Dominica is not on The 20 unhealthiest countries on earth

The 20 unhealthiest countries on earth, ranked

A street bar at a bus terminal in Bridgetown, Barbados

A new global health ranking has identified the healthiest — and unhealthiest — countries in 2019.

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The Indigo Wellness Index, compiled and led by Richard Davies at the economics consultancy Bloomsbury Economics and published by the investment business LetterOne in the new journal Global Perspectives, is one of the most comprehensive records of its kind to date, covering 191 countries.

The index created a series of rankings based on 10 key measures, ordering the countries from the weakest performers (ranked No. 1) to the strongest (ranked, for example, No. 191).

The 10 measures were healthy life expectancy, blood pressure, blood glucose (diabetes risk), obesity, depression, happiness, alcohol use, tobacco use, inactivity (too little exercise), and government spending on healthcare.

It then calculated a ratio to assess how close each country is to the best score overall — the worst score is zero, while the best score is one.

Read more: RANKED: The 19 best countries to live in if you're a woman

While Canada came out on top as the healthiest country, war-torn sub-Saharan African countries were some of the worst performers. Perhaps more surprising, though, are the poor rankings for countries considered to be idyllic, such as St. Lucia and Barbados, which, the data show, came down to poor diet and lack of exercise.

Scroll down to see the unhealthiest countries in the world, ranked in ascending order.

Note: Countries where data were missing on more than one measure (including South Sudan, Palau, Niue, Tuvalu, Cook Islands, Bahamas, Equatorial Guinea, and Libya) were excluded from the final index, which features 151 countries, 68 of which had all 10 measures available, and 83 of which had 9 measures available. The final ranking accounts for over 95% of the world's population.

=18. Samoa — 0.41. Blood glucose levels, obesity, and binge drinking put this country into the top 20.

=18. Dominican Republic — 0.41. High levels of depression, drinking, and blood pressure gave this Caribbean nation an identical score.

=18. Egypt — 0.41. Low government spending on healthcare, high diabetes risk, and obesity levels tied Egypt for 18.

=16. Jamaica — 0.40. The Caribbean island of Jamaica scored poorly across a number of measures, including obesity, state spending, smoking, depression, and blood glucose.

=16. Latvia — 0.40. Blood pressure and binge drinking were to blame for Latvia's place in the top 20.

=14. Trinidad and Tobago — 0.39. This dual-island Caribbean nation received poor scores for depression, blood pressure, and blood glucose.

=14. Serbia — 0.39. This Balkan country scored poorly because of a lack of exercise and alarming blood-pressure scores.

=12. Ukraine — 0.38. Depression and blood pressure were the categories that Ukraine scored poorly on. The country has been involved in a military conflict with Russia for years.

=12. Lithuania — 0.38. The same two categories — depression and blood pressure — tied this European country for the No. 12 spot.

=9. Georgia — 0.37. A number of categories stood out for Georgia, including diet (high levels of obesity and blood glucose), depression, and binge drinking.

=9. Iraq — 0.37. Inactivity, low life expectancy, lack of state spending, low levels of happiness, and high levels of obesity were the most concerning factors here.

=9. Haiti — 0.37. Haiti scored poorly on happiness, state spending, and life expectancy.

8. Central African Republic — 0.36. Life expectancy and state spending were the standout categories for this African country.

7. Armenia – 0.35. This Asian country is the seventh unhealthiest because of its blood-glucose, blood-pressure, and depression scores.

=5. Barbados — 0.34. It may seem idyllic, but this Caribbean country had alarming scores across a wide variety of categories, including blood pressure, depression, obesity, inactivity, and binge drinking.

=5. Federated States of Micronesia — 0.34. Obesity, drinking, and low government spending on health tied Micronesia for fifth place.

4. Bulgaria — 0.33. Sunny Beach may look like the perfect holiday spot, but Bulgaria is the fourth unhealthiest country because of blood pressure, depression, and drinking.

3. Kiribati — 0.31. Obesity is the biggest concern in this country in Oceania, putting it in third place.

2. St. Lucia — 0.29. Binge-drinking, blood-pressure, and blood-glucose scores made St. Lucia the second unhealthiest country.

1. South Africa — 0.28. Scoring poorly on all measures, South Africa's scores for obesity, drinking, and life expectancy in particular made it the unhealthiest country in 2019.