Seven of the top 10 healthiest countries in the world are in Europe with the rest in Asia, according to the 2019 edition of the Bloomberg Healthiest Countries Index released yesterday. The United States placed 35th out of the 169 countries on the list, which was topped by Spain.

The index has the 10 healthiest countries in the world as (from first to 10th) Spain, Italy, Iceland, Japan Switzerland, Sweden, Australia, Singapore, Norway, and Israel.

The countries on the index were ranked according to health risks (tobacco use, high blood pressure, obesity); the availability of clean water; life expectancy; malnutrition and causes of death. On the other hand, the index imposed penalties on risks such as tobacco use and obesity. It also took into account environmental factors such as access to clean water and sanitation.

Based on these criteria, each country was given a rating out of a top score of 100. As can be expected from this methodology, all of the countries in the top 10 are developed nations with strong economies. It also means the countries at the bottom of the list are all developing nations.

Eating habits might provide clues to health levels enjoyed by Italy and Spain, said researchers. The healthy eating habits Italians and Spaniards are noted for include the Mediterranean diet, supplemented with extra-virgin olive oil or.

The diet is probably a factor in Spain having the highest life expectancy at birth among the 27 countries that are members of the European Union. By 2040, Spain is forecast to have the longest life expectancy in the world at almost 86 years. Behind it will be Japan, Singapore, and Switzerland.

"Primary care is essentially provided by public providers, specialized family doctors and staff nurses, who provide preventive services to children, women and elderly patients, and acute and chronic care," said a 2018 review of Spain by the European Observatory on Health Systems and Policies. Spain has posted a welcome decline in cardiovascular diseases and deaths from cancer.

As might be expected, wealthy Japan was the healthiest Asian nation. It jumped three places from the 2017 survey into fourth and replaced Singapore, which fell to eighth.

During the last ranking in 2017, Italy ranked the highest and was, therefore, the healthiest country in the world. In the 2019 edition, Italy scored over 93 points and had a life expectancy over 80 years.