That’s according to the 2019 edition of the Bloomberg Healthiest Country Index, which ranks 169 countries according to factors that contribute to overall health. Israel is 54 spots ahead of the United States.

The report, which was published Sunday, shows that four European nations were among the top 10: Iceland (third place), Switzerland (fifth), Sweden (sixth) and Norway (ninth). Japan was the healthiest Asian nation. Israel fell to 10th place from 9th in 2017.

The Bloomberg Index ranks countries on life expectancy, access to medical care, sanitation and diet. Countries are penalized for tobacco use, obesity and other health risks.

Researchers say eating habits may provide clues to Israel’s healthy population, as well as Spain, which placed first. It is well-known that Mediterranean diets based on vegetables, olive oil, garlic and legumes like lentils, sesame seeds, humous and tahini lower the risk of cardiovascular disease and reduce fats.

In the US, life expectancy has been dropping due to deaths from drug overdoses and suicides. America placed 64th due in part to a very high rate of obesity. Recent figures estimate that about 40 percent of the country, that’s more than 93 million citizens, are overweight and considered morbidly obese.

China, home to 1.4 billion people, rose three places to 52nd. Life expectancy in China is on track to surpass the US by 2040, according to the Institute for Health Metrics and Evaluation.

Sub-Sahara African countries accounted for 27 of the 30 unhealthiest nations in the ranking. Haiti, Afghanistan and Yemen were the others. Mauritius was the healthiest in Sub-Sahara Africa, placing 74th globally, as it had the lowest death rate by communicable diseases in a region still marred by infectious mortality.