Health security risk index
INFORM-style aggregation, on 0 to 10, of epidemic and AMR hazard, disease burden and undernutrition against health-system and IHR capacity, each component oriented by its own polarity.
geometric
expert weights · floor 0.1 where geometric
1,000 draws
normalisation, weights, aggregation, imputation
5 components
25 leaf indicators
67% minimum
modelled share ≤ 20%
From indicators to the composite
Shows where an outbreak is likely, where it would land on a vulnerable population and where the system could not contain it; each sub-index stays visible.
- Epidemic event frequencyIndicator · IND · 1Average annual number of distinct infectious-disease outbreak events in the country reported by WHO or a regional public-health agency over the latest five years, counting each event once whatever its duration.
- Reported cholera cases, per 100,000 populationIndicator · IND · /10*5Cholera cases reported to WHO in the year per 100,000 of the mid-year population.
- Bloodstream infections due to MRSAIndicator · IND · %Share of Staphylococcus aureus bloodstream infections that are methicillin-resistant, among patients with a tested blood sample.
- Bloodstream infections due to E. coli resistant to third-generation cephalosporinsIndicator · IND · %Share of Escherichia coli bloodstream infections resistant to third-generation cephalosporins, among patients with a tested blood sample.
- Under-five mortality rateIndicator · IND · /10*3Probability, per 1,000 live births, that a child born in the year dies before reaching age five at current age-specific mortality.
- Maternal mortality ratioIndicator · IND · /10*5Deaths of women from pregnancy-related causes during pregnancy or within 42 days of its end, per 100,000 live births, as modelled by the UN inter-agency group.
- Premature mortality from major non-communicable diseasesIndicator · IND · %Probability, in percent, of dying between exact ages 30 and 70 from cardiovascular disease, cancer, diabetes or chronic respiratory disease.
- Tuberculosis incidenceIndicator · IND · /10*5Estimated new and relapse tuberculosis cases of all forms per 100,000 population in the year.
- Malaria incidenceIndicator · IND · /10*3Estimated new malaria cases per 1,000 people living in areas at risk of transmission.
- HIV incidenceIndicator · IND · /10*3New HIV infections in the year per 1,000 uninfected people of all ages.
- Stunting among children under fiveIndicator · IND · %Share of children under five whose height-for-age is more than two standard deviations below the WHO Child Growth Standards median (modelled estimate).
- Wasting among children under fiveIndicator · IND · %Share of children under five whose weight-for-height is more than two standard deviations below the WHO Child Growth Standards median, from the latest national survey.
- Anaemia among women of reproductive ageIndicator · IND · %Share of women aged 15 to 49 with haemoglobin below the WHO threshold for their pregnancy status, adjusted for altitude and smoking.
- Medical doctors per 1,000 populationIndicator · IND · /10*3Practising or professionally active medical doctors, generalists and specialists, per 1,000 population.
- Nurses and midwives per 1,000 populationIndicator · IND · /10*3Nursing and midwifery personnel, professional and associate, per 1,000 population.
- Hospital beds per 1,000 populationIndicator · IND · /10*3Inpatient beds in public, private, general and specialised hospitals and rehabilitation centres, per 1,000 population.
- UHC service coverage indexIndicator · IND · {score}Index from 0 to 100 of the average coverage of essential services across reproductive, maternal, newborn and child health, infectious disease, non-communicable disease and service capacity and access.
- DTP3 immunisation coverageIndicator · IND · %Share of surviving infants who received the third dose of diphtheria-tetanus-pertussis-containing vaccine, as estimated by WHO and UNICEF.
- Second-dose measles immunisation coverageIndicator · IND · %Share of children who received the second dose of measles-containing vaccine by the nationally recommended age.
- Births attended by skilled health personnelIndicator · IND · %Share of live births attended by a doctor, nurse or midwife trained to manage normal deliveries and refer complications.
- Current health expenditure, share of GDPIndicator · IND · %Spending on health goods and services consumed in the year, from all financing sources, as a percentage of GDP (SHA 2011).
- IHR laboratory capacity (SPAR C4)Indicator · IND · {score}Self-reported SPAR score, from 0 to 100, for national laboratory systems: specimen referral and transport, biosafety, quality and testing for priority pathogens.
- IHR surveillance capacity (SPAR C5)Indicator · IND · {score}Self-reported SPAR score, from 0 to 100, for early-warning, event-based and indicator-based surveillance and event verification.
- IHR health emergency management capacity (SPAR C7)Indicator · IND · {score}Self-reported SPAR score, from 0 to 100, for emergency risk assessment, preparedness planning, emergency operations and logistics.
- IHR risk communication capacity (SPAR C10)Indicator · IND · {score}Self-reported SPAR score, from 0 to 100, for risk communication systems, community engagement and management of misinformation in emergencies.
- Epidemic and AMR hazard sub-indexSub-index · SUB · w 1 · 22.2%Composite of outbreak event frequency, reported cholera and resistance among MRSA and E. coli bloodstream infections.
- Disease burden sub-indexSub-index · SUB · w 1 · 22.2%Composite of under-five and maternal mortality, premature non-communicable disease mortality and the incidence of tuberculosis, malaria and HIV.
- Undernutrition sub-indexSub-index · SUB · w 0.5 · 11.1%Composite of child stunting, child wasting and anaemia among women of reproductive age.
- Health-system capacity sub-indexSub-index · SUB · w 1 · 22.2%Composite of doctor, nurse and bed density, UHC service coverage, routine immunisation, skilled birth attendance and health spending.
- IHR operational capacity sub-indexSub-index · SUB · w 1 · 22.2%Composite of the SPAR laboratory, surveillance, health emergency management and risk communication capacity scores.
- Health security risk indexDomain index · IDX · geometricINFORM-style aggregation, on 0 to 10, of epidemic and AMR hazard, disease burden and undernutrition against health-system and IHR capacity, each component oriented by its own polarity.
- Human and systems vulnerabilityPillar · PILLAR · 8 indicesHow susceptible are people, livelihoods, ecosystems and essential systems to harm when a shock arrives?
- NXS-GRX Composite RiskComposite · COMPOSITE · four pillarsComposite = (HTE × VUL × MSF × LCC)^(1/4), each pillar on 0–10 floored at 0.1; pillar = expert-weighted geometric mean of its domain indices
Run this index's own aggregation
Set each component, change the aggregation or the weight uncertainty, and watch the interval, the class probability and each component's contribution respond.
Treatment, normalisation, weighting, aggregation, uncertainty
- Treatment
- WINSORISE
- Outlier rule
- |skew| > 2, kurtosis > 3.5
- Normalisation
- INFORM_0_10
- Imputation
- NONE
- Coverage minimum
- 67% of components
- Modelled share cap
- 20% of weight
- Weighting
- expert
- Aggregation
- geometric
- Scale
- 0 to 10
- Uncertainty
- 1,000 Monte Carlo runs over normalisation, weights, aggregation, imputation
- Framework basis
- INFORM Risk methodology (geometric dimensions); IHR (2005) monitoring framework; JRC COIN 10-step guide; OECD/JRC Handbook (2008)
5 components, 25 indicators
Epidemic and AMR hazard sub-index w 1
Composite of outbreak event frequency, reported cholera and resistance among MRSA and E. coli bloodstream infections.
| Indicator | Unit | Evidence | Sources | Share |
|---|---|---|---|---|
| Epidemic event frequencyIND.HLT.epidemic.outbreak_event_frequency | 1 | Class B | who-disease-outbreak-news, who-weekly-bulletin-afro, africa-cdc-epidemic-intelligence | 40.0% |
| Reported cholera cases, per 100,000 populationIND.HLT.epidemic.cholera_cases.p100k | /10*5 | Class B | who-gho, who-cholera-annual-report | 20.0% |
| Bloodstream infections due to MRSAIND.HLT.amr.mrsa_bloodstream | % | Class B | who-glass, who-gho | 20.0% |
| Bloodstream infections due to E. coli resistant to third-generation cephalosporinsIND.HLT.amr.ecoli_3gc_bloodstream | % | Class B | who-glass, who-gho | 20.0% |
Disease burden sub-index w 1
Composite of under-five and maternal mortality, premature non-communicable disease mortality and the incidence of tuberculosis, malaria and HIV.
| Indicator | Unit | Evidence | Sources | Share |
|---|---|---|---|---|
| Under-five mortality rateIND.HLT.burden.under5_mortality | /10*3 | Class C | un-igme, wb-wdi, who-gho | 16.7% |
| Maternal mortality ratioIND.HLT.burden.maternal_mortality | /10*5 | Class C | un-mmeig, wb-wdi, who-gho | 16.7% |
| Premature mortality from major non-communicable diseasesIND.HLT.burden.ncd_premature_mortality | % | Class C | who-ghe, wb-wdi | 16.7% |
| Tuberculosis incidenceIND.HLT.burden.tb_incidence | /10*5 | Class C | who-global-tb-programme, wb-wdi | 16.7% |
| Malaria incidenceIND.HLT.burden.malaria_incidence | /10*3 | Class C | who-world-malaria-report, wb-wdi | 16.7% |
| HIV incidenceIND.HLT.burden.hiv_incidence | /10*3 | Class C | unaids, wb-wdi, who-gho | 16.7% |
Undernutrition sub-index w 0.5
Composite of child stunting, child wasting and anaemia among women of reproductive age.
| Indicator | Unit | Evidence | Sources | Share |
|---|---|---|---|---|
| Stunting among children under fiveIND.HLT.nutrition.stunting | % | Class C | unicef-who-wb-jme, wb-wdi, who-gho | 33.3% |
| Wasting among children under fiveIND.HLT.nutrition.wasting | % | Class B | unicef-who-wb-jme, wb-wdi, smart-surveys | 33.3% |
| Anaemia among women of reproductive ageIND.HLT.nutrition.anaemia_women | % | Class C | who-gho, wb-wdi | 33.3% |
Health-system capacity sub-index w 1
Composite of doctor, nurse and bed density, UHC service coverage, routine immunisation, skilled birth attendance and health spending.
| Indicator | Unit | Evidence | Sources | Share |
|---|---|---|---|---|
| Medical doctors per 1,000 populationIND.HLT.system.physician_density | /10*3 | Class B | who-nhwa, wb-wdi | 11.1% |
| Nurses and midwives per 1,000 populationIND.HLT.system.nurse_midwife_density | /10*3 | Class B | who-nhwa, wb-wdi | 11.1% |
| Hospital beds per 1,000 populationIND.HLT.system.hospital_beds | /10*3 | Class B | who-gho, wb-wdi, oecd-health | 11.1% |
| UHC service coverage indexIND.HLT.system.uhc_service_coverage | {score} | Class C | who-gho, wb-wdi | 22.2% |
| DTP3 immunisation coverageIND.HLT.system.dtp3_coverage | % | Class C | who-unicef-wuenic, wb-wdi | 11.1% |
| Second-dose measles immunisation coverageIND.HLT.system.mcv2_coverage | % | Class C | who-unicef-wuenic, wb-hnp-stats | 11.1% |
| Births attended by skilled health personnelIND.HLT.system.skilled_birth_attendance | % | Class B | unicef-who-joint-database, wb-wdi | 11.1% |
| Current health expenditure, share of GDPIND.HLT.system.health_expenditure.gdp | % | Class B | who-ghed, wb-wdi | 11.1% |
IHR operational capacity sub-index w 1
Composite of the SPAR laboratory, surveillance, health emergency management and risk communication capacity scores.
| Indicator | Unit | Evidence | Sources | Share |
|---|---|---|---|---|
| IHR laboratory capacity (SPAR C4)IND.HLT.security.spar_laboratory | {score} | Class B | who-spar, who-jee | 25.0% |
| IHR surveillance capacity (SPAR C5)IND.HLT.security.spar_surveillance | {score} | Class B | who-spar, who-jee | 25.0% |
| IHR health emergency management capacity (SPAR C7)IND.HLT.security.spar_emergency_management | {score} | Class B | who-spar, who-jee | 25.0% |
| IHR risk communication capacity (SPAR C10)IND.HLT.security.spar_risk_communication | {score} | Class B | who-spar, who-jee | 25.0% |
Health
Disease burden, health-system capacity and health-security preparedness.
| Sub-domain | Indicators |
|---|---|
| Disease burden and mortality | 8 |
| Health system capacity | 11 |
| Health security (IHR) | 5 |
| Epidemic and outbreak | 2 |
| Antimicrobial resistance | 2 |
| Nutrition | 3 |
Anchor frameworks (pillar structure and definitions only): WHO GHO; IHR JEE 3rd ed.; IHR SPAR 2nd ed.; SDG 3.
All 31 health indicators
| Indicator | Domain | Sub-domain | Component | Unit | Levels | Crosswalks |
|---|---|---|---|---|---|---|
| Under-five mortality rateIND.HLT.burden.under5_mortality | HLT | Disease burden and mortality | vulnerability | /10*3 | COUNTRY | WB_WDI SH.DYN.MORT SDG 3.2.1 WHO_GHO MDG_0000000007 |
| Neonatal mortality rateIND.HLT.burden.neonatal_mortality | HLT | Disease burden and mortality | vulnerability | /10*3 | COUNTRY | WB_WDI SH.DYN.NMRT SDG 3.2.2 |
| Maternal mortality ratioIND.HLT.burden.maternal_mortality | HLT | Disease burden and mortality | vulnerability | /10*5 | COUNTRY | WB_WDI SH.STA.MMRT SDG 3.1.1 WHO_GHO MDG_0000000026 |
| Life expectancy at birthIND.HLT.burden.life_expectancy | HLT | Disease burden and mortality | vulnerability | a | COUNTRY | WB_WDI SP.DYN.LE00.IN WHO_GHO WHOSIS_000001 |
| Premature mortality from major non-communicable diseasesIND.HLT.burden.ncd_premature_mortality | HLT | Disease burden and mortality | vulnerability | % | COUNTRY | WB_WDI SH.DYN.NCOM.ZS SDG 3.4.1 WHO_GHO NCDMORT3070 |
| Tuberculosis incidenceIND.HLT.burden.tb_incidence | HLT | Disease burden and mortality | hazard | /10*5 | COUNTRY | WB_WDI SH.TBS.INCD SDG 3.3.2 WHO_GHO MDG_0000000020 |
| Malaria incidenceIND.HLT.burden.malaria_incidence | HLT | Disease burden and mortality | hazard | /10*3 | COUNTRY | WB_WDI SH.MLR.INCD.P3 SDG 3.3.3 WHO_GHO SDGMALARIA |
| HIV incidenceIND.HLT.burden.hiv_incidence | HLT | Disease burden and mortality | hazard | /10*3 | COUNTRY | WB_WDI SH.HIV.INCD.TL.P3 SDG 3.3.1 WHO_GHO SDGHIV WB_WDI SH.HIV.INCD.ZS |
| Medical doctors per 1,000 populationIND.HLT.system.physician_density | HLT | Health system capacity | coping capacity | /10*3 | COUNTRY | WB_WDI SH.MED.PHYS.ZS WHO_GHO HWF_0001 SDG 3.c.1 |
| Nurses and midwives per 1,000 populationIND.HLT.system.nurse_midwife_density | HLT | Health system capacity | coping capacity | /10*3 | COUNTRY | WB_WDI SH.MED.NUMW.P3 WHO_GHO HWF_0006 SDG 3.c.1 |
| Hospital beds per 1,000 populationIND.HLT.system.hospital_beds | HLT | Health system capacity | coping capacity | /10*3 | COUNTRY | WB_WDI SH.MED.BEDS.ZS WHO_GHO WHS6_102 |
| UHC service coverage indexIND.HLT.system.uhc_service_coverage | HLT | Health system capacity | coping capacity | {score} | COUNTRY | SDG 3.8.1 WHO_GHO UHC_INDEX_REPORTED WB_WDI SH.UHC.SRVS.CV.XD |
| Population with catastrophic out-of-pocket health spendingIND.HLT.system.catastrophic_oop | HLT | Health system capacity | vulnerability | % | COUNTRY | SDG 3.8.2 WB_WDI SH.UHC.OOPC.10.ZS |
| Out-of-pocket spending, share of current health expenditureIND.HLT.system.oop_share | HLT | Health system capacity | vulnerability | % | COUNTRY | WB_WDI SH.XPD.OOPC.CH.ZS WHO_GHO GHED_OOPSCHE_SHA2011 |
| Current health expenditure, share of GDPIND.HLT.system.health_expenditure.gdp | HLT | Health system capacity | coping capacity | % | COUNTRY | WB_WDI SH.XPD.CHEX.GD.ZS |
| DTP3 immunisation coverageIND.HLT.system.dtp3_coverage | HLT | Health system capacity | coping capacity | % | COUNTRY | WHO_GHO WHS4_100 WB_WDI SH.IMM.IDPT SDG 3.b.1 |
| Second-dose measles immunisation coverageIND.HLT.system.mcv2_coverage | HLT | Health system capacity | coping capacity | % | COUNTRY | WHO_GHO MCV2 WB_WDI SH.IMM.MEA2 SDG 3.b.1 |
| Births attended by skilled health personnelIND.HLT.system.skilled_birth_attendance | HLT | Health system capacity | coping capacity | % | COUNTRY | WB_WDI SH.STA.BRTC.ZS SDG 3.1.2 |
| Travel time to the nearest health facilityIND.HLT.system.health_facility_travel_time | HLT | Health system capacity | vulnerability | min | COUNTRY, ADM1, ADM2, CITY, GRID | |
| IHR core capacity score (SPAR)IND.HLT.security.spar_capacity | HLT | Health security (IHR) | coping capacity | {score} | COUNTRY | SDG 3.d.1 WHO_GHO SDGIHR2021 WHO_GHO SDGIHR2018 |
| IHR laboratory capacity (SPAR C4)IND.HLT.security.spar_laboratory | HLT | Health security (IHR) | coping capacity | {score} | COUNTRY | SPAR C4 WHO_GHO IHRSPAR2_C04 JEE D1 |
| IHR surveillance capacity (SPAR C5)IND.HLT.security.spar_surveillance | HLT | Health security (IHR) | coping capacity | {score} | COUNTRY | SPAR C5 WHO_GHO IHRSPAR2_C05 JEE D2 |
| IHR health emergency management capacity (SPAR C7)IND.HLT.security.spar_emergency_management | HLT | Health security (IHR) | coping capacity | {score} | COUNTRY | SPAR C7 WHO_GHO IHRSPAR2_C07 JEE R1 |
| IHR risk communication capacity (SPAR C10)IND.HLT.security.spar_risk_communication | HLT | Health security (IHR) | coping capacity | {score} | COUNTRY | SPAR C10 WHO_GHO IHRSPAR2_C10 JEE R5 |
| Epidemic event frequencyIND.HLT.epidemic.outbreak_event_frequency | HLT | Epidemic and outbreak | hazard | 1 | COUNTRY, ADM1 | |
| Reported cholera cases, per 100,000 populationIND.HLT.epidemic.cholera_cases.p100k | HLT | Epidemic and outbreak | hazard | /10*5 | COUNTRY | WHO_GHO CHOLERA_0000000001 |
| Bloodstream infections due to MRSAIND.HLT.amr.mrsa_bloodstream | HLT | Antimicrobial resistance | hazard | % | COUNTRY | WHO_GHO AMR_INFECT_MRSA SDG 3.d.2 |
| Bloodstream infections due to E. coli resistant to third-generation cephalosporinsIND.HLT.amr.ecoli_3gc_bloodstream | HLT | Antimicrobial resistance | hazard | % | COUNTRY | WHO_GHO AMR_INFECT_ECOLI SDG 3.d.2 |
| Stunting among children under fiveIND.HLT.nutrition.stunting | HLT | Nutrition | vulnerability | % | COUNTRY | WB_WDI SH.STA.STNT.ME.ZS SDG 2.2.1 WHO_GHO NUTSTUNTINGPREV FAO_FAOSTAT 21025 |
| Wasting among children under fiveIND.HLT.nutrition.wasting | HLT | Nutrition | vulnerability | % | COUNTRY, ADM1 | WB_WDI SH.STA.WAST.ZS SDG 2.2.2 WHO_GHO NUTRITION_WH_2 FAO_FAOSTAT 21026 |
| Anaemia among women of reproductive ageIND.HLT.nutrition.anaemia_women | HLT | Nutrition | vulnerability | % | COUNTRY | WB_WDI SH.ANM.ALLW.ZS WHO_GHO NUTRITION_ANAEMIA_REPRODUCTIVEAGE_PREV SDG 2.2.3 FAO_FAOSTAT 21043 |
Health security risk index, world
The world reading of this index, every country as a tile and the largest movements since the previous edition.
- Previous edition
- —
- Range since 2016
- —
- Coupled composite
- —
- Coupling score S
- —
- Pulse, latest week
- —
- Outlook, 12 months
- —
- Method
- Indicator Standard 1.0 · NXS-GRX 2026
- Draws
- 1,000
No released values yet. The first edition draws the history here with its interval band and class bounds.
Country values
- Tiles
/api/v1/public/grix/risk-products/tiles/hlt/{z}/{x}/{y}.mvt- Observation key
nis:IDX.HLT.security.health_security_risk:{ISO3}:{YEAR}:A
Series that read this index
Crosswalks and validity checks
Crosswalks map leaf indicators to source code lists; established indices are used for validity checks, never re-weighted as inputs.
| Code system | Leaf indicators mapped |
|---|---|
WHO_GHO | 22 |
WB_WDI | 18 |
SDG | 17 |
SPAR | 4 |
JEE | 4 |
FAO_FAOSTAT | 3 |
Platforms, standards and ways to take part
Field and service platforms of GCRI, GRF and GRA, the Nexus Risk Standards for this domain, learning, working groups and open calls. Every link is a live page.
Across the Nexus
GCRI Health · GCRI Biotechnology and Biosecurity · GRF Health and Biosecurity Governance · GRA Insurance
Cite and reuse
See this index in every country profile
Each profile shows this index with its interval and class once released.
Status
The methodology, structure and definitions of The Global Risks Index are a preparatory working draft (2026), circulated for review and comment and not for implementation. No value appears until an edition is released from a governed evidence cut; values then carry intervals, classes, sources and their correction pathway. Simulators run the published methods on numbers you choose and never show a NXS-GRX value.
What NXS-GRX is not
NXS-GRX is research and risk-analytics information. It is not a credit or ESG rating and uses no rating scale, not a benchmark for financial instruments, not official statistics, not an emergency warning or official classification, and not advice. It must not be used to evaluate natural persons. Risk classes are bands on a published scale, never rankings of countries or people.
Institutions and sources
The Nexus Consortium is stewarded by three independent not-for-profit institutions: GCRI Canada as Lead Institution, Consortium Secretariat and lead contracting organization, The Global Risks Forum (GRF) and The Global Risks Alliance (GRA). Technology, infrastructure and service providers work with the Consortium at arm's length under written agreements, like every other external party in the public-private-planet model, and hold no role in its stewardship.
Every value carries the attribution of its sources, which keep their own licences. External names are cited for interoperability only. Nexus-authored text is intended for CC BY 4.0 on release.
Avis en français
La méthodologie et les définitions du NXS-GRX sont un projet de travail préparatoire (2026). Le NXS-GRX est une information de recherche et d'analyse des risques : ni notation, ni indice de référence financier, ni statistique officielle, ni alerte, ni conseil. Les classes de risque sont des bandes sur une échelle publiée, non des classements.