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Thursday, 9 August, 2001, 21:01 GMT 22:01 UK
NHS 24th in world health league
NHS is not as efficient as Malta health service, say analysts
The UK ranks only 24th in the world when it comes to the efficiency of its health system, according to World Health Organisation (WHO) analysts.

Perhaps surprisingly, the Sultanate of Oman in the Middle East came out on top of the heap.

A more detailed WHO study last year placed the UK 18th in the world.

However the way the "league tables" have been calculated has been criticised by UK health analysts.

The survey, by the Global Programme on Evidence for Health Policy at the World Health Organisation in Geneva, measured the life expectancy in 191 countries against the amount of resources spent per head of population.

They looked at trends in the years between 1993 and 1997.

Country ranking
1: Oman
2: Malta
3: Italy
4: France
5: San Marino
6: Spain
24: UK
72: US
189: Namibia
190: Zambia
191: Zimbabwe
Source: WHO
Several European countries did well, among them Italy, France and Spain, and much smaller states such as Malta, Andorra and San Marino also made the top 10.

The US - home to some of the finest hospitals in the world - managed only a paltry 72nd place.

Oman was nudged to the top by a spectacular performance in reducing child mortality - from 310 per 1,000 births to just 18 per 1,000 over the past four decades.

HIV handicap

The authors of the report conceded that countries with a high prevalence of HIV and Aids gained an artificially low ranking on the table as a result, simply because the effects on average life expectancy were so pronounced.

An accompanying editorial by Professor Martin McKee, from the London School of Hygiene and Tropical Medicine, pointed out flaws in the methods used by the researchers - but said it was right to try to rank the countries, even if the results were not particularly reliable.

Health systems are not simply measured in terms of prolonging life

Tony Harrison, King's Fund
He wrote: "It has invoked the concept of stewardship, which implies a more active involvement in promoting health than most governments have previously assumed.

"It has not, however, provided a valid answer to the question of whether one system is better than another."

Tony Harrison, from the Kings Fund, an independent think tank which specialises in the analysis of health systems, agreed that while the study was an interesting exercise, it could not be relied upon.

He told BBC News Online: "Health systems are not simply measured in terms of prolonging life. There are many treatments - such as cataract removal, for example, which greatly improve quality of life, without necessarily extending it.

"There are, in addition, many other factors which determine good health and longevity, not just the state of the health system."

He added: "I think there is also a degree of diminishing returns for the most modern health systems. Countries like Oman are achieving improvements in mortality which the UK was achieving decades ago.

"Investment of large amounts of money will only produce small improvements in longevity in the UK."

The BBC's health correspondent Neil Bennett
"Most countries at the top of the list have Mediterranean diets"
WHO report's author Dr David Evans
"We took into account resources available to different countries"
See also:

20 Feb 01 | Health
UK children top drugs league
14 Jul 00 | Health
Analysis of NHS performance
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