Spain has been ranked as the healthiest country by the 2019 edition of the Bloomberg Healthiest Country Index.

The index evaluates 169 economies according to factors that affect overall health. In the previous index, which was released in 2017, Spain had placed in sixth place.

The other countries forming part of the top 10 are as follows: Italy (second place), Iceland (third place), Japan (fourth), Switzerland (fifth), Sweden (sixth), Australia (seventh), Singapore (eighth), Norway (ninth) and Israel (tenth).

Factors taken into consideration include life expectancy and penalties of risks including tobacco use and obesity. Environmental factors such as access to clean water and sanitation are also taken into account.

United Nations data revealed that among European Union nations, Spain boasts the highest life expectancy and is only surpassed by Japan and Switzerland on a global scale. Additionally, the University of Washington’s Institute for Health Metrics and Evaluation revealed that by 2040, Spain is also expected to have the highest lifespan, at almost 86 years.

The European Observatory on Health Systems and Policies 2018 review of Spain said: “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.”

Eating habits could also be particularly influential, with a study conducted by the University of Navarra Medical School saying a “Mediterranean diet, supplemented with extra-virgin olive oil or nuts, had a lower rate of major cardiovascular events than those assigned to a reduced-fat diet.”

On the other hand, North America lagged behind its European counterparts. Aside from Canada placing 16th, the results recorded in the U.S. and Mexico – which fell to 35th and 53rd place respectively – were not as successful.

While Japan ranked as the healthiest Asian country, China climbed three rankings to 52nd.

As for the unhealthiest nations, Sub-Saharan economies made up 27 out of the 30 worst. The remaining three were Haiti, Afghanistan and Yemen.