data briefing: The UK may be one of the healthiest countries in the world, but it faces the same rationing dilemma as the poorest nations, writes John Appleby

For anyone in the NHS who has problems with the avalanche of circulars, guidance and general paperwork about the reforms, it is worth reading the latest World Health Report from the World Health Organisation. In particular, the annex dealing with basic demographic and health indicators for WHO's 191 member states puts the UK's health and healthcare issues into some perspective.

Statistical comparisons are always tricky. Whether it is hospitals' unit cost comparisons or countries' spending on healthcare, there are difficulties in comparing like with like, understanding why variations exist and judging whether differences are important. Often the UK is compared with its industrialised, western peers - but why? Usually it is to make the point that it is in the lower half of league tables showing spending on healthcare per head (although it does rather well in health league tables).

Relative to its G8 or Organisation for Economic Co-operation and Development partners, the impression is that the UK - and by implication, the NHS - is struggling in terms of its healthcare system, and to a lesser extent its health. But another comparative view puts it in perspective on both counts.

Judged on some key health indicators, the UK is one of the healthiest countries in the world. Average life expectancy at birth for males born in the UK is now 75. This is 26 years higher than the average for Africa and 10 years more than the world average. The average life expectancy for Europe is 69 years, a figure surpassed by the UK more than 40 years ago.

In Zambia, the probability of death for a man aged between 15 and 59 is the highest in the world - 77 per cent. In the UK the equivalent figure is 11 per cent. For children under five, the probability of death for Africa is, at 17 per cent, nearly 20 times higher than in the UK.

Such gross disparities are mirrored in the differences in national wealth. Per capita GDP (allowing for differences in purchasing power) is 10 times higher in the UK than for Africa as a whole, and more than 30 times higher than for the poorest African country, Chad. Not only is the UK richer, it also devotes a higher percentage of its GDP to healthcare than poorer countries. In 1995, the UK spent about 6.9 per cent of its GDP on healthcare - low by OECD standards, but outstripping most African, south-east Asian, eastern Mediterranean and western Pacific countries.

The World Health Report also implies that our NHS is, broadly, the health system of choice for achieving key healthcare goals such as equity, efficiency and fairness in financing. But WHO highlights one issue with which the NHS is still to get to grips: the impossibility of any government (no matter how rich) providing and financing everything for everybody.

In other words, rationing is inevitable. But having rightly - in the view of WHO - rejected market solutions that ration according to ability to pay, politicians and the public in the UK seem reluctant to debate openly alternatives to price rationing. Are waiting lists, GP receptionists, a general reliance on keeping activity in budget and ad hoc interventions by the health secretary to restrict prescribing really the best non-price rationing mechanisms the NHS can come up with? The 1999 World Health Report. www.who.int/whr/1999/en/report.htm