Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
4 Nov

The World’s Healthiest Countries (and What We Can Learn From Them)

More than anything, the Primal Blueprint is a pragmatic approach to diet and lifestyle. It is not dogma; rather, it is based on empirical evidence suggesting that following the diet and many lifestyle behaviors of our early ancestors is the healthiest way to live. Though we keep abreast of the latest scientific news, how we feel when we eat, exercise, and live Primally is what motivates us to follow the Primal Blueprint. Results matter, and so we feel it might be useful to take a look at some of the healthiest countries in the world and understand what works for them.

We’ve drawn from several recent surveys of the healthiest countries. The Forbes survey, for example, focused almost entirely on healthcare, life expectancy, and air quality, which are certainly important issues – but how much can we really learn when the top ten countries all make the list for the same reasons? The Foreign Policy and Men’s Health lists offered different perspectives, tending to focus on nutrition and exercise. By looking at all three, I think you’ll get a fairly complete picture of what works, and what doesn’t work, to make these countries the healthiest.

Here are our top 10 countries (America not included) in no particular order:


With an average life expectancy of 86 for women and 79 for men, Japan has some of the longest-lived citizens in the world. And amazingly enough, much of Japan no longer features the bucolic, serene environments of the Kurosawa films that many assume still flourish. Japanese business culture has grown high stress and impacted, but the healthy diet – rich in seaweed and fish – has remained the same. Government-sponsored exercise programs contribute to the longevity, too.

What can we learn from Japan? Eat fish and exercise – so basically, just keep doing what we’ve been doing.


Men’s Fitness gave the Outback its top ranking. Their reasoning? The low rates of heart disease, stroke, and high blood pressure resulting from all the volleyball they play and steak they eat. Huh? A mainstream mag promoting red meat consumption? Amazing! What they fail to mention is that much of Australia’s cattle is range-fed, meaning most of their steak is raised the way nature intended.

Not that we needed to tell you, but intense bouts of exercise – like in beach volleyball – and grass-fed steaks are perfect for the Primal lifestyle.


Sweden’s claim to good health is pretty undeniable: high cancer survival rates and excellent children’s healthcare. And their public healthcare is famously comprehensive, owing in part to the high government spending. But plenty of other countries have universal healthcare with less impressive results. Why is that? Sweden approaches healthcare from a holistic point of view, knowing that happier citizens are healthier citizens. From well-lit public places promoting evening walks to creating happier professional lives for its workers, Sweden understands the Primal idea that health isn’t just about medicine.


Sometimes, it’s not what you eat that’s important, but how you eat it. Greece puts heavy emphasis on the social aspect of dining. A meal is to be enjoyed, savored. And, in turn, the relaxation that accompanies a nice leisurely dinner aids in digestion. Now, though we doubt Primal man was much of a slow eater, not having to watch your surroundings for possible predators and being able to enjoy your food would have been a luxury even Grok would welcome. Don’t forget that eating is a social activity; eat Primally, but do so with friends and loved ones.


Shopping for the day’s groceries in Italy often means making several stops – at the butcher, the grocer, the baker. The Costcos and Ralph’s are few and far between, meaning that the focus is on fresh, unprocessed foods. Go to an American grocery store and you’ll be assaulted by cans, packages, and Styrofoam (as well as fresh vegetables and meats, provided you stick to the perimeter); but in Italy, you simply aren’t inundated with all the processed, pre-packaged food. And that means buying fresh, whole foods becomes an everyday part of life.


Just like Sweden, Iceland places a heavy emphasis on healthcare, offering extensive pre- and post- birth healthcare for mother and child. The result? The world’s healthiest infants, with just two deaths before the age of five for every 1,000 births. Primal man knew the evolutionary imperative of providing for your offspring, and so does Iceland. Parents are also guaranteed three months of paid professional leave for every child, which undoubtedly makes for happy families.


Longtime trade embargo notwithstanding, Cuba enjoys some of the best healthcare in the world. Cuban healthcare focuses on early detection and prevention. Medicine and medical equipment are often in short supply, making prevention a necessity. Cuba highlights the effectiveness of such a strategy. If Cuba can keep its citizens healthy despite the embargo and substandard equipment, what does that say about the American tradition of popping pills and chronic treatment? It sounds like maybe Primal, healthy living is the best healthcare around.


Thirty years ago, Finland had the highest death rate from heart disease among men – about 5 deaths per 1,000. Local governments began promoting healthy living, and today, fruit and vegetable intake has more than doubled. Smoking has dwindled, too. Nowadays, Finland men have a heart disease death rate about average for the region – 1 per 1,000 – and one of the lowest infant mortality rates. Just goes to show what a little focus on fresh whole foods and clean living can do.


All the usual culprits are here: nationalized healthcare, high tax rates, fresh, whole foods. So it’s no surprise that Germany ranks among the world’s healthiest countries. But Germany also has incredibly clean air, promoting a very active, outdoorsy culture that relishes walking and bike riding. Fresh, whole foods and clean air – what’s not to like?


Experts marvel at France’s low rates of heart disease in spite of the high fat content of its cuisine. Conventional wisdom says fat = bad! Of course, fat’s never turned us off, but it’s nice to see it being praised, rather than demonized. France also tends to eat longer, slower meals and use fresh, whole ingredients.

What activities, habits, or traditions of cultures around the world have caught your eye as being particularly health? Hit us up with a comment in the boards!

Further Reading:

A Sanitized World is a Healthier World?

Deconstructing Healthcare in America – A Modest Proposal

Healthy Tastes Great! – Japanese Cuisine

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. To vouch for Italy – I lived there for 8 months and with as many carbs (pasta, bread, pizza, etc) as I was eating every day I definitely should have gained a ton of weight – but I didn’t. I honestly attribute that to how fresh and unprocessed their foods were (even the pastas!). (As a side note, its a lot easier not eating pasta in the U.S. anymore, because, honestly, nothing can compare).

    Holly wrote on November 4th, 2008
  2. Very interesting article Mark! Thanks for the post. I can’t wait to visit these places.

    All the Best,

    Andrew R

    Andrew R wrote on November 4th, 2008
  3. Interesting how much emphasis is placed on rice in Japan yet they certainly don’t have an obesity issue. What am I missing?

    Jim Jones wrote on November 4th, 2008
  4. Aaron wrote on November 4th, 2008
  5. Men’s Fitness may want to take a second look at Australia.

    Like the U.S. and Canada and the U.K., etc…Australia has seen it’s obesity and type 2 Diabetes rate keep climbing year after year.

    Here is an article from the Sydney Morning Herald –

    DR wrote on November 4th, 2008
  6. A lesser known fact about Greece is that they place great emphasis on greens in their diet. Greens – often cooked with tomatoes, garlic, and onions – are usually a large part of meals. This was probably used as a “filler” in leaner times, but contributes to their healthy lifestyle. And the greens of the old days – and in many places present day – are wild. Also, at least on the islands, the produce and seafood are superfresh – most often picked the same day they are prepared and eaten.

    Alex wrote on November 4th, 2008
    • Regarding Greece, Crete in particular has one of the lowest heart attack rates in the world if not the lowest. Just as I have given up wheat I find they eat huge quanities of bread and beans, with low to moderate consumption of meat and dairy.

      Maybe the huge quantities of olive oil and fresh home grown fruit and veg help. But maybe it means beans and bread and it is whole meal is not so bad.

      I only changed my diet about 6 weeks ago but in that time my cholesterol has gone up from 4 to 5.6. The bad lDL is about 2.5 and i am told I should change back to my old diet. Not convinced either way yet. I never believe what just a few people are saying I have to reaserch and read the studies etc.

      Jan wrote on March 1st, 2013
  7. I love this post and this is very interesting how other countries differ from America. My brother visited Germany and Italy and yes, this post is exactly how he described the people and their diet=”healthy” in these 2 countries. Italy has very thin people, he was there 2 weeks and saw no one ever eating junk food, and they walked alot, very happy, friendly people. YES, we certainly can learn from these top 10 countries that are the healthiest in diet and lifestyle. Eating Primal is so healthy, it’s the way to go! Thanks for this very awesome post, i always had high interest in other countries and their cultures, i certainly learned ALOT from this post today!!!!;)

    Donna wrote on November 4th, 2008
  8. Aaron,
    I read the article you sent Jim. It makes me think “both” my grandma’s ate small amounts of rice often and both slim. But, they ate a very healthy diet, lots of fresh vegetables, fruits, meats. One of my grandma’s lived to be 93, my other is still alive at 96 years old.

    Donna wrote on November 4th, 2008
  9. Right now in Sweden we´re having a heated debate about diet and obesity and the old “truths” about how over-weight people should limit fat and stick to fruits and whole wheat etc.
    The Swedish equivelance to the FDA is actually re-viewing their guidelines and may admit that they have actually been wrong all this time…

    A Swedish doctor has stirred a lot of feelings when she a few years ago started recommending her patients a strict LCHF-diet with great results on diabetes and overweight. She was initially criticized and even fired (I think)she is now a groundbreaker…

    And this is in a country where the idea of carbo loading was invented!

    Jonas Colting wrote on November 4th, 2008
  10. in my country (Eastern Europe, post soviet block) during my childchood (late 70s/early 80s) sweets were available in government rations only, I believe 1 or 2 chocolate bars per month. Cola was a luxury – cans were subjects of collections among the well off ones :)

    And those days, in my primary school for 5 classes, ~ 150 kids of age 15 only one or two was overweight, while now when I take my 3 yo daughter to a playground and I look around – every second child has this problem and they don’t wait until their teens – it’s starts at 5-6 now :(

    zbiggy wrote on November 4th, 2008
  11. Where is New Zealand!!!!!! Probably been a bit patriotic but we have free healthcare, clean air, huge outdoors lifestyle and grass fed beef and lamb. Our obesity is behind that of Australia too!!!!

    Dr Dan wrote on November 4th, 2008
  12. Jim Jones, it often comes down to the amounts of rice in the diet. The Japanese eat a little in combination with protein and lots of green vegetables (and a fair amount of daily movement) is OK. When they go to fatten Sumo wrestlers in Japan, however, the major dietary component is rice – thousands of calories worth per day. Yes, they add some beer and some protein, too, but nothing puts on the fat like an abundance of rice.

    Mark Sisson wrote on November 4th, 2008
  13. Seriously speaking, I thought some of france’s and italy’s longevity was attributed to their wine consumption!

    I agree with Dr Dan – NZ has got to be up there.

    I wonder what diabetes rates exist in asia where they typically eat a lot of rice/noodles/carbs (although they do eat lots of fish and veggies).

    Ryan wrote on November 4th, 2008
  14. “eat a lot of rice/noodles/carbs” in Asia means about 2280 kcals per day. These included 360g carbs – according to a 1972 Japanese research mentioned in Gary Taubes’ GCBC.

    At this level of energy intake, I guess it’s not so important high or low carb, it’s just called Calorie Restriction.

    zbiggy wrote on November 4th, 2008
  15. “The Japanese eat a little in combination with protein and lots of green vegetables (and a fair amount of daily movement) is OK. “

    I wouldn’t call 2-3 cups a day “a little.” Every meal in Japan, Korea, and China includes a refined starch, either white rice or noodles. The rice is served in bowls about the size of one cup. They do eat animal protein and freshly prepared or pickled vegetables at every meal, including breakfast. Before I ever heard about LC, I discovered it on my own while losing weight in Korea. I had plateaued while trying to lose that last ten pounds. Looking at my plate, I chose to cut the rice portion in half because it contained less nutrition than the veggies and the small portion of animal protein. The owner of a boarding house where I was staying commented that the tiny dollop of rice on my plate must be the reason why my stomach was flat.

    Sonagi wrote on November 4th, 2008
  16. I think it is also interesting to note the decline of health in some of these countries as they become “westernized”. I remember reading an article somewhere on the McDonalds in Japan carrying a double big mac or something ike that. My in-laws are from Thailand and the Philippines and can both attest to how much “fatter” and unhealthier people have gotten since adopting a more “western” diet. And yes, some wahoos came in years ago and preached how bad the coconut is for you and so many southeast asians are cutting back on the coconut despite it working for them for generations.

    Son of Grok wrote on November 4th, 2008
  17. I follow the LC diet and PB style but living in Asia and originally from a Mediterranean country sometimes I wonder how bad eating rice or pasta can be. Japan, Italy, Spain,…most great cooking countries have a strong dependency on pasta, rice and bread. The things in common between Med and Asia healthy styles are i) the absence of processed foods, ii) adoration for natural ingredients iii) enjoyment of eating as a social event and iv) some level of wine/alcohol consumption during meals. Mark,it is not obvious to me the relation between low carb (in the form of rice, bread and pasta) and the success of these healthy countries diet. The thought of these starches being unhealthy would shock any proud Italian Mamma (and its Japanese equivalent)!

    Oscar wrote on November 4th, 2008
  18. Not sure I agree about Australia. We do like our steak, and we have been known to play volleyball, but I think the laidback lifestyle and the determination to sneak days off and dodge work any chance we get probably has the biggest part to do with why we aren’t keeling over left and right! :)

    Jamie Atlas from Fitness Insights

    Fitness Insights wrote on November 5th, 2008
  19. Nice to see Australia so high on the list!

    Andrew(AJH) wrote on November 5th, 2008
  20. Nice to see Sweden up there (though I’m not Swedish).
    I just think it’s great that their Government guidelines now accept the fact that a high fat, low carb diet is healthy.
    Hopefully it’s the first country of many.
    Mark from

    Mark McManus wrote on November 5th, 2008
  21. Speaking about eating pasta in Italy as a sublime experience, I too, can agree.

    I used to think it was because I was so happily enjoying my vacation and the relaxed atmosphere of meals, but there is another difference.

    Last November, we visited the De Cecco factory in Abruzzo and learned that there are two countries which require a different formulation and have their own production lines…Japan and the USA.

    When all flour products in the US became “enriched,” the USDA also required that pasta imported by the US be made from enriched flour.

    We came home with a suitcase of specialty pastas available only to restaurants and specialty shops.

    Conversely, when our friends visit, they think the American version of De Cecco tastes strange and has a different texture.

    Pat wrote on November 5th, 2008
  22. Dear Mark,

    I love your blog, I saw it on Mizfits post. I loved all the info you gave us! As a runner/cyclist and health freak, I love learning more and more about our bodies. Thanks so much I am adding you to my blogroll!!!

    bobbi wrote on November 5th, 2008
  23. Mark,
    what about the okanowans of japan whats there secret?


    Bill wrote on November 5th, 2008
  24. I’m a firm believer that people who don’t let themselves get stressed out over things add to longevity. Learning how to control stress as much as possible is a key to being healthier in addition to eating Primal and exercising!!!!

    Donna wrote on November 5th, 2008
  25. Donna,

    Managing my stress came naturally through practicing the PB. I am thinking it is probably mostly hormonal, but suddenly I am just not as stressed out as I used to be.

    Son of Grok wrote on November 5th, 2008
  26. Son of Grok,
    That’s great! Oh yes, eating Primal does wanders. Eating bad food affects one’s mood just as eating healthy food does the same.
    I’m so proud of you that you’re controlling stress, good for you Son of Grok!!!!

    Donna wrote on November 5th, 2008
  27. You don’t want to get sick in Cuba if you are an average Cuban.

    From Canada’s National Post, which assessed Cuba and its health system in a three-part series:

    “Even the most commonly available pharmaceutical items in the U.S., such as Aspirin and rubbing alcohol, are conspicuously absent [in Cuba]… Antibiotics… are in extremely short supply and available only on the black market. Aspirin can be purchased only at government-run dollar stores, which carry common medications at a huge markup in U.S. dollars. Cuban defector Dr. Leonel Cordova told the New York Times about his experience practicing in Cuba, “[E]ven if I diagnosed something simple like bronchitis… I couldn’t write a prescription for antibiotics because there were none.”

    “Under the Cuban government’s health care monopoly, the state assumes complete control. Private, non-governmental health facilities, where ailing citizens could buy treatment, are illegal.7 As a result, average Cubans suffer long waits at government hospitals, while many services and technologies are available only to the Cuban party elite and foreign “health tourists” who pay with hard currency. Moreover, access to such rudimentary medicines as antibiotics and Aspirin can be limited, and there are reports that citizens excluded from the foreign-only hospitals often must bring their own bed sheets and blankets while in care”.

    Terry wrote on November 5th, 2008
  28. As an Australian, I was quite suprised to see us so far up the list. I think the main reason we have good health and longevity is due to a better than average health care system, certainly not a better than average diet. We’re definitely following in the footsteps of America in terms of junk food and we work longer hours than ever before, leaving less time for exercise. One of the best things we have going for us is so many immigrants from countries such as Greece, Italy and Vietnam which gives us exposure to a wide range of fresh healthy foods and a greater variety in our diet than some other nations. Still I’d love to see much less processed junk in the supermarkets.

    Louise wrote on November 6th, 2008
  29. I was surprised to see Australia up there. We do love sport, but more as spectators than participants these days and even then it’s a love surpassed by a love of beer. I can count the number of lean middle-aged (50+) men I know on one hand.

    Our obesity rate exceeds that of the US (60% overweight or obese) and diabetes is on the rise. One in three Australians will die of heart disease, another from cancer. Perhaps Men’s Health only spoke to the surviving third?

    Steve C wrote on November 10th, 2008
  30. Just this morning i talked to my brother about this post. He said after visiting Germany “twice” that he believes in his opinion it’s just got to be the #1 healthiest place on earth to live and Germans love Americans. He told me “why” the air is incredibly clean. There’s NO oil refineries, no plants to cause pollution. Their forest is called “Black Forest” because their leaves do not die due to oxygen all year long. Their forest are dark green trees-cedar, evergreen,etc. Looking at the forest in Germany is so dark that’s how it got it’s name. And yes, the Germans eat very healthy, alot of meat and plenty of vegetables, very healthy people, NO obesity. And, he’s had lunch with some Germans and have a beer with lunch-incredibly happy people! Living in Germany is a piece of paradise!!!!

    Donna wrote on November 10th, 2008
    • I lived in Germany by the black forest, for about 14 years and I found that their diet hardly includes any creamy sauces! Salads don’t have any salad cream, they make it with vinegar and oil and all meals go with salads made like this, thus balancing the fat intake. Everything is freshly cooked and fruits are plenty, even the black forest famous cake is not very sweet, but very delicious.
      They have a saying ” Nach dem Essen sollst du schlafen oder 300 schritte laufen.” Which roughly translated means ” after a meal you should sleep or walk 300 steps,
      Sleep will help the digestion, and walking will help the digestion, you chose, just don’t sit around crunching your stomach up!
      An earlier post here suggests that Germans are miserable, this is far from the truth, I found them rather jolly and they like to laugh. God knows who he associated himself with!
      The air is crisp fresh and clean! Winters are cold and crisp too, but no damp that gets to your bones, like in Britain where a lot of people have rheumatism and flu and one cold after another!
      It’s as healthy place to live and if I had the chance, I would live there again. To most of the Germans good health is an attitude. .Brits like to winch and often use Ill health as an excuse. That’s just the way we are!

      Oriet wrote on November 9th, 2015
  31. Wow. I would never have had Australia down as one of the healthiest countries in the world. Interesting article.

    Tom Parker - Free Fitness Tips wrote on November 11th, 2008
  32. …this post really got my attention! how nice living in a healthy country!

    but in asia, especialy in third-world countries, mostly people eat noodles, rice and canned goods. So many of them have diabetes….it is because people have less income that they cant afford to have healthy foods for thier meal. whats important to them is that they can eat wether its a healthy food or not…its really sad to know that many asian children are malnourished..whew!

    please keep on posting about healthy lifestyle 2 encourage others to be healthy….not only for thier own good but also for our mother earth!!!

    BELLE wrote on November 17th, 2008
  33. As an Australian vegetarian female who hasn’t played beach volleyball in 6 years, I think the reasoning behind putting us on the list is bogus, especially as we were labeled “fattest nation” this year.

    Good to see you acknowledge us, though.

    amy wrote on November 27th, 2008
  34. Hey Mark!

    The good news is that many-a-nation send delegations abroad to study successful models. Hopefully it won’t take too long until the whole world will enjoy better health care…

    Great design +_+

    axel g wrote on December 14th, 2008
  35. Volleyball – Australia? You must be kidding. The only time I’ve seen beach volleyball played is when the 2000 Olympics were held in Sydney. I’ve lived in Australia all of my life, and if you were to rate volleyball as one of our national sports, you’d be laughed out of the room. Football (soccer, Aussie Rules, Rugby League and Union), cricket and netball are probably our national sports – mostly watched by the majority, not played. Unfortunately we are following the USA lead of big portions and over-processed foods, but we do have the saving grace of a large number of immigrants from Arabic and Asian countries, bringing their cooking in.

    Did you know that there is a large incidence of diabetes in pregnant Asian women? So much for all that rice and vegetables.

    Chris wrote on January 3rd, 2009
  36. I am from Italy originally (Rome specifically), and went to Paris for the first time. I hadn’t been to Europe in 20 years, so this was almost like going again for the first time. When I got to Paris, I nearly fainted when I had my first croissant. There were things that I noticed that were not in the American food I have become accustomized to. Texture, decadence, flavor, and richness and also satisfaction.

    I noticed that I ate less because the food had SO much more flavor in it. Having a portion 1/2 the size was enough for me. I stayed for 3 weeks and lost 15 lbs with no special effort on losing weight.

    I spoke with this one older gent at a caffe, and asked him why the food tastes so good. He commented on the air, the water, the environment, the attitude. Food thrives there because the Europeans value it so much. The Earth is prized and respected, knowing that it will produce such amazing food. He also commented on how the people have higher standards for food, so garbage quality won’t last. He also said that people let the ingredients do the work, while Americans throw every spice in the cabinet into a dish. Something with few ingredients tastes amazing because the ingredients are of the highest quality. As if to build a monument with the finest materials would produce an amazing structure.

    One day, I pray that the people of the US will DEMAND that our food be valued in such a manner, for every quality of our lives will improve vastly.

    Massimo wrote on June 16th, 2009

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