The past century has witnessed an unprecedented increase in life expectancy.

But all you have to do is visit an extended care facility—AKA nursing home—to wonder if those extra years are always worth living.

What most of us want is not just long life but a healthy old age. And a provocative new study published in The Lancet looks at some of the key factors that determine what the researchers call “healthy life years,” or HLYs.

Its conclusions should be required reading for the new administration as it takes on the enormous challenge of an ailing health care system and a sinking economy.

Enlightened social and economic policies, the findings show, can go a long way toward improving health and longevity.

The study compared healthy life years in 25 countries that are part of the European Union, including France, Italy, Sweden, Denmark, Latvia, Estonia, Hungary, Malta, and the UK. The highest life expectancies for men were 80.4 years in Italy and 80.3 in Sweden. The lowest, just over 71 years, were in Latvia and Lithuania.

Even more startling differences showed up in HLYs. Men in Denmark could expect to enjoy 23.6 years of healthy life after turning 50. Men in Estonia could expect only nine.

Among women, the French enjoy the longest lives, averaging 85.4 years, followed by Italian women at 85.3 years. Latvian and Hungarian women had life expectancies of just over 79 years. Again, HLYs varied even more dramatically. Danish women can expect to enjoy more than 24 years of good health after 50, women in Estonia only 10.4 years and those in Hungary just over eleven.

What accounts for these shocking differences in healthy life years? “Generally, citizens in the established European countries have both longer and healthier lives than do most of those in the ten new EU countries,” the authors note. Those more established countries, in turn, typically have stronger economies and better social support systems.

And that makes a big difference in health prospects.

The higher a country’s gross domestic product, the study found, the more healthy years of life its citizens enjoy. The more money a country spends on elder care, the higher its HLY.

Long-term unemployment was linked to lower life expectancy and poorer health. That’s not surprising. Being chronically unemployed is devastating in almost every way. But the survey also showed that education is an important driver of good health. “Within every age group, people with more years of education make fewer demands on health care than do people with less years,” the researchers report. Life-long learning was also linked to more healthy years of life.

Good health, in other words, is more than just a matter of medicine.

With the economy in deep trouble, unemployment rising, and health care in tatters, the challenges that face the new president are beyond enormous. The good news: almost anything that bolsters the economy, provides employment, expands educational opportunities, and improves the social support for the elderly will resound in better health.