Global Health Laws: Which Countries Have The Most Health Freedoms?

Many of us take the health freedoms that we have for granted, expecting that people all around the world enjoy the same rights as we do. However, this is unfortunately not the case as health related laws can vary greatly from country to country, and rules related to health and wellbeing are no exception.

In this article, we explore some of the differences in health rules and regulations between different countries, so you’re aware of what to expect when travelling and working abroad. We also mention the countries with universal healthcare.

Which countries have the most health freedoms?

Many of us take for granted the freedoms we have in our home country, and when it can be a harsh reality to suddenly realise you may not be able to access the same health services that you’re used to. As an expat, this can be especially important if you have any ongoing conditions, or if you’re trying to organise international health insurance for your time away.

We conducted a study comparing some of the biggest differences in health freedoms across 50 different countries from around the world, comparing:

1. tobacco restrictions
2. alcohol restrictions
3. laws around recreational and medicinal cannabis
4. abortion laws
5. access to universal healthcare
6. laws around euthanasia
7. paid maternity leave

Healthcare freedoms across the world

We look at how health laws vary from country to country to reveal which countries where you are the freest to look after your health in the way you choose.

1/ Universal healthcare

Universal healthcare gives citizens and residents of a country access to a publicly-funded healthcare system. While these systems may not always have the shortest queues and don’t tend to offer certain treatments such as cosmetic surgery, they do provide people with an excellent safety net in case they suddenly fall seriously ill.

Countries without access to universal healthcare

A total of nine countries in our study (18%) do not have a universal healthcare system in place, meaning that falling ill in these locations can end up being an expensive affair. The majority of these countries are in Eastern Europe, with Cyprus and the United States also appearing on the list.

If you are travelling to a country without universal healthcare either for a short trip or an extended stay, it is even more important to ensure that you are fully covered by appropriate international health insurance. This will allow you to get the treatment you need without being subject to unforeseen bills.

2/ Alcohol

Approximately two-thirds (66%) of the countries in our study require you to be 18 years or older to purchase alcohol, while six countries (12%) have a slightly lower age requirement, and 11 countries (22%) require you to be older.

Countries with lower alcohol restrictions

All six of the countries where it is possible to purchase alcohol below the age of 18 are in Western Europe. With the exception of Luxembourg, the age restrictions can vary depending on the strength or type of the alcohol being purchased, with lower strength beverages being available to people from the age of 16.

Countries with higher alcohol restrictions

The countries where alcohol restrictions are slightly more stringent are far more spread out than those where they are laxer. However, they can be roughly grouped into three areas, those being North America, Asia, and Northern Europe, with those Northern European countries consisting of Nordic and Baltic states.

Again, some countries vary their restrictions based on the strength of the alcohol being purchased, such as Norway and Finland, while the age requirement for purchasing alcohol in Sweden depends on whether it’s being purchased to be consumed on or off-premises.

Meanwhile, Canada’s laws vary depending on the state or territory you live in, with Alberta, Manitoba and Quebec setting their age requirement at 18 while for the rest of the country you need to be 19 years of age.

The countries with the highest age requirement to purchase alcohol are the United States, Indonesia and India, where you need to be at least 21 to legally purchase alcohol.

3/ Recreational Cannabis

Recreational cannabis, or marijuana, has been illegal in most of the world for decades if not longer.

However, in recent years, laws surrounding cannabis have become much more relaxed in many parts of the world, with some going as far as to legalise it for recreational use, while many others have simply decriminalised the drug.

Countries with relaxed laws for recreational cannabis

So far, only three countries have legalised the use of cannabis in a recreational capacity, those being Canada, Mexico and South Africa.

Two other countries, the United States and Australia, have legalised the drug in certain states or territories. A total of 19 states in the USA have legalised the use of the drug, while in Australia it has only been legalised in the Australian Capital Territory (ACT), while also being decriminalised in the Northern Territory and South Australia.

The vast majority of countries where recreational cannabis has been decriminalised are in Europe, while four countries in Southern and Central America have also followed suit.

4/ Medicinal Cannabis

When it comes to using cannabis for medicinal purposes, many countries have been a lot more willing to revise their drug laws. Medicinal marijuana is now legal in 35 countries in our study (70%), with Spain looking to fully legalise the drug for medical usage by the end of 2022.

Countries where medicinal cannabis is illegal

There are 13 countries that we looked at where medicinal cannabis is still fully illegal, with all of these being spread across Europe and Asia. While the repercussions for marijuana possession in some of these countries can be severe, such as Singapore, many do not stringently enforce these bans, suggesting a gradual shift in attitudes toward cannabis.

There is also one country where the legality of using medical marijuana varies from place to place, which is the United States. In the USA, medical marijuana remains illegal at the federal level, though with 37 states and D.C. have legalised its use, more than half the country can now legally use marijuana in a medical context.

5/ Abortion

Abortion law is a controversial topic, and while there are many heartfelt arguments both for and against it, reproductive healthcare remains essential.

The majority of countries (58%) that we looked at have no restrictions placed on the availability of abortions, with only one country banning it outright.

Countries restrictions on the availability of abortions

The majority of countries in our study (58%) placed no restrictions on the availability of abortions, making a more liberal approach the most popular worldwide. However, while abortions are freely allowed in many countries, many parts of the world do place restrictions on their availability due to ethical concerns.

These restrictions can vary quite dramatically in their severity, from blanket bans on abortion as seen in the Philippines, to making them available on socioeconomic grounds or to preserve physical or mental health.

Abortions are much more easily accessed in the early stages of pregnancy before the foetus is more developed. In most countries you are able to terminate your pregnancy in these first few weeks, though once it reaches the later stages, more countries impose limitations on who can access abortion services.

The strongest restrictions, other than blanket bans, are when abortion is only available if the mother’s life is threatened by the pregnancy. This restriction is active in four countries in our study, those being Brazil, Chile, Indonesia, and Ireland.

There are seven countries with the weakest restrictions, where your socioeconomic situation can be reason enough to be allowed an abortion. These include the United Kingdom, Taiwan, Japan, India, Finland, Iceland and Cyprus.

In the United States and Mexico, abortion rights vary depending on the part of the country in which you live. The Mexican Supreme Court decriminalised abortion in the country in 2021 in a marked shift from their long-time conservative stance on the matter.

However, reproductive rights have taken a step in the opposite direction in the United States, where the US Supreme Court recently voted against women having the right to an abortion, leaving individual states to determine their own laws and policies.

6/ Tobacco

In the vast majority (86%) of countries in our study, the legal age at which you can buy tobacco products is 18. However, there are some countries that do things differently, most of which have a higher age limit for tobacco.

Countries with lower tobacco restrictions

The only country in our study where the age limit for purchasing tobacco is at all lower than 18 is Switzerland, where each district, called a “canton”, sets its own tobacco regulations.

There are 12 cantons where the age limit for purchasing tobacco products is 16, while you’ve to be 18 to do so in 11 cantons.

That leaves three cantons where there is no legal age requirement for the purchase of tobacco products.

Countries with higher tobacco restrictions

Of the 50 countries we looked at, six have regulations that require you to be older than 18 to purchase tobacco products. Most of these countries are located in Asia, while the remaining two are both North American, suggesting that there are distinct regional attitudes towards tobacco that have affected these policies.

In Canada, laws relating to the sale of tobacco products change depending on the province or territory in which you live, with the federal law being that nobody under the age of 18 may purchase them. Of these different regions, five require you to be 18 to purchase tobacco, seven require you to be at least 19, while the province of Prince Edward Island requires you to be 21 years of age.

The United States and Singapore have the highest national age restrictions for the purchase of tobacco at 21 years of age. Japan and Taiwan set their age requirement at 20, while in South Korea you need to be 19 to purchase tobacco.

7/ Euthanasia

Euthanasia refers to the intentional ending of someone’s life to relieve their pain and suffering. There are two main forms of euthanasia, passive and active. Passive euthanasia is when the treatment required for a patient to continue is withheld, and is by far the much more common variety.

The other form of euthanasia is active, whereby someone who is not fatally ill wants to end their life, usually due to intense pain or suffering. This form of euthanasia is much more controversial, though a growing number of countries are beginning to make this legal.

Countries where all forms of euthanasia are illegal

Only three countries in our study, Indonesia, Japan and the Philippines, do not allow any form of euthanasia. This includes both active and passive euthanasia, meaning that if it is possible for someone to be kept alive, then they should be.

All three of these countries are in East and Southeast Asia, suggesting a localised negative attitude towards the concept of euthanasia.

Countries where active euthanasia is legal

There are nine countries in our study where active voluntary euthanasia is permitted, meaning that you are able to choose to end your own life. This is often subject to stringent medical and psychological criteria being met to ensure that the decision is rational and ethical.

While Australia allows active voluntary euthanasia, individual states and territories are allowed to determine many of their own laws, including those surrounding euthanasia. This means that while the practice is legal in most parts of the country, it is currently against the law in Australia’s Northern Territory.

8/ Paid maternity leave

Paid maternity leave is incredibly important as it gives mothers a safety net around the birth of their child, allowing them to recover from the physical ordeal of childbirth while also giving them time to bond with their newborn child.

That this leave is paid is crucial for giving women of all socioeconomic backgrounds and financial situations the same opportunity to have a child without worrying about how they’re going to pay the bills.

1/ Estonia

Weeks of paid maternity leave: 62

Estonia has the most paid maternity leave at 62 weeks, allowing new mothers to take well over a year off work to rest, recover and spend time bonding with their newborns. During these 62 weeks, mothers receive 100% of their pay, relieving the pressure that can be added by having reduced pay or unpaid maternity leave.

2/ Bulgaria & Croatia

Weeks of paid maternity leave: 58

Bulgaria and Croatia tie for second place with 58 weeks of paid maternity leave in each country, making them the only countries in our study other than Estonia to offer more than a whole year of maternity leave.

However, neither country goes as far as guaranteeing 100% of new mothers’ pay, with Bulgaria paying 90% while mothers in Croatia receive 100% for the first 26 weeks, and a flat rate for the remainder.

Health freedom scores

In this section we have pooled the data from the various factors covered in the previous section to create an overall ranking in which we can reveal which countries have the best overall health freedoms. Where will your country place?

Countries with the greatest health freedom

1/ Switzerland

Health freedom score: 8.34

Switzerland has the greatest overall freedom when it comes to managing your own health, with a health freedom score of 8.34. With universal healthcare, legal medicinal cannabis, active voluntary euthanasia and readily available abortion services, Switzerland has an open-minded approach to health that gives the individual choice as well as a solid safety net.

2/ Luxembourg

Health freedom score: 7.83

Luxembourg is the country with the second highest health freedom score of 7.83, only losing out to Switzerland when it comes to tobacco legislation. However, Luxembourg offers new mothers six weeks more paid maternity leave than our first-place holder, so it’s a very close call.

3/ Canada

Health freedom score: 7.60

In third place, with a health freedom score of 7.60, is Canada. Canada performed well across the board and is one of the few countries where recreational cannabis is legal. However, the age at which you are able to purchase tobacco and alcohol is slightly higher than most other countries in our study.

Countries with the least health freedom

50/ United States

Health freedom score: 2.88

The United States is the country with the worst level of health freedom in our study, scoring a measly 2.88 out of 10. One of the few countries without universal healthcare, and the only one not to guarantee any paid maternity leave, you’ll find it much more difficult to manage your health in the US without worrying about the financial burden of doing so. Additionally, while the country may have relatively lax laws concerning recreational marijuana, access to alcohol and tobacco products is more restricted than in any other country.

49/ Indonesia

Health freedom score: 3.00

Indonesia has the second lowest level of health freedom in our study, earning a health freedom score of 3.00. While Indonesia does have universal healthcare and the tobacco purchase age is set at 18, all other factors have much higher than average restrictions. All cannabis is illegal, as are all forms of euthanasia, and abortions are only legal if performed to save a woman’s life. Though the country does provide 12 weeks of paid maternity leave, this is still one of the shorter lengths of leave available across the different countries.

48/ Philippines

Health freedom score: 3.35

With a health freedom score of 3.35, the Philippines has the third lowest overall health freedom in our study. The health freedoms here are quite similar to those in Indonesia, though there are a few differences. The main difference is that all abortions is prohibited regardless of circumstance, making it the only country in our study to completely ban the practice. The remaining differences are that the purchase age for alcohol is 18 rather than 21, and the length of paid maternity leave is slightly longer at 15 weeks.

Health freedoms across the world

Key:

	Decriminalized
	Legal
	Illegal
	Varies
	No restriction
	Prohibited altogether
	To preserve health/mental health/on socioeconomic grounds
	To save a woman’s life
	Active voluntary euthanasia
	Passive euthanasia

Wherever you move, go with total peace of mind

At William Russell, we have nearly 30 years of helping expatriates finding best places in the world to move abroad and settle into their new lives overseas by providing world-class international health insurance. Plus, we produce lots of expert material to help you and your family adapt to life abroad.

Making the move to another country can be challenging. But no matter where you go, you can take one thing off your mind. William Russell offers international health insurance that covers you for everything from minor injuries to long hospital stays, and we can even offer medical evacuations to patients who require treatment in other countries.

Methodology

We wanted to find out how health laws vary from country to country, revealing which parts of the world have the most health freedoms. We took eight factors and considered them each independently, to find which countries are the most restrictive for each.

We used data from Wikipedia to find the smoking age, drinking age, age of consent, euthanasia law, maternity leave, and legality of both recreational and medicinal cannabis. We then used data from World Population Review to find out which countries have universal healthcare, as well as the different restrictions placed on abortion around the world.

Once we collected the data for these various factors, we combined them into a single score to represent the overall health freedoms in each country. This score gave each factor an equal weighting and allowed us to reveal the countries where you are the freest to look after your health in the way you choose.