Singapore students topped both the Program International Student Assessment (PISA) and the Trends in International Mathematics and Science Study (TIMSS). In the 2016 EF English Proficiency Index taken in 72 countries, Singapore place 6th and has been the only Asian country in the top ten. Healthcare Singapore has a generally efficient healthcare system, even though health expenditures are relatively low for developed countries. The World Health Organisation ranks Singapore's healthcare system as 6th overall in the world in its World Health Report. Singapore has had the lowest infant mortality rates in the world for the past two decades. In 2019, Singaporeans had the longest life expectancy of any country at 84.8 years. Women can expect to live an average of 87.6 years with 75.8 years in good health. The averages are lower for men. Singapore is ranked 1st on the Global Food Security Index. As of December 2011 and January 2013, 8,800 foreigners and 5,400 Singaporeans were respectively diagnosed with HIV, but there are fewer than 10 annual deaths from HIV per 100,000 people. There is a high level of immunisation. Adult obesity is below 10%. In 2013, the Economist Intelligence Unit ranked Singapore as having the best quality of life in Asia and sixth overall in the world. The government's healthcare system is based upon the "3M" framework. This has three components: Medifund, which provides a safety net for those not able to otherwise afford healthcare; Medisave, a compulsory national medical savings account system covering about 85% of the population; and Medishield, a government-funded health insurance program. Public hospitals in Singapore have a considerable autonomy in their management decisions, and notionally compete for patients, but remain in government ownership. A subsidy scheme exists for those on low income. In 2008, 32% of healthcare was funded by the government. Healthcare accounts for approximately 3.5% of Singapore's GDP. Culture Despite its small size, Singapore has a diversity of languages, religions, and cultures. Former prime ministers of Singapore, Lee Kuan Yew and Goh Chok Tong, have stated that Singapore does not fit the traditional description of a nation, calling it a society-in-transition, pointing out the fact that Singaporeans do not all speak the same language, share the same religion, or have the same customs. Singaporeans who speak English as their native language would likely lean toward Western culture (along with either Christian culture or secularism), while those who speak Chinese as their