America Is Not the Greatest Country on Earth. It’s No. 28

Violence, alcoholism, and obesity pose the biggest risks in the U.S. But the rest of the world isn’t doing much better.

Every study ranking nations by health or living standards invariably offers Scandinavian social democracies a chance to show their quiet dominance. A new analysis published this week—perhaps the most comprehensive ever—is no different. But what it does reveal are the broad shortcomings of sustainable development efforts, the new shorthand for not killing ourselves or the planet, as well as the specific afflictions of a certain North American country.
Iceland and Sweden share the top slot with Singapore as world leaders when it comes to health goals set by the United Nations, according to a report published in the Lancet. Using the UN’s sustainable development goals as guideposts, which measure the obvious (poverty, clean water, education) and less obvious (societal inequality, industry innovation), more than 1,870 researchers in 124 countries compiled data on 33 different indicators of progress toward the UN goals related to health.
The massive study emerged from a decadelong collaboration focused on the worldwide distribution of disease. About a year and a half ago, the researchers involved decided their data might help measure progress on what may be the single most ambitious undertaking humans have ever committed themselves to: survival. In doing so, they came up with some disturbing findings, including that the country with the biggest economy (not to mention, if we’re talking about health, multibillion-dollar health-food and fitness industries) ranks No. 28 overall, between Japan and Estonia.

Eradicating disease and raising living standards are lofty goals that have attracted some of the biggest names to philanthropy. Facebook Inc. founder Mark Zuckerberg and Priscilla Chan, his wife and a pediatrician, on Wednesday pledged $3 billion toward the effort. The new study itself was funded by (but received no input from) the Bill & Melinda Gates Foundation. The 17 UN Sustainable Development Goals (SDGs) themselves are a successor to the Millennium Development Goals, a UN initiative that from 2000 to 2015 lifted a billion people out of extreme poverty, halved the mortality of children younger than five years old, and raised by about 60 percent the number of births attended to by a skilled health worker.
The research team scrubbed data obtained on dozens of topics from all over the world. For example, to make sure they had adequate data on vaccine coverage for each region, they looked at public surveys, records of pharmaceutical manufacturers, and administrative records of inoculations. “We don’t necessarily believe what everybody says,” says Christopher Murray, global heath professor at the University of Washington and a lead author of the study. “There are so many ways they can miss people or be biased.”
The U.S. scores its highest marks in water, sanitation, and child development. That’s the upside. Unsurprisingly, interpersonal violence (think gun crime) takes a heavy toll on America’s overall ranking. Response to natural disasters, HIV, suicide, obesity, and alcohol abuse all require attention in the U.S.
QuickTake How Half the World Got So Big
Also noteworthy are basic public health metrics that America. doesn’t perform as well on as other developed countries. The U.S. is No. 64 in the rate of mothers dying for every 100,000 births, and No. 40 when it comes to the rate children under age five die.

“The U.S. isn’t doing as well as it perhaps should compared with some countries in Western Europe,” Murray said.

In all regions of the world and across the economic development spectrum, the problem of overweight children has grown worse, the study shows.
The authors lauded five countries in particular, one from each quintile, for their prominent gains:

• Timor-Leste rebuilt its health service since 2000 after years of war. 
• Tajikistan reformed its health system in the late 1990s and is winning a battle against malaria.
• Colombia's health insurance program reaches more people than ever and covers more scenarios, including cancer.
• Taiwan enacted road-safety laws that reduced auto-related deaths there.
• Iceland, which barely edges out Singapore and Sweden for the No. 1 spot, is credited for aggressive anti-tobacco policies and its publicly funded universal health-care system. 

The research group allowed organizers to “harness people’s knowledge and expertise, local data sources, and quirky knowledge that only somebody locally may know,” said Murray. But the UN goals were a tough starting point, given their nebulous categories and confusing terminology. The whole system has the intuitive clarity of Britain's pre-1971 monetary system, with its pound (or quid), shilling (or bob),  pence, half-crown, and farthing. Economist William Easterly of New York University has ridiculed the SDGs as “senseless, dreamy, garbled.” But making fun of international bureaucratese is as easy as measuring progress toward the UN goals is hard. And that’s exactly what the new Lancet enterprise does—combing the world of public-health research to measure where each nation succeeds, or needs work. The voluminous work that went into the paper may make measuring the UN goals on health seem even more daunting: The researchers were able so far to evaluate just 70 percent of the health-related indicators called for by the UN.
It may not be pretty, but “we have no chance of success if we can’t agree on what’s critical,” said Linda Fried, dean of the Mailman School of Public Health at Columbia University.

--With assistance from Hayley Warren in London.