Funded by the Bill & Melinda Gates Foundation (BMGF), an international team of researchers have ranked the best and worst nations based on access to healthcare, and the quality of it, using a novel metric.
Published in The Lancet, it reveals that the US, by far the wealthiest nation on Earth, comes in at #29. This doesn’t sound great if you think America’s strange, lop-sided, and under-attack healthcare system is the best in the world, but it’s still quite high on the list, mind you – there are 195 nations on Earth, after all. It’s also in familiar company, with the UK, Singapore, and South Korea all appearing in the upper levels of the ranking.
The team behind this endeavor are all collaborators on the Global Burden of Disease (GBD), a tool that aims to quantify health loss so that others can rectify such problems. Using reams of collected data from the GBD initiative’s 2016 assessment of the world’s health, they’ve now published it in the form of a ranking.
Known as the Healthcare Access and Quality (HAQ) Index, it’s primarily derived from an assessment of the incidences of 32 causes of preventable death. These include diseases you can avoid by getting vaccinated, cardiovascular diseases, surgery-treatable gastrointestinal conditions, a variety of cancers, and so on.
The open-access paper – a hallmark feature of BMGF research publications – explains that if people have access to solid healthcare systems, there should be lower incidences of these afflictions.
Using carefully weighted methods, each country was scored on a scale from 0-100. Here, 0 represents the worst levels of the incidences of these preventable diseases from 1990 to 2016. This scoring was conducted on a global, national, and (in parts) subnational level.
Fortunately, it looks like between 1990 and 2016, there has been a global improvement in such matters. Sub-Saharan Africa and South-East Asia have seemingly drastically improved since the turn of the millennium, compared to the time period beforehand.
The overall country rankings make for some interesting reading, and can be viewed in full here. The top 10 are:
1 – Iceland
2 – Norway
3 – Netherlands
4 – Luxembourg
5 – Australia
6 – Finland
7 – Switzerland
8 – Sweden
9 – Italy
10 – Andorra
The bottom 10 are:
186 – Burundi
187 – Ivory Coast
188 – South Sudan
189 – Kiribati
190 – Guinea
191 – Afghanistan
192 – Chad
193 – Guinea-Bissau
194 – Somalia
195 – Central African Republic
There is no single factor that explains these trends. Access and deployment of healthcare depend on population numbers and distribution, government policy, trust (or lack thereof) in the healthcare system (including vaccines), the presence of socio-economic inequality, and more. Quality healthcare depends on how it’s managed, integrated into the country’s infrastructure, and funded.
Seven countries were assessed on subnational levels too, and in all cases, it inferred that healthcare is not given out equally. The authors found that in China, for example, Beijing had a HAQ score of 91.5, but in Tibet, it’s 48. In Japan, by way of contrast, the smallest subnational disparity was observed, coming in at a difference of 4.8 from the highest HAQ to the lowest.
Then, there’s the US. It has a disparity value more than twice that of Japan’s, which the team tentatively linked to challenges of getting healthcare to everyone that needs it, and – most importantly – economic and healthcare inequality in poorer regions.
Whatever you think of the politics, it’s impossible to argue that healthcare in the US is weirdly expensive compared to other developed nations for individual Americans; significantly, this means those with larger wallets have access to better healthcare. The Affordable Care Act (“Obamacare”) was a way of leveling the playing field for the less well-off; sadly, the latest GOP tax bill was essentially a redistribution of wealth to the rich.
As others have before it, this study hints that inequality – in the US, or anywhere – is a killer.