Smaller European nations punch above their weight in health sciences

Denmark, Switzerland and the Netherlands stand out for performance relative to population.

29 March 2024

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The dominant national health-sciences performance in the Nature Index is that of the United States.

A trend that is less immediately obvious is that European countries also do well, especially in comparison with their overall standings in the database.

Among the leading 50 countries and territories for high-quality health-sciences research, 11 of the top 20 are located in Europe. This is two more than for the top 20 of last year’s overall Nature Index ranking.

Comparing national performance in the health sciences relative to population size — by dividing the main Nature Index metric, Share, by every 1 million people — is even more revealing.

By this measure, the leading four countries in the health-sciences top 20 are all relatively small nations in Europe: Denmark (Share of 63.7 per million people); Switzerland (36.8); the Netherlands (32.1) and Sweden (31.7).

Using Share in this way for any subject area does tend to benefit small countries, but the potential reasons behind the success of these leading European systems warrants closer attention.

Denmark is the home of the one of the world’s largest pharmaceutical companies, Novo Nordisk, whose linked foundation invests heavily in Danish research. Switzerland is also synonymous with major healthcare companies, such as Roche and Novartis.

A closer look at the health-sciences performance of the Netherlands, meanwhile, shows it is second only to the United States for the number of hospitals among the leading 50 healthcare institutions in the Nature Index.

Sweden is the only country outside North America and China with an academic institution — the Karolinska Institute — among the leading 10 universities in health sciences. Its contribution to clinical-research journals tracked by the index is bigger than major global universities such as Stanford University in California or the University of Oxford in the United Kingdom.

Are there particular characteristics of these countries’ healthcare systems that can explain their strong showing in high-quality clinical research? That is a trickier question to answer.

Healthcare provision in continental Europe is more regulated than it is in the United States, where the system is much more privatized. Data also indicate that the United States spends a far higher amount of its gross domestic product (GDP) on healthcare.

But apart from the relatively high amount spent by the United States, there is no obvious pattern between general health spending and research outcomes. Expenditure in health research and development, on the other hand, seems to be a stronger indicator of success. Estimates from the World Health Organization, which only cover certain countries, suggest that Denmark and the Netherlands are among the highest spenders in the world in this area of research.