This week, I’d like to break from tradition and start by divulging a personal fact. And that is: I’m a firm believer that rugby is the greatest sport ever invented. Yes. I’ve been playing rugby since my first year in high school and, to this day, continue to play fly half at amateur level for Sefton RUFC in Merseyside.

As you can probably guess, there are few events I eagerly anticipate more than the Rugby World Cup, which, as it happens started last week.

However, on the blog this week, I wanted to bring my passion for rugby together with my interests as a GP; so myself and the team have been hard at work, assembling what we call The Rugby World Cup of Health.

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We thought it would be interesting to compare and analyse the health profiles of all 20 participating countries, and share this data with you. This year, the playing field provides a wide and varied range of nations from across the globe, with markedly different cultures and healthy living habits.

So, we researched available data for each country on a range of measurements, such as alcohol consumption, mean BMI, and air quality score. We assembled these into four separate categories: Weight Management; Life Span; Alcohol and Tobacco; and Health Services.

Then, we allocated points for each of the 13 indicators; where a nation placed bottom, we issued 0 points; where they placed second from bottom, 1 points; and so on. For first place, we issued 19 points, plus one bonus point.

As well as compiling an overall leaderboard, we thought it might be interesting to see the world cup would play out, based on these scores.

Here’s what we found:


Weight management:

RWC weight managment


  • Of the nations analysed, Japan had the healthiest figures in all three measures. In terms of obesity prevalence, Japan’s figure was half that of second-placed Namibia, and around a quarter of most of the analysed European states. One has to presume that this could be, at least in part, attributed to the ‘typical Japanese diet’, high in fresh fish and vegetables; but also perhaps to healthier attitudes toward food (more particularly portion sizes) in general.
  • Island states, such as Samoa and Tonga, had the highest prevalence of obesity and highest mean BMI. The topic of high obesity rates in certain pacific islands has been one of much debate among health experts, and there are several theories as to why it is so prevalent. Despite a diet which has historically been abundant in fresh fish, one theory, particularly in the case of Samoa, points towards the ‘westernisation’ of the culture; which has brought fast food and labour-saving devices to a relatively small (and, some think, thereby more culturally susceptible) population. Others have pointed toward the limited land mass available on these islands and resultant limited capacity to generate fresh produce as a possible cause. Another much-debated theory is the oft-supposed genetic predisposition to obesity among the islander population, however evidence to support this is not conclusive.
  • The obesity epidemic in the US has been well documented, but New Zealand’s appearance so far down the table may come as a shock to many. With the data available, it is difficult to determine why the issue is such a pertinent one in New Zealand. Possible factors might include; the growing population of older people; or more worryingly, as suggested by an Auckland University professor in a Guardian article earlier this year, the increasing availability and cheapness of fast food.


Life span:

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  • A popular location for retirees, it should come as no surprise that Australia performs so well in the life span category. With a significant aging population, the country’s health facilities are well-geared towards the treatment of older people.
  • Japan had the longest overall life expectancy of the countries analysed, which you have to believe is significantly attributable to its favourable weight management figures.
  • The link between poor air quality and potential health problems is evidenced in countries such as Romania and Georgia, where pollution is high and life expectancy is comparatively shorter than in the other nations we analysed.


Alcohol and tobacco

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  • As a less Westernised culture, alcohol consumption and tobacco are not inherent cultural fixtures in Fijian everyday life. (What’s more, the Fiji alcohol consumption figure stated actually includes tourist consumption.)
  • On Pacific Islands Tonga and Samoa, alcohol consumption is also low, but tobacco use is very high. This may, again, be the impact of Westernisation in evidence.
  • Without wanting to brandish stereotypes, France’s historically receptive cultural attitude to wine is well-known, and evidenced here. But this can also be said for other Western European countries analysed, such as the UK and Ireland. In the UK, a culture of binge-drinking obviously plays a pivotal in this comparatively high alcohol consumption figure.
  • France’s prevalence of smokers has contributed to a lower position on the table, but this figure, while high, is not significantly higher than that of the many other countries listed.
  • The UK as a whole would have fared worse, if smoking figures were included from the same recorded time as the other nations. Smoking figures from the UK individual member states were available from as recently as 2013; whereas for the rest of the world, the most recent available data was from 2008. In this time, smoking prevalence in the UK has dropped dramatically, from approximately 28% to 20% overall. This falling trend may also be present in other countries; however comparable (more recent) data which was consistent across each participating country was not available. The UK nations’ relatively respectable scoring in the smoking category does therefore not serve as a wholly accurate comparison; however, it does serve to demonstrate the significant drop in smoking prevalence which has occurred since the 2007 indoor smoking ban, and this is certainly favourable news.


Health services:

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  • Can the US’s high health spending figure be attributed to its high pricing at point of patient care? Perhaps. But a high obesity prevalence, and presence of related health issues such as diabetes and high blood pressure as a consequence of this, may also be helping to push this figure up. The high spend in this respect, while it indicates that health facilities are readily available, may be construed as something of a ‘false positive’.
  • In poorer Pacific Island countries, and less developed countries such as Namibia, healthcare provisions are obviously sparser. However, once again, the reverse argument could also be made that with relatively small populations and a simpler way of living, the need for healthcare in these countries may not be as great as it is in more densely populated nations. But with the high obesity rate present in Samoa and Tonga, it perhaps serves more as an indication that those who are living with obesity-related illnesses on these islands are less likely to seek treatment.
  • Australia’s older population is perhaps an indicator of why healthcare in the country is so well-staffed and accessible.
  • But what about Scotland’s figures? When you pair this information with the country’s somewhat lower life expectancy, is this apparent evidence of high investment in healthcare to be taken as an indicator of high demand, ergo, a generally unhealthier population?



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  • Superior BMI figures, comparatively low alcohol and tobacco consumption and longer life expectancy have sealed it for Japan.
  • Although they didn’t emerge as clearly favourable in any one particular category, Italy and Canada generally performed well across each of the criteria.

On a final note: It is worth remembering that in the pools, not one UK nation managed to make it past the group stage. Let’s hope the story is different when it comes to the real world cup.

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