Spain topped the ranking In the 2019 edition, rising from sixth place in the previous gauge, published in 2017 beating Italy to the crown.

Four additional European nations were among the top 10: Iceland (third), Switzerland (fifth), Sweden (sixth) and Norway (ninth).

The index grades nations based on variables – such as life expectancy – while imposing penalties on risks such as tobacco use and obesity.

It also takes into consideration environmental factors, including access to clean water and sanitation.

Spain has the highest life expectancy at birth among European Union nations and is expected to overtake Japan by 2040 to become the country with highest lifespan in the world.

READ MORE: Spain set to have longest life expectancy in the world

The Mediterranean diet is partly responsible for Spain’s high ranking on the list.

Researchers say eating habits may provide clues to health levels enjoyed by Spain and Italy, as a “Mediterranean diet, supplemented with extra-virgin olive oil or nuts, had a lower rate of major cardiovascular events than those assigned to a reduced-fat diet,” according to a study led by the University of Navarra Medical School.

But Spain’s excellent National Health Service was also credited with putting Spain in the top spot.

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“Primary care is essentially provided by public providers, specialized family doctors and staff nurses, who provide preventive services to children, women and elderly patients, and acute and chronic care,” according to the European Observatory on Health Systems and Policies 2018 review of Spain, noting a decline the past decade in cardiovascular diseases and deaths from cancer, noted Bloomberg in the report.

READ MORE: Want to know the secret to long life? Live in Spain