It’s comforting to think of health as a matter of personal lifestyle. Perhaps it's equally discomforting to think you might not have total control over your physical well-being. Here in the West we like to distill our ideas of health down to a handful of abstract decisions which sustain some notion of autonomous personal choice: Do I hop on the couch or the treadmill? Should I take it easy on the coffee? Birthday cake? Cigarettes? Is it time for a check-up?
Then, of course, there are the limitless varieties of answers brought to you by the free market. You can buy a Bowflex, go organic, sign up for yoga class, drink light beer or perhaps settle with an acai berry and colloidal silver concoction that’ll undo fifteen years of bodily neglect in one easy payment. There’s no shortage of ways to embrace or ignore your personal health in the first world, but for 1.1 billion people on the planet the very opposite is true.
Apart from lacking ubiquitous commerce peddling health and wellness from every angle, the third world remains effectively barred—geographically, economically and politically—from attaining what we here consider basic health provisions that sustain the current potential of a 21st century human lifespan. Their very landscape of well being bears almost no resemblance to that of the western world; obesity, diabetes and other afflictions of excess blooming in the West are conversely absent in the developed world. While Angolans could contract potentially fatal bush diseases like malaria in their backyards, we stay insulated in our concrete metropolises. So what’s the real debaser in this equation?
The biggest third world diseases have, at some point, also been the biggest in the first world. Malnutrition, pneumonia, tuberculosis and of course HIV/AIDS; we know the trouble is lack of medicine, treatment and general resources to meet the challenge. Some argue this awareness in the West has only aggravated the issue, forming capitalist networks which perpetually profit from distributing “some aid but, tragically, not enough” to countries in need, rather than inspiring real systemic changes in these underprivileged countries. Whether or not you agree, identifying the world’s darkest areas in health and wellness should no doubt be part of the solution.
We've ranked the world’s 10 unhealthiest countries according to the Social Progress Imperative 2013 health and wellness measures. For contrast, the healthiest countries score nearly 70 on the index.
10 Rwanda: 35.65
Nearly 1 in 10 children die in Rwanda before their fifth birthday thanks, in large part, to diarrhoea from malnutrition, or malaria from an infected mosquito. Rwanda’s problem isn’t lack of access to health care so much as a plain shortage — estimates suggest every two doctors in the country are responsible for 100,000 people. To monitor the whole population in a year, they’d need to give 137 separate check-ups a day. Even if it could be done, the country still faces a raw medicine shortage, and the world still has no cure at all for the 3% of HIV-positive Rwandan adults.
9 South Africa: 35.28
HIV-positive South Africans outnumber the entire population of Norway. It’s the biggest AIDS body in the world with 13.6% of blacks afflicted and 5.6 million of the total population including whites. The distinction matters because study after study finds essentially two South Africas when it comes to health; the life expectancy of whites being 71 years, and blacks only 48. Given that the latter outnumber the former nearly 10 to 1, it’s the black population that really represents the state of social progress in this country where medical systems only have 16% of the population covered.
8 Ghana: 35.24
With a 1.3% AIDS prevalence rate, Bill Gates called Ghana’s healthcare system the most successful in all of Africa after his 2013 visit. But the reason the country still ranks so low in wellness has to do with two primary factors: The dire state of air, water and sanitation facilities, which were totally neglected until the 90s, and the drastic variability of healthcare between the rural and urban. Whereas major cities come well stocked with hospitals, clinics and pharmacies, for most rural Ghanaians the facilities remain too few, too distant and too unaffordable. Nearly 1 in 20 Ghanaian babies will die within a year of birth.
7 Senegal: 35.14
In Senegal, few roads lead to Rome. Lack of transportation and usable roads to and from rural areas make healthcare a rare prospect for many in this western-most African country. The average life expectancy here is 57.5 years, but like most of the continent the number rests in the middle of a vast health disparity between highly distanced rural and urban peoples; an overwhelming amount of pastoral Senegalese would consider themselves lucky to break their 50s. Imagine the difficulty of starting a family in Senegal’s undeveloped countryside, where 1 out of every 10 women die during labour.
6 Kenya: 32.49
The country of Kenya remains plagued by resource inadequacy and, quite literally, half measures in wellness infrastructure. About half of Kenya lives below the poverty rate; nearly half of Kenyans giving birth will do so without medical aid present; the average Kenyan lives just over half a century. Since the AIDS pandemic the average lifespan here fell by a whole decade, and with anywhere from 7-16% of the population now battling the disease, a Kenyan child has about a 1 in 10 chance of being orphaned.
5 Botswana: 30.36
At one of the worst points in the AIDS pandemic, when 1 in 4 adults had the disease, the estimated average lifespan in Botswana dropped to 35 years. Fortunately today those estimates are significantly lower, but their variability reflects a pessimistic reality about measuring health in sub-Saharan Africa. Just as professional health services fail to reach most of the rural population, so too might data collectors. When citizens with the poorest living conditions are the ones most likely to be overlooked, drastic improvements in the national stats should be taken with a grain of salt.
4 Uganda: 26.97
Lack of opportunities lead many Ugandan women to sex work, which puts them at a much greater health risk than men. Persisting gender inequalities in general make tackling health from a national standpoint rather difficult, with women’s cultural subordination becoming an added obstacle to diffusing health services. This could partly explain the highly volatile stats coming out of Uganda—one commissioner claiming a doubling of HIV infections from 2003 to 2005, and a stark infant mortality rate of 61 in 1,000 children.
3 Nigeria: 26.18
It’s strange to think Nigeria, the so-called Giant of Africa, could become one of the world’s top 20 economies in the near future. Nigeria is very much becoming an "advanced" country stuck in the shadow of the African sub-Sahara, but if it means more resources to tackle the country’s deeply entrenched health inequalities, it’s certainly an optimistic trend. Assuming the current government plans to take serious measures against corruption (for real this time), Nigeria’s economic boom could trigger high-quality health institutions that combat the country’s medicinal “brain drain”. Estimates show as many Nigerian doctors work in the U.S. as in their entire home country, where the UNAIDS Report recently flagged the second biggest flare up of new HIV infections in the world.
2 Mozambique: 23.59
With 3 physicians for every 100,000 people, nearly 1 in 7 children die by the age of five in this former Portuguese colony. Now let’s throw disparities into the equation: While the official HIV rate is 11.5% nationwide, the prevalence in the southern Maputo and Gaza provinces is more than double that. Apply that difference to other national figures. How great is the risk of being born in rural Mozambique, when even the prosperous parts average the overall rate to 3 doctors per 100,000, and 1 in 7 chances of infant death?
1 Ethiopia: 23.03
It’s the number one pity case for international poverty and suffering. It’s where every other socially-conscious college graduate considers spending a summer. Unfortunately it’s also a pitiful reputation that’s mostly warranted, with a single medical doctor per 100,000 people across the country. For a sense of reference, the healthiest country in the SPI index (the U.K.) has a score of 68.1. Ethiopia’s fraction of that comes from an average lifespan of 48, and chronic disease spreading in poor areas augmented by pervasive superstitions around causes and cures for illness.
That you contract gonorrhea from touching a stone covered in female dog urine is a common belief in some rural communities. In others, eating a black goat’s reproductive organs will cure the same part of your own body. To most of the world, these beliefs extend beyond the absurd and ridiculous. But perhaps the greater absurdity is a country caught between antiquated lifestyles and challenges of the modern age; hundreds of millions forced to fight off new world diseases without new world cures or access to education.