029 per capita — among the 20 wealthiest nations in the world. This relative wealth has likely helped maintain and improve its population’s good health. As is the case in most developed industrial economies, Iceland’s population has universal access to important amenities including clean water and electricity. Also, with 3.5 physicians per 100,000 residents, Icelanders are much more likely to have access to doctors than the populations of most other countries.

4. Japan
> Life expectancy: 83.3 years
> Infant mortality rate (per 1,000 live births): 2.0
> Health expenditure per capita: $3,741
> Unemployment rate: 3.7%

Many of the healthiest countries in the world have relatively small populations, but Japan has a population of more than 127 million people. A person born in Japan today is expected to live 83.3 years on average — a longer life expectancy than in every nation in the world and five years longer than the typical American’s life expectancy. Strangely, the nation has one of the highest death rates in the world, at 10.1 deaths for every 1,000 people. However, while a high death rate can point to a country’s health risks, in Japan this is likely due to the nation’s disproportionately older population.

3. Norway
> Life expectancy: 81.5 years
> Infant mortality rate (per 1,000 live births): 2.0
> Health expenditure per capita: $6,308
> Unemployment rate: 3.4%

While other Nordic countries have among the healthiest populations in the world, Norway compares slightly better by several measures. For example, there are 4.3 physicians for every 1,000 Norwegians, a higher rate than in all but three countries. The nation also has an infant mortality rate of two deaths for every 1,000 live births, fourth lowest in the world. Affluence tends to correlate with a healthier population as residents of wealthier nations have access to better treatment and healthier diet and exercise options. Norway’s GDP per capita of $67,166 is more than $20,000 greater than that of Denmark, Sweden, or Finland.

2. Qatar
> Life expectancy: 78.4 years
> Infant mortality rate (per 1,000 live births): 6.8
> Health expenditure per capita: $2,882
> Unemployment rate: 0.3%

Qatar stands out as the only Middle Eastern nation to make this list. Until recently, it also stood out as one of few healthy nations without a state-run health care system, although that is no longer the case — the Qatari government implemented a universal single-payer system in 2014. The nation is able to afford the new health care system for its roughly 2.2 million residents due its relative wealth. Qatar is a large oil and natural gas producer, operations that are largely government controlled. As a result, Qatar has the highest GDP per capita in the world at $137,162 per person — a greater GDP than that of the 50 poorest nations in the world combined. Wealth is important to improving health as it allows access to better care. There are 1.5 deaths for every 1,000 Qatari residents each year. In contrast, the U.S. death rate is 8.2 deaths per 1,000 people.

1. Luxembourg
> Life expectancy: 81.8 years
> Infant mortality rate (per 1,000 live births): 1.5
> Health expenditure per capita: $6,518
> Unemployment rate: 6.1%

Luxembourg has one of the higher smoking rates among women and one of the highest rates of alcohol consumption per capita in the world. Despite these behaviors, the small European nation boasts the healthiest population in the world. Luxembourg has the lowest infant mortality rate, at 1.5 deaths for every 1,000 live births — less than a third of the U.S. rate. The country has one of the longest life expectancies in the world, at nearly 82 years on average.

10. Nigeria
> Life expectancy: 52.4 years
> Infant mortality rate (per 1,000 live births): 69.4
> Health expenditure per capita: $217
> Unemployment rate: 7.5%

Nigeria is the most populous nation in Africa with more than 170 million residents. Unfortunately, that population lives in one of least healthy countries in the world. A typical person born today in Nigeria has a life expectancy of just 52.4 years. An average American can expect to live at least 25 years longer on average. Like so many unhealthy nations, the country struggles with an unsustainable birth rate, with more than 40 births each year for every 1,000 residents. Each year, the population grows by 2.7%, close to four times the U.S. rate of 0.7%. The high birth rate is accompanied by a high infant mortality rate, at nearly 70 deaths for every 1,000 live births, 12 times the U.S. rate.

9. Kenya
> Life expectancy: 61.0 years
> Infant mortality rate (per 1,000 live births): 35.5
> Health expenditure per capita: $101
> Unemployment rate: 9.2%

Compared to the other least healthy countries in the world, Kenya has a somewhat higher life expectancy. At just 61 years on average, however, it is still 17.8 years less than the U.S. life expectancy. Apart from physical health, Kenya’s 44 million residents also are often victims of violence. Islamic radicals have unleashed several deadly terror attacks on the East African nation in the last few years, including an attack on the Westgate Mall, which killed 67 people, and the assault last April on the Garissa University college, which resulted in the deaths of 147 people, mostly students.

8. Zambia
> Life expectancy: 59.2 years
> Infant mortality rate (per 1,000 live births): 43.3
> Health expenditure per capita: $192
> Unemployment rate: 13.3%

Zambia has been relatively free of the violence that has plagued much of the region. The nation has also experienced robust economic growth in the past decade, as it has benefitted from its substantial copper reserves. Despite benefitting from these conditions, the nation’s residents have one of the lowest levels of well-being in the world. The nation’s rapid population growth may be a part of the problem. The current population is growing at rate faster than 3% per year, roughly four times the U.S. growth rate. Low income and high unemployment are likely to restrict residents’ available income and access to health care. More than 13% of the nation’s workforce is unemployed, higher than in all but a few nations. Zambia’s extremely low 0.2 physicians per 1,000 people likely further restricts residents’ access to care. The United States’ ratio, in contrast, is 2.5 physicians per 1,000 people.

7. Lesotho
> Life expectancy: 49.3 years
> Infant mortality rate (per 1,000 live births): 69.2
> Health expenditure per capita: $297
> Unemployment rate: 26.2%

Like many of the least healthy countries in the world, Lesotho’s population suffers from an extremely high infant mortality rate, which is indicative of both a population’s health, and the quality of health care in the country. For every 1,000 live births in the country, an average of 69.2 end in the death of the newborn, more than 12 times the U.S. rate. More than one-quarter of Lesotho’s workforce is unemployed, worse than in nearly every country in the world. These individuals are much less likely to be able to afford basic health care as well as the basic amenities that allow for healthy living. In fact, nearly one in five Lesotho residents do not have access to clean water, and only 21% of the population has access to electricity.

6. Burundi
> Life expectancy: 56.3 years
> Infant mortality rate (per 1,000 live births): 54.1
> Health expenditure per capita: $62
> Unemployment rate: 6.9%

Since 1993, Burundi has attempted to establish a democracy through numerous coups and violent shifts of power. Amidst the instability and suspected human rights violations, the Burundi government has failed to provide adequate health care infrastructure. The country spends just $62 on health care per capita annually, one of the lowest such figures worldwide. By comparison, the health care expenditure for one U.S. resident could fund 148 Burundians. Someone born in Burundi today is expected to live for just 56.3 years, about 23 years less than the 78.8 year U.S. life expectancy. Burundi is one of the poorest countries in the world, and its people have limited access to vital resources such as water and electricity. Further straining the already insufficient resources is the country’s high birth rate. The 44 live births per 1,000 people annually helps yield the seventh fastest population growth on the planet.

5. Central African Republic
> Life expectancy: 49.9 years
> Infant mortality rate (per 1,000 live births): 91.5
> Health expenditure per capita: $24
> Unemployment rate: 7.4%

The Central African Republic spends just $24 per citizen on health care annually, nearly the lowest such figure on the planet. The country may not have the resources to spend much more as it is one of the poorest countries with a $609 GDP per capita. Like in many impoverished African countries, political instability and violent infighting has left health care largely in the hands of international aid organizations — and health outcomes are extremely poor. Nearly one in 10 babies born in CAR die before reaching the age of one, among the worst infant mortality rates worldwide. A Central African is expected to live for just 49.9 years, one a just a handful of countries in the world where life expectancy is lower than 50 years.

4. Chad
> Life expectancy: 51.2 years
> Infant mortality rate (per 1,000 live births): 85.0
> Health expenditure per capita: $74
> Unemployment rate: 7.0%

Although recent oil wealth has helped lift Chad from the extremes of poverty that plague most of Africa, its $2,627 GDP per capita remains one of the lowest in the world. Since the World Bank helped the desert nation construct an oil pipeline in 2003, the share of residents living below the poverty line fell from 62.9% to 38.4% today. However, the Chadian government spends less of its oil profits on its people than initially agreed upon with the World Bank. Chad spends just $74 per capita on health care annually, one of the lowest expenditures of any country. Health outcomes are equally poor. The average Chadian is expected to live for just 51.2 years, about 28 years less than the average American.

3. Democratic Republic of Congo
> Life expectancy: 58.3 years
> Infant mortality rate (per 1,000 live births): 74.5
> Health expenditure per capita: $26
> Unemployment rate: 8.0%

The Democratic Republic of Congo is still recovering from a decade of civil war that officially ended in 2003. The country lost millions of lives to violence, disease, and starvation during the war. The nation remains one of the poorest and least healthy places in the world. For every 100,000 Congolese each year, there are 325 new cases of tuberculosis, one of the highest incidence of the disease of any country. A sign of poor diet and maternal health care, 75 out of every 1,000 babies born will die before the age of one. By comparison, the U.S. infant mortality rate is 5.6 out of 1,000. The country’s unstable government leaves much of its medical care in the hands of international aid organizations, and the country spends just $26 per capita on health care annually. In contrast, health care expenditures for the average American could fund about 350 Congolese.

2. Mozambique
> Life expectancy: 54.6 years
> Infant mortality rate (per 1,000 live births): 56.7
> Health expenditure per capita: $71
> Unemployment rate: 22.6%

Mozambique is slowly recovering from a 16-year civil war that ended in 1992. It remains one of the poorest and least healthy countries on the planet. There are just 0.04 physicians per 100,000 people, or about 1,100 doctors to serve the country’s population of 27.2 million. More than one in 10 Mozambicans aged 15 to 49 has HIV, and each year 551 out of every 100,000 people contract tuberculosis. Disease and malnutrition have led to significantly poor health outcomes. The average Mozambican is expected to live for just 54.6 years, about 24 years less than the average American. Mozambique’s situation may improve in the coming years, as gas fields discovered in 2011 have the potential to bring much-needed wealth into the country.

1. South Sudan
> Life expectancy: 55.2 years
> Infant mortality rate (per 1,000 live births): 60.3
> Health expenditure per capita: $52
> Unemployment rate: N/A

After gaining independence from Sudan in 2011, South Sudan underwent a bloody civil war that has left its 11.9 million residents in the midst of a humanitarian crisis. Just 58.7% of the South Sudanese population has access to clean water, and just 5.1% have access to electricity. An estimated 3.9 million South Sudanese are at risk of starvation. Putting a further strain on already limited resources, the nation is home to one of the highest birth rates worldwide, and its population is growing at the fourth fastest rate. A product of war, famine, and poor health, the average South Sudanese is expected to live for just 55.2 years, about 24 years less than the average American.

Methodology

To determine the most and least healthy countries, 24/7 Wall St. collected data on 23 measures in more than 170 countries. These measures were grouped into three categories: health, access, and economy.

While our index aspires to be comprehensive, many measures are also interrelated. To account for interdependence, our index was created using a geometric mean rather than the traditional arithmetic mean. We then used the geometric mean of each index to calculate a country’s overall score. Potential scores ranged from 1 to 171, with lower values indicating better scores.

One challenge was data availability for all 171 countries. We addressed this challenge in two ways. We accepted data for the most recent year available but no older than 2011. Also, data had to be available for at least 75% of countries. In addition, we only considered countries with at least 250,000 people.

The health category captured both outcomes and residents’ behaviors in each country. Infant mortality, fertility, maternal mortality, and the incidence of various diseases came from the World Bank. We used the World Bank’s life expectancy figure for males as a proxy for life expectancies for all people because it is much more widely available in the countries reviewed. Smoking rates also came came the World Bank. Lastly, we considered per capita alcohol consumption rates from the World Health Organization (WHO).

The access category was designed to measure the availability of specific resources critical to the health of a population. We looked at the share of a country’s population with access to clean water, clean air, and electricity — all data came from the World Bank. Additionally, we looked at the concentration of physicians in each country as a proxy for how easily residents can access health care.

Economic conditions also have an impact on health and health outcomes. The economy category included per capita health expenditure by public and private sources, as well as poverty and unemployment rates. All economic data came from the World Bank.

Click here to see the healthiest countries in the world.

Click here to see the least healthy countries in the world.

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