The venerable Washington-based Commonwealth Fund has given the National Health Service high rankings in a study comparing the health-care systems of eleven developed nations, including USA, NZ, Canada, France, Sweden and Germany. The NHS came top overall and top for effective care, safe care, coordinated care, patient-centred care, access despite cost and efficiency. Furthermore, out of 11 only Sweden and New Zealand were cheaper in cost per head. That said the UK came 10th out of 11 on the "Healthy Lives" measure. France was top, with Sweden second and USA last. The three measures that were combined to measure "Healthy Lives" were rate of preventable deaths, infant mortality and healthy life expectancy at age 60. It is thought that the social determinants of health, deprivation and lack of autonomy could be the cause of the UK's poor ranking for "Healthy Lives".