What Country In The World Has The Best Public Health Care System As Well As Top Surgeons?

This question was originally posted on Quora.com and was answered by Boris Ezomo, Surgeon who still knows his basic medicine



“What country in the world has the best public health care system as well as top surgeons etc?”

In the medical profession, we use the Infant mortality rate as an indicator of how good the public health is.

Infant mortality is the death of young children under the age of one. This death toll is measured by the infant mortality rate (IMR), which is the number of deaths of children under one year of age per 1000 live births.

I will explain why this is the only true indicator.

When children die because of congenital (diseases you are born with) disease, it affects equally the whole human race irrespective of country.

Poor post natal care, poor access to doctors and health workers, poverty, lack of vaccinations, etc., is what can cause a child under one to die. This varies from country to country and is affected by politics and the ability to provide good public health.

The life expectancy that non professionals like to quote as evidence of health care is very, very wrong. As an example, the life expectancy is much higher in Mediterranean and Black Sea countries. This is due to the diet, while the lower life expectancy rate among males in Russia is mainly due to alcohol and tobacco related diseases. In other words, environment is a more important reason for how long you live and not the health care. In other words, have the best doctors look after you while you smoke two packs of cigarettes a day. You will still die from respiratory diseases long before your time.

So here you go. The greener the shade, the fewer children die. The redder, the more children die before the age of one.



I will extract a few key ones for comparison.

Worst is Afghanistan where 121 children die out of every 1000.

The best is Monaco at 1.8 children. We like to ignore them because of the small population, and in statistics we do not like small numbers.

So the next statistically sound representation is Japan with only 2.2 deaths.

How do the rest measure up?

Cuba is 4.4 children die out of 1000.

USA is 5.8.

UK it's 4.3.

Slovenia it's 3.8.

Ireland it's 3.8.

Russia it's 6.8.

List of countries by infant and under-five mortality rates

I used the the CIA figures rather than the UN ones to rule out claims of bias.

What it means is that Cuba under sanctions has healthcare superior to that of the U.S. and comparable to Western Europe. With Eastern Europe there has been a large variable ranging from better than the west to slightly worse than western Europe.

Having one super hospital in an area that is not accessible to the general population does not affect the total health of a community.

As for the country with top surgeons, there is no such thing.

Surgery is based on skill. The more you do it, the better you are. If you do a certain number of one particular surgery, you can be rated as an authority, especially if it is a rare procedure. And including other surgeons referring that type of surgery to you.

Naturally, if the right instruments are available is a factor.

So in a country where a certain disease is common, for example vesico-vaginal fistula is common in Nigeria — it does not require any hi-tech equipment. A Nigerian consultant gynaecologist, who does hundreds of those surgeries a year, is a better surgeon than any gynaecologist in the US or UK trying to do the same operation when in the whole country there may only be a hundred cases in total.

Likewise, a knee surgeon doing 100 knee replacements in a small district hospital in Scotland would be regarded as a top surgeon in knee replacements, rated higher than one sitting in a national centre who does only 25 a year.

So there are no countries with top surgeons. Top surgeons vary from one type of surgery to another, which is mainly based on how often they do it.

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