Below is a list of the top 15 healthiest countries in the world as ranked by Forbes magazine. To arrive at their rank, research staff at Forbes examined statistics such as pollution; the percentage of a country's population with access to improved drinking water and sanitation; infant mortality rates; the rate of prevalence of tuberculosis; the density of physicians per 1,000 people; undernourishment rates; and healthy life expectancy for men. Forbes eliminated from the analysis the countries that did not have statistics in every measure (including some that would likely have made the top 15 such as Ireland, Belgium, and Norway.

The 15 healthiest countries in the world are:

1. Iceland
   This small Scandinavian island in the North Atlantic is the healthiest country in the world due to its long healthy life expectancies, low pollution levels, high density of physicians per capita, and low TB and infant mortality rates.
2. Sweden
   The largest of the Scandinavian countries – both in area and population – Sweden has some of the cleanest air in the world. Its infant mortality rate and TB prevalence are some of the lowest in the world. But the physician density, while relatively high, is not enough to knock Iceland from the top spot.
3. Finland
   Rounding out the top three is yet another Scandinavian country. Finland shares the clean air, low TB prevalence, and low infant mortality rate of its regional brethren ahead of it on the list, but comes up just a little short on those measures to crack the top two.
4. Germany
   The German health care system, one of the best in the world, provides one of the highest physician densities on the list and Germany’s clean air solidifies its position in the top five.
5. Switzerland
   Switzerland has the second-highest health spending per capita of all the countries considered and has one of the world’s highest physician densities and longest healthy life expectancies. However, its air pollution levels are higher than the others in the top five.
6. Australia
   Australia has an excellent health care system that requires insurance companies to charge policyholders the same premiums regardless of their status or past. The country also has some of the world’s cleanest air, but its relatively high TB prevalence keeps it out of the top five.
7. Denmark
   While this forth Scandinavian country to make the list has some of the highest income taxes to help pay for the country’s universal health care coverage, the Danish health care system isn’t very efficient, perhaps due in part to its having one of the lowest physician densities on the list. The country does have one of the highest healthy life expectancies on the list.
8. Canada
   Canadians enjoy one of the world's longest life expectancies despite having the lowest physician density on the list. Our neighbor to the north also has one of the lowest TB rates, but gets marked down for its relatively high infant mortality rate.
9. Austria
   Austria has a relatively high physician density and a low infant mortality rate, but its poor air quality and high TB prevalence prevent it form climbing any higher on the list.
10. Netherlands
    This highly urbanized, densely populated nation suffers from pollution in the water, air, and soil, but its low TB rate and average healthy life expectancy keep in the top ten.
11. United States
    The U.S.far outspends any other country on health care, but 15% of the population still lacks health insurance. However the U.S does have the lowest infant mortality rate in the world, the second-highest healthy life expectancy, and a low TB rate.
12. Israel
    Israel has one of the highest levels of air pollution on the list, but its physician density is the highest in the world and life expectancy is average for the countries on the list.
13. Czech Republic
    The Czech Republic has one of the list’s lowest healthy life expectancies as well and relatively poor sanitation and high TB prevalence. However, the country now boasts one of the world’s lowest infant mortality rates.
14. Spain
    A high physician density, healthy life expectancy, and low infant mortality rate make Spain a pretty healthy place to live, but a high tuberculosis rate and air pollution temper this somewhat.
15. France
    France’s excellent health care system, clean air and high density of physicians per capita landed it on the list, while poor wastewater treatment and a high tuberculosis rate kept France from climbing any higher.

_{Source: Forbes Special Report: World's Healthiest Countries, Allison Van Dusen and Ana Patricia Ferrey, April 08, 2008.
Photo: keeshu, MorgueFIle license}

The following is a list of the healthiest cities in America as ranked by Sperling's BestPlaces and Centrum. The Centrum Healthiest Cities Study is a comprehensive "health report card" of U.S. cities based on the key factors that can contribute to overall well-being.

To compile the list, Sperling’s and Centrum culled data on 50 U.S. cities from both public and private sources and assessed each city against 50 select measures in five major categories: Physical Activity, Health Status, Nutrition, Lifestyle Pursuits, and Mental Wellness.

The top 10 healthiest U.S. cities are:

1. San Jose, CA
   This northern California city gets high marks for mental wellness, low rates of cigarette smoking, and high fruit and vegetable consumption.
2. Washington, DC
   Citizens of the nation’s capital have great overall mental and emotional health, along with good rates of dental care and low average body mass index (BMI).
3. San Francisco, CA
   These Bay Area residents have low average BMI and get lots of physical activity, and the city has the most physicians per capita.
4. Seattle-Bellevue-Everett, WA
   Despite the rain, Northwesterners in the Seattle have the highest physical activity and vigorous exercise of any city and also make the healthiest lifestyle choices.
5. Salt Lake City-Ogden, UT
   Residents of this home to the Mormon Tabernacle have high rates of mental wellness and physical activity.
6. Oakland, CA
   The third Bay Area city to make the list, Oakland boasts high overall health status, good dental care, and low smoking rates.
7. Sacramento, CA
   This inland city in northern California has the lowest rate of asthma and also scores highly on exercise rate and intensity.
8. Orange County, CA
   The smallest (by area) county in California, this southern enclave has high rates of physical activity and also score well in mental wellness and rates of restful sleep.
9. Denver, CO
   Residents of this mile-high city in the Rockies have low BMIs and a high level of physical activity.
10. Austin-San Marcos, TX
    Home the University of Texas, this region scores high in physical activity and has one of the highest numbers of gyms and heath clubs per capita.

For more information on living healthy, join the Healia Health Community for Excercise and Fitness or the Healia Health Community on Diet and Nutrition.

_{Source: Sperling’s Best Places. More information about the methods and resources used can be found here: http://www.bestplaces.net/docs/studies/healthy_methodology.aspx}

Complementary and alternative medicine and therapies have existed for centuries and continue to be practiced today. Treatments include a range of health practices and products from dietary supplements to acupuncture. Some people use these medicines and therapies to treat specific diseases and health conditions, and others use them for holistic or spiritual reasons. Although studies have shown that some complementary and alternative medicine and therapies are effective for certain indications, the effectiveness of most of these therapies has not yet been shown scientifically.

The top 6 complementary and alternative medicines and therapies among American adults in 2007 are:

1. Dietary supplements (17.7% of people): These include a range of herbs, botanicals, vitamins, and minerals such as fish oil, glucosamine, and Echinacea.


2. Deep breathing exercises (12.7%): These exercises involve slow and deep inhalation and exhalation. Deep breathing is believed to relieve stress and provide relaxation.


3. Meditation (9.4%): This ancient discipline has its origins in Eastern spiritual teachings. People are taught to focus their minds to achieve a heightened sense of awareness, tranquility, and balance.


4. Chiropractic treatment (8.6%): Chiropractors attempt to modify the spine and joints to help relieve pain and improve well-being. Common indications are for the back, headaches, and other injuries.


5. Massage (8.3%): Massage therapists knead muscles and tendons to improve function of connective tissues and to promote calmness and pain relief.


6. Yoga (6.1%: Many types of yoga involve controlled breathing, stretching, and meditation to achieve balance physically, mentally, and spiritually.

For additional information, join the Complementary and Alternative Medicine Support Group on Healia Communities


_{Source: CDC, National Health Statistics Reports, No. 12, based on data from the 2007 National Health Interview Survey conducted by the CDC; http://nccam.nih.gov/news/2008/nhsr12.pdf}

_{Photo: judepics, Flickr, Creative Commons}

Many common winter holiday activities can help you burn off the extra calories you consume by eating big meals and holiday treats. Below is a list of winter holiday activities and the number of calories you will burn if you engage in them for one hour. The number of calories burned is based on a person weighing 150 lbs. If you weigh more, you will burn more calories, and if you weigh less you will burn fewer calories.

For more information about physical activity, join the Healia Health Community on Exercise and Fitness.

_{Source: Indiana State Department of Health www.in.gov/isdh/}

_{Photo: Derek Faulkner, Flickr, Creative Commons}

Bad breath can be unpleasant but it may also be more than just a nuisance. It can signal a change in the body and may even be a sign of a serious disease. The following is a list of the main causes of bad breath, some of which you may find surprising:

• Foods
  You are likely aware that certain foods can cause bad breath, onions and garlic for example. But the breakdown of food particles from some less flavorful foods can also cause odor. Foods high in protein like meat and nuts as well as dairy products are produce amino acids that bacteria along the gastrointestinal tract use for fuel. The byproduct of this is a foul smell. Eating foods that contain volatile oils, including garlic, onions, and several other vegetables and spices, causes you to emit these oils form your lungs until the food has passed through your body, meaning they can cause bad breath for as long as three days!


• Dental problems
  Poor oral hygiene can cause food particles remain in your mouth where they form a thin film called plaque. These bacteria emit hydrogen sulfide vapors, the same gas responsible for the sulfur smell in rotten eggs. Also, if you have gum disease (gingivitis or periodontitis) it can cause bad breath, regardless of your oral hygiene.


• Dry Mouth
  Saliva cleanses your mouth and without it, dead cells and bacteria can accumulate in your mouth. This happens naturally as we sleep, leading to the familiar “morning breath,” especially if you sleep with your mouth open. Other natural causes of dry mouth include aging and reduced chewing.


• Medications
  Several medications can reduce your saliva production, causing dry mouth and bad breath. Dry mouth is one of the most commonly listed side effects of medications and can occur when taking antidepressants, diuretics, antihistamines, beta blockers, chemotherapy drugs used to treat cancer, and even aspirin.


• Mouth breathing
  Day or night, breathing through your mouth can dry it out, causing bad breath. Some people breathe through their mouths naturally, while others do so because of a medical issue such as sleep apnea, snoring, or asthma.


• Respiratory tract infections
  Infections of the upper or lower respiratory tract can lead to bad breath. In addition to oral infections such as tooth and gum disease mentioned above, this may include sinus infections that cause a buildup of bacteria in the sinuses and result in post-nasal drainage into the back of your throat; throat infections such as strep throat; and even bronchitis. All of these conditions cause mucus production that can feed bacteria living along the respiratory tract.


• Chronic diseases
  Ongoing disease conditions may also cause bad breath. Chronic lung infections can cause a very foul odor to the breath, but so can several diseases that are not directly related to the respiratory tract. Some cancers can cause a distinctive breath odor. Kidney failure, which prevents the body from eliminating waste products, can cause a urine-like odor to the breath, and liver failure, which prevents the body from detoxifying chemicals, may cause a fishy odor. Gastroesophageal reflux disease (GERD), which causes stomach contents to flow up into the esophagus, can cause bad breath. Metabolic disorders such as uncontrolled diabetes can cause the breath to have a fruity smell.


• Very low carbohydrate diet
  If you don’t eat enough carbohydrates (sugars), either because you skip meals or you are on a low carb diet, your breath may take on the same fruity smell as someone with uncontrolled diabetes. In both cases, the body lacks carbohydrates to provide energy to the brain so it begins breaking down proteins and fats to make new carbs, a process which creates ketone bodies as a byproduct. The substances accumulate in the body (ketosis or ketoacidosis) and are excreted in the breath.


• Tobacco products
  Smoking dries out your mouth and causes its own unpleasant mouth odor. Both smking and chewing tobacco increase the risk of gum disease and tooth decay, which also cause bad breath.


• Alcohol
  Alcohol consumption can dry out the mouth, leading to bad breath. Also, consuming too much alcohol can make you more likely to snore or sleep with your mouth open, further drying out the mouth and causing bad morning breath.

_{Sources: Mayo Clinic, www.mayoclinic.com; U.S. News and World Report, "8 Surprising Causes of Bad Breath" By Megan Johnson, December 2, 2008.}

_{Photo: lastrandy, Flickr, Creative Commons}

The following is a list of the bestselling prescription medications worldwide in the year 2006 ranked by global sales. Brand names appear in bold, followed by generic names in parentheses and approximate global sales in billions of 2006 U.S. Dollars.

The top 10 bestselling prescription medicines are:

1. Lipitor (atorvastatin) - $14.4 billion in sales
   Cholesterol-lowering statin drug has been the world’s bestselling drug for seven years in a row. (Approved in December 1996)


2. Advair (fluticasone/salmeterol) - $6.1 billion
   Long-acting asthma control medication combines a medicine that treats inflammation with one that helps open up the airways. (August 2000)


3. Plavix (clopidogrel) - $6.1 billion
   Anti-clotting drug helps treat cardiovascular diseases caused by narrowing of the arteries in the heart, extremities, and brain. (November 1997)


4. Nexium (esomeprazole) - $5.2 billion
   Bestseller in the class of drugs called proton pump inhibitors (PPIs) that reduce stomach acidity for people with ulcers or gastroesophageal reflux disease (GERD). (March 2000)


5. Norvasc (amlodipine) - $4.9 billion
   Calcium channel blocker treats high blood pressure by reducing smooth muscle tension in the arteries; can also relieve the pain of angina. (July 1992)


6. Remicade (infliximab) - $4.4 billion
   Helps reduce inflammation caused by autoimmune disorders, especially rheumatoid arthritis. (August 1998)


7. Enbrel(etanercept) - $4.4 billion
   Similar to Remicade, Enbrel treats autoimmune diseases like rheumatoid arthritis by preventing inflammation. (November 1998)


8. Zyprexa (olanzapine) - $4.4 billion
   Newer-generation antipsychotic drug used to treat schizophrenia and bipolar disorder. (September 1996)


9. Diovan (valsartan) - $4.4 billion
   Angiotensin receptor blocker treats high blood pressure and congestive heart failure. (December 1996)


10. Risperdal (risperidone) - $3.9 billion
    Similar to Zyprexa, this antipsychotic drug is used to treat schizophrenia. (December 1993)

_{Source: MedAdNews 200 - World's Best-Selling Medicines, MedAdNews, July 2007 http://www.medadnews.com/}

_{Photo: Brooks Elliott, Flickr, Creative Commons}

This year, several states in the South rank as the least healthy states in the United States. Every year, America’s Health Rankings, a collaborative partnership between United Health Foundation, the American Public Health Association, and Partnership for Prevention, provides an annual analysis of national health on a state-by-state basis, ranking them from the most to the least healthy. Researchers analyzed 22 different health measures, which are a combination of health determinants and health outcomes, to compile the rankings. Health determinants are factors that can affect the future health of a population. Health outcomes measure what has already occurred, either through death or missed days due to illness.

This year’s top 10 least healthy states are:

1. Louisiana
   Louisiana tops this year’s list of least healthy states, the same spot it occupied in the first rankings done in 1990. While the state does not rate worst on any single measure, it has the second highest number of cancer deaths and premature deaths as well as the second highest level of infant mortality. In addition, it makes the top 5 in obesity rate, violent crime, child poverty, rate of people uninsured, infectious diseases, and preventable hospitalizations. Bright spots are low levels of binge drinking and low numbers or poor mental health days.


2. Mississippi
   Louisiana’s neighbor Mississippi is runner up for least healthy state, as it was 19 years ago, although that is one spot better than last year when it topped the list. Having these two states top the list is not surprising because the Mississippi River delta is one of the poorest regions in America. Mississippi is worst in obesity rate, child poverty, and rate of cardiovascular –related deaths, second worst in number of poor mental days, infant mortality, and premature deaths. On the good side, the state is actually fourth best for low binge drinking rates and ranks in the top 15 for low levels of violent crime.


3. South Carolina
   Up six spots from last year, South Carolina is another Southern state with serious health issues. The state ranks worst in violent crime rate and second worst in high school graduation rate, and it is in the top ten for obesity rates, occupational fatalities, child poverty, infant mortality, and premature deaths. However, public health funding and immunization coverage are above average along with a low rate of binge drinking.


4. Tennessee
   Up one spot from last year, Tennessee is third worst on the list for violent crime and infant mortality, fourth worst in obesity and cancer deaths, and fifth worst for smoking, preventable hospitalizations, and cardiovascular deaths. On the plus side, Tennessee is tied for the lowest rate of binge drinking.


5. Texas
   Nine spots worse than last year, Texas has the second highest rate of child poverty in the nation and ranks worst in health insurance coverage. Bright spots include above average rankings in smoking, binge drinking, infant mortality rate, and cancer deaths.


6. Florida
   Florida ranks second worst for geographic disparity (differences in mortality rates among counties), third worst in infectious disease and health insurance coverage rates, and has the fifth highest rate of violent crime. Some positives include top ten rankings in obesity rates, air pollution, and immunization coverage.


7. Oklahoma
   Improving four spots from last year (but still 12 spots worse than the initial survey in 1990), Oklahoma has the second lowest number of primary care physicians per capita, the second highest rate of cardiovascular-related deaths, and the third highest smoking rate. The State is average in several areas including high school graduation rate, infectious disease rates, and air pollution. It ranks in the top 15 for lowest binge drinking rate and highest per capita public health funding.


8. Arkansas
   A success story on the list, Arkansas improved five spots this year and ranks 2 spots above its 1990 placement. Fifth worst in immunization coverage, Arkansas also has the sixth highest rate of obesity, occupational fatalities, poor physical health days, and premature deaths. The state is average in public health funding and geographic disparity and has the seventh lowest binge drinking rate of any state.


9. Nevada
   The lone Western state on the list is also the only state outside of the southern region to make the list. Nevada has the worst high school graduation rate in the nation, the only state with a rate below 60%, and also the worst immunization coverage. Nevada has the third most violent crime and the third lowest public health funding. On the other hand, it ranks in the top 15 for low air pollution, obesity rates, and preventable hospitalizations.


10. Georgia
    The Peach State is the worst for air pollution and also has the third lowest high school graduation rate in the nation and the fourth highest rate of infectious disease. The State dose rank above average in low smoking rates, high immunization coverage, and public health funding and boasts the nation’s ninth lowest rate of binge drinking.

Related blog post: The Top 10 Healthiest States in America

_{Source: America’s Health Rankings, 2008. http://www.americashealthrankings.org/2008}

_{Photo: colros, Flickr, Creative Commons}

Every year, America’s Health Rankings, a collaborative partnership between United Health Foundation, the American Public Health Association, and Partnership for Prevention, provides an annual analysis of national health on a state-by-state basis, ranking them from the most to the least healthy. Researchers analyzed 22 different health measures, which are a combination of health determinants and health outcomes, to compile the rankings. Health determinants are factors that can affect the future health of a population. Health outcomes measure what has already occurred, either through death or missed days due to illness.

This year’s top 10 healthiest states are: This year’s top 10 healthiest states are:

1. Vermont
   Vermont tops the list as the healthiest state for the second year in a row. A broad range of health initiatives has helped smoking rates decline to 17.6 percent of the population, slow the rise in obesity below the U.S. national average, and keep the number of people without health insurance low..


2. Hawaii
   Hawaii is tops in air pollution, has a low smoking rate and is tied for second for the lowest rate of obesity. On the other hand, Hawaiians have one of the highest rates of binge drinking.


3. New Hampshire
   The Granite State boasts the lowest rate of child poverty and highest immunization rate along with the third lowest rate of violent crime. However, lower than average public health funding and high numbers of poor mental health kept it from topping the list.


4. Minnesota
   Dropping down from last year’s number 2 spot, Minnesota is still tops in both cardiovascular deaths and premature deaths and also has low smoking rates. The low rate of public health spending, high binge drinking, and merely average obesity rate dragged Minnesota down this year.


5. Utah
   This Western state is tops in smoking rate at 11.7% of adults, nearly 3 percent fewer than number two finisher California. Utah is in the top ten on most parameters, however a high occupational fatality rate, high levels of uninsured people, low immunization coverage and a bottom ten finish in physicians per capita work against it.


6. Massachusetts
   Tops in occupational fatalities and health insurance coverage, Massachusetts also has low smoking and obesity rates, but high binge drinking rates and average levels of violent crime high school graduation rates and child poverty land it at number six.


7. Connecticut
   Tied for the top spot in immunization coverage, Connecticut also boasts low smoking and obesity rates. However, average levels of binge drinking and child poverty along with high rates of infectious disease and low public health funding keep Connecticut from climbing higher on the list.


8. Idaho
   Low rates of violent crime, infectious disease, and air pollution along with better than average rates of smoking, obesity, binge drinking, and high school graduation rates temper Idaho’s 45^th place ranking in immunization coverage and dead last finish in physicians per capita.


9. Maine
   The fourth state from the Northeast to make the top 10, Maine has the lowest violent crime rate of any state and also boasts low rates of infectious disease and good insurance coverage. Below average rankings on smoking and binge drinking rates as well as poor immunization coverage and high cancer deaths keep Maine below its Northeastern brethren on the list.


10. Washington
    This West Coast state is tops in infant mortality and boasts a top six finish in smoking rates, child poverty, preventable hospitalizations, and occupational fatalities, but the state also ranks 48^th in immunization coverage and ranks below average in poor physical health days and geographical disparity (differences in of mortality rate among counties).

_{Source: America’s Health Rankings, 2008. http://www.americashealthrankings.org/2008/}

_{Photo: Paraflyer, Flickr, Creative Commons}

Have you noticed an increase in gluten-free products in your grocery store? If you are wondering why, it may be related to an increase in information on celiac disease, an autoimmune disease whereby a person’s intestinal tract cannot tolerate food containing gluten. As a result the body cannot absorb nutrients, increasing the risk of more serious conditions. Gluten is the protein found in grains such as wheat, rye and barley.

One out of 133 people is affected by celiac disease, which is diagnosed by specific blood tests and a bowel biopsy. Symptoms include abdominal cramping, gas, bloating, diarrhea or constipation, and anemia. Treatment consists of cutting all wheat and related grains out of one’s diet.

Yikes! that might seem difficult, and the tricky part isn’t giving up traditional bread. Gluten is found in foods not usually thought of as “grainy” such as: cold cuts, soups, hard candies, soy sauce, many low or non-fat products, even licorice and jelly beans. Because of the “hidden” ingredients, reading food labels becomes an essential part of any trip to the grocery store. Thankfully, due to growing demand, it is getting easier to find gluten-free products at the local grocery store.

For more information, including links to gluten-free recipes, search www.healia.com.

gluten free celiac disease food allergy

Strep throat is a bacterial infection of the throat caused by streptococcus bacteria. It can affect anyone, but is most common in children ages 5 to 15. If your child is complaining about a sore throat, it is important to determine if it is from a cold, which is caused by a virus, or if it is strep throat, caused by a bacterial infection. Without knowing the cause of a sore throat, it is hard to determine how to treat it. Strep throat may not get better unless it is treated with antibiotics, but antibiotics have no effect on viral infections.

In general, signs and symptoms of strep throat include:

• throat pain
• difficulty swallowing
• red and swollen tonsils, sometimes with white patches or streaks of pus
• swollen, tender lymph nodes in the neck
• fever
• headache
• rash
• Stomachache, often accompanied by vomiting in younger children

Unfortunately, many of these symptoms are similar to those of a sore throat caused by the common cold. However, one big difference is that strep throat is not associated with a cough. These symptoms can also be indicators of other viral illness or tonsillitis.

With a simple throat swab or rapid antigen test, your doctor can determine whether or not it is strep throat. If so, the doctor can prescribe antibiotic treatment to begin right away.

Want to learn more? Ask an Expert at Healia Health Communities. You can also connect with others in Healia’s Health Community for Streptococcal Infections. 


_{Photo:Ateo Fiel, Flickr, Creative Commons}

health strep throat sore throat