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University of York checks 'sick as a parrot' syndrome

Posted on 2 December 2002

If your national football team does well, your country is likely to have a good health system - at least if you compare FIFA statistics with those of the World Health Organisation. Or does this just go to show that simplistic statistics can prove anything?

Andrew Street of the Centre for Health Economics at the University of York and John Appleby of the King's Fund think tank in London, have compared the FIFA rankings for 176 countries' international teams against the ranking for the same countries on the WHO performance index. WHO ranked the French system the highest - and their football team is also highly successful, taking 2nd place.

By contrast, England's team was placed 13th while our health system was 18th. Brazil, which was top of the football rankings, did not make the top 20 of health systems.

Andrew Street said: "This paper started as a joke. The intention was to sow doubt about supposedly sophisticated attempts by the World Health Organisation to measure health system performance.

"There are some serious messages though. The most notable is that data can be mis-used to prove almost anything you like - such as that countries with better football teams will have better health systems.

"Of course, any relationship between FIFA and WHO rankings is entirely spurious! However, the exercise illustrates the problem WHO has in measuring performance, how information is used to improve systems, and what the public should make of all this information."

The WHO rankings were based on the length of life expectancy without a disability; distribution of good health across the population; how responsive a health system is to the people it serves, and how well it protects people from the financial problems of illness. Calculations were also made as to the gap between what each country's health service could be expected to achieve, compared to what it actually achieved.

The researchers then turned to national football rankings, which are also a complex procedure. In part ranks are based on whether teams win, lose or draw. But in international matches FIFA adjusts results according to whether sides are considered weak or strong, the number of goals scored and conceded, and whether games are played at home or away. Allowances are also made for the status of a game - a World Cup match is twice as important as a result of a friendly.

Andrew Street added: "Just because the WHO analysis looks sophisticated it does not mean it is right. There is a temptation to accept such analyses because the ‘nuts and bolts' of the work are impenetrable. By playing WHO at their own game, we hope to have made people more sceptical of accepting the WHO results at face value."

"We're health pundits rather than football specialists, so we'll leave it to others to question the FIFA analysis."

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David Garner
Senior Press Officer

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