Czech the facts

When the Nanny State Index (which I edit) was published a few months ago, the Czech Republic came at the bottom the league. It is the freest country in the EU for smoking, drinking, vaping and eating food, and this freedom does not seem to do the Czechs any harm. One of the findings from the Index was that there is no correlation between nanny state scores and life expectancy. Despite the Czech Republic's relative lack of lifestyle regulation, its citizens are not noticeably unhealthy; ten out of the 28 EU countries have lower life expectancies.

So I was surprised to read last week that the Czechs are not only the unhealthiest people in the EU but are the unhealthiest people in the world. And my flabber was well and truly gasted when I heard that the healthiest country in the world was none other than Afghanistan, with Eritrea, Malawi and Somalia all making it into the top ten.

Suspecting that the results had been misreported by the newspapers I looked for the source and was led to a report produced by an organisation called Clinic Compare. And there it was in black and white: 'The Czech Republic was exposed as the most unhealthy country in the world... Residents of Afghanistan were named the healthiest'.

What eccentric methodology was used to put the Aghans at the healthiest end of the spectrum and the Czechs at the unhealthiest? It turned out that the report's authors simply assumed that countries with high rates of alcohol consumption, smoking and obesity were sick while those with low rates of alcohol consumption, smoking and obesity were healthy. No other criteria were used.

This is the lifestyle theory of medicine turned up to eleven. Never mind hunger and disease. Never mind violence and malnutrition. If a nation doesn't comply with the three tenets of western 'public health' puritanism it is unhealthy per se.

And yet if you look at people's actual health, the reality is rather different. Life expectancy in Afghanistan is currently 61 years. In the Czech Republic, it is 79 years. The adult mortality rate in Afghanistan is 260 per 1,000 people. In the Czech Republic, it is 84 per 1,000 people. The infant mortality rate in Afghanistan is 6.6 per cent. In the Czech Republic, it is 0.3 per cent.

But alcohol is banned in Afghanistan, very few women smoke, and people are too poor to be fat so it is a 'public health' utopia, right? Similarly, Niger might come second to bottom in the United Nation's Human Development Index but its people are careful to avoid 'lifestyle-related diseases' by dying, on average, twenty years earlier than the people of Luxembourg. Consequently, Niger is the third healthiest country in the world while Luxembourg is the ninth unhealthiest.

This is clearly bonkers but it is what happens when you mistake inputs for outcomes. The 'public health' lobby has become obsessed with three modifiable lifestyle factors - alcohol, obesity and tobacco. Unable to see beyond this trio of risk factors for diseases of affluence and old age, there are some who have convinced themselves that they are all that matters.

Taken to its logical conclusion, this tunnel-vision leads to bizarre pronouncements, such as when the Director-General of the World Health Organisation visited North Korea and complimented the regime on how few fat people she observed or when Oxfam described Ethiopia as the 'best country' for obesity.

Under no reasonable criteria is the Czech Republic the most unhealthy country in the EU, let alone the world. Perhaps it would be if 'public health' dogma was correct, but that says more about the dogma than the country. A more credible input-based ranking system suggests that the Czech Republic is the 30th most healthy country in the world (the UK is 23rd). If we use life expectancy as the sole measure, it comes 35th. Either way, it is comfortably inside the top quartile.

In fairness, we cannot blame the 'public health' lobby for this particular piece of misinformation. Clinic Compare is a price comparison website for cosmetic surgery which promises to give customers 'the first step towards a new you'. It may not be the most reliable source of global health statistics, but that did not stop the Evening Standard, the Independent and numerous other global media outlets repeating its nonsense verbatim.

It is slightly worrying that none of the journalists who covered the story asked themselves whether it passed the smell test, but so much quackery, garbage and clickbait crosses their desk under the umbrella of 'health news' that it is no surprise if they have become desensistised to piffle.


First published at Spectator Health