Why the world’s richest countries aren’t the healthiest

New research across 38 advanced economies says national health is not a simple byproduct of wealth. Smaller countries with steady primary care often outperform richer peers on core health outcomes.

The work compared how well each country turns health resources into longer lives, stronger prevention, and fair access to care.

Money is not the whole story

The United Nations has a goal to ensure healthy lives for all ages (SDG 3). It sets targets for maternal health, child survival, infectious disease control, and more.

The work was led by Ali Emrouznejad, professor and chair in business analytics at the University of Surrey (US). His research focuses on efficiency analysis and performance measurement in public services.

“Money isn’t everything when it comes to national health,” said Professor Emrouznejad.

The study judged performance by asking how efficiently countries convert spending and staffing into results. That approach favors systems that reach people early, keep care equitable, and avoid waste.

What the model measures

The team built a composite indicator, a single score that blends many health measures into one. It weighs indicators that reflect both desirable results, like coverage, and undesirable ones, like mortality.

The researchers used a directional distance function (DDF), a method that measures how far a country sits from a best practice frontier. In simple terms, it checks who gets more health for the same or fewer inputs.

The analysis tied indicator weights to a penalty to boost fairness and compared results across alternative models. In that work, Australia, Norway, Sweden, Iceland, and Israel posted the highest combined scores.

The model also accounts for climate related pressures, which can strain prevention and care. That choice matters because heat, smoke, and floods disrupt services and worsen chronic disease.

Public trust shapes national health

Public trust in health institutions affects how people use services and follow guidance. When trust is strong, prevention programs reach more people and treatment begins earlier.

Systems with low public trust often see delayed care and confusion about access. Those delays raise costs later and weaken national performance on major health measures.

Where wealth and health part ways

The United States spent 12,555 dollars per person on health, yet life expectancy was 76.4 years – several years below the OECD average. Those figures come from the OECD country profile.

High spenders can still lag when access is uneven and prevention is thin. Countries that make primary care easy to reach often avoid costly hospital care later.

Many top performers guarantee universal coverage, everyone can get needed care without financial hardship. That policy aligns incentives toward early detection and steady management of common conditions.

Efficient systems also track data closely and adjust resources quickly. They reduce avoidable deaths by keeping wait times short and vaccination rates high.

Global patterns behind health efficiency

Many countries with smaller populations coordinate their services more tightly, which reduces uneven access and cuts delays.

These systems often strengthen basic care first because it supports the largest share of health needs.

Other countries rely more on private insurance, which can create gaps in coverage. Those gaps weaken prevention and raise costs when problems grow before anyone receives care.

Health systems on a warming planet

Climate hazards are not a distant problem for health planners. A recent Lancet Countdown report documents rising heat risks, smoke exposure, and weather shocks that compound existing health gaps.

Countries that build clinics to withstand heat and floods, protect workers, and plan for surges tend to keep services running. The Surrey team’s scoring rewarded that kind of environmental health planning.

What this means for leaders

First, prevention delivers more health-per-dollar than rescue care. Vaccination, hypertension control, and mental health support are low cost compared with intensive hospital care.

Second, equity is a performance strategy, not just a value statement. When coverage is universal, people seek care earlier and complications fall.

Third, strong primary care absorbs shocks, including seasonal waves and climate linked events. When the front door holds, hospitals are not overwhelmed.

“Policymakers should prioritize on prevention, sustainability and equitable access over simply increasing health budgets,” stated Professor Emrouznejad.

That guidance also points to practical benchmarking that shows who is getting more for what they spend.

Any index has limits because choices about inputs and outputs shape results. Still, the core signal here is consistent – smart strategy beats raw spending.

The study is published in Annals of Operations Research.

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