How individuals assess their own health provides a holistic overview of both physical and mental health. Adding such a perspective on quality of life complements life expectancy and mortality indicators that only measure survival (OECD, 2025[1]). Despite its subjective nature, self-rated health has proved to be a good predictor of future healthcare needs and mortality (Palladino et al., 2016[2]). Still, international comparisons are complicated by socio-cultural differences, as well as differences in socio‑economic and demographic characteristics (notably poorer and older populations are more likely to report poor health, all else being equal), and the formulation of survey questions (see the “Definition and comparability box”).
Around 8% of adults considered themselves to be in poor health on average across OECD countries in 2024 (Figure 3.22). This ranged from over 13% in Japan and Latvia, followed by 12% in Estonia and Portugal, to under 3% in Colombia and New Zealand. Korea, Japan and Portugal stand out as countries with high life expectancy but relatively poor self-rated health. In general, women tend to self-report worse health than men, reflecting differences in health perception, access to care and prevalence of certain chronic conditions. The difference in poor self-rated health between men and women is largest in Lithuania, Korea and Portugal, with gaps surpassing or close to 4 p.p. In contrast, gender differences are much smaller in Canada, Australia, Colombia and Switzerland.
People on lower incomes are, on average, less positive about their health than those on higher incomes in all OECD countries (Figure 3.23). More than 80% of adults in the highest income quintile rated their health as good or very good in 2023, compared to 59% of adults in the lowest income quintile, on average across OECD countries. Socio‑economic disparities are particularly marked in Lithuania and Latvia, with an income gap of 40 p.p. or more. Differences in smoking, harmful alcohol use and other risk factors are likely to explain much of this disparity (see Chapter 4 “Non-medical determinants and risk factors”). Socio‑economic disparities are relatively low in New Zealand and the Slovak Republic, which have a gap of less than 8 p.p.
Self-rated health tends to decline with age. In many countries, there is a particularly marked decline in how people rate their health when they reach their mid‑40s, with a further decline after reaching retirement age (see section on “Self-rated health and disability at age 65 and over” in Chapter 10). Data from the PaRIS International Survey of People Living with Chronic Conditions show that, on average across 17 OECD countries, 65% of primary care users aged 45 and over with chronic conditions report their health as good, very good or excellent, which is much lower than the 91% of primary care users aged 45 and over without chronic conditions (Figure 3.24) (OECD, 2025[1]). Across OECD countries, primary care users aged 45 and over with chronic conditions in Canada, the United States and Switzerland reported better health, with nearly 80% or more rating their general health positively. In contrast, in Portugal and Italy, about 40% or lower reported good health. These differences may reflect variations in how countries manage chronic disease care or ensure access to primary care services. When comparing primary care users without chronic conditions, differences across countries are smaller. More than 95% of primary care users without chronic conditions in France, Switzerland, Canada, the United States and Belgium reported good health. In contrast, Portugal and Italy have the lowest percentages, with less than 80% reporting good health.
