What do the healthiest countries have in common?

Although each of the ten countries has its own institutional history, several structural factors appear again and again in places with the highest healthy life expectancy:

• Universal health coverage and strong primary care. All of the leaders combine broad population coverage with a strong emphasis on early detection and continuous management of chronic disease. Robust primary care limits complications that lead to prolonged disability.
• Low mid-life mortality from NCDs. Countries such as Japan, Spain and Israel have relatively low rates of premature death from cardiovascular disease and certain cancers. This translates into more years lived to older ages and a higher share of those years in good health.
• Favourable social determinants of health. High incomes, lower poverty, higher educational attainment and strong social safety nets reduce exposure to harmful working conditions, environmental risks and catastrophic out-of-pocket spending on health.
• Health-conscious lifestyles and environments. Diet patterns (for example, Mediterranean diets in Spain and Italy, or traditional diets in Japan), low smoking prevalence in recent cohorts and opportunities for physical activity support healthy ageing.
• Data systems and governance. High-performing systems invest in health information, screening registries and continuous quality improvement. This allows them to respond faster to new risks and to target interventions to groups with the largest health gaps.

These drivers are important not only for increasing life expectancy but particularly for keeping the additional years as healthy as possible. For countries looking to close the HALE gap, investing in primary care, prevention and equitable access to services is usually more effective than focusing only on hospital-based treatment at very old ages.