Scotland is the worst performing small country in Western Europe, according to a report by business leaders.
The Federation of Small Businesses' annual Index of Wealth compared 10 countries on economic performance, employment rates, health and education.
Scotland's life expectancy rate was a major factor in it coming bottom.
FSB Scotland said the new SNP government had its work cut out to improve the nation, but ministers said Scotland "can and will do better".
Scotland also fell by one place, to 17th, in the Organisation for Economic Co-operation and Development's table of the world's 24 most developed countries.
The FSB Scotland index examined countries with fewer than nine million people, including Norway, Iceland and the Republic of Ireland.
The report was written by John McLaren, honorary research fellow at the University of Glasgow.
He said Scotland had fallen one place from ninth after the previous bottom country, Austria, improved its employment rate.
"The reason why Scotland is stuck at the bottom of the pile is largely due to our poor health and our low life expectancy," he said.
Figures released last year by the Office for National Statistics said Scotland had the lowest life expectancy in the UK for both men and women.
The figures were 74.2 for men and 79.3 for women, compared to the UK average of 76.6 and 81 years.
Other statistics released by the Registrar General for Scotland last year showed that life expectancy was rising, but that the gap between rich and poor was widening.
However, Mr McLaren added that even if health was taken out of the equation Scotland would still be "fairly low" on the table, in about fifth or sixth place.
FSB Scotland policy convener Andy Willox said: "The index clearly shows that, on these indicators, Scotland is the worst small country in western Europe, and requires urgent action to improve both our life chances and life expectancy.
There are calls for health to be put at the heart of decision-making
"Coming as it does so soon after the election of an SNP government, this year's index shows the new First Minister Alex Salmond will have his work cut out for him if he is to match reality with his aspiration of making Scotland healthier, wealthier and fairer."
Despite being above average on three of the four indicators, life expectancy in Scotland remains well below the OECD average.
"We are already far down the table of comparator countries, and on every count we are travelling in the wrong direction," Mr Willox added.
"Health, education, the employment rate and economic performance are all interlinked.
"Improvements in health or education should help businesses recruit and retain healthy and highly skilled staff, thus boosting productivity and ultimately economic growth."
The index showed Glasgow City is the worst performing local authority area in Scotland, with the poorest record in three of the four indicators: mortality, education and employment
Mr Willox added: "That Glasgow is the worst performing part of Scotland on all but one of the indicators is deeply troubling."
Finance Secretary John Swinney said he was not surprised by the report's conclusions.
"This reflects some of the arguments we have put forward for a very long time that Scotland is under-performing," he said.
"This directly challenges some of the rhetoric from the previous government... everything in the garden is far from rosy in Scotland.
"This report is an indication of the scale of the challenge that the government faces."
He said that transforming economic growth would address a number of other problems highlighted in the report.
"We have made it very clear that our purpose is to increase susrtainable economic growth in Scotland."
The BMA wants the Scottish Executive to introduce health impact assessments for all government policies.
Living in poverty
Dr Peter Terry, chairman of the BMA in Scotland, said health needed to be put at the heart of decision-making.
"Our public health is affected by a whole range of factors in society," he said.
"It is widely known that people living in poverty or those from disadvantaged communities are more likely to experience poor health."
"Health is improving, although the improvement is greater in more affluent areas."