An average Indian’s peak productive period lasts a mere seven years – less than half of that of a Chinese worker.

In fact, India ranked 158 among 195 others in terms of “expected human capital,” a study published this week in the Lancet journal has found. Expected human capital denotes the number of years an individual can work at peak productivity between the ages of 20 and 64. This is calculated based on the life expectancy adjusted for health, and the years of schooling adjusted for the quality of learning.

Among the countries ranked ahead of India are China (20 years), Russia (19), and Sri Lanka (13). Finland topped the list with 28 years.

Besides the physical capital of buildings and equipment, researchers say human capital, in terms of education and health, is just as important for economic productivity. But India’s population is among the unhealthiest in South Asia, and the quality of its education leaves a lot to be desired.

Using censuses and household surveys, the 2016 Global Burden of Disease study, and the results from standardised tests of school-going children, the researchers studied the changes in educational attainment, quality of learning, health, and survival of populations between 1990 and 2016.

For the health status, they looked at the prevalence of diseases and impairments that affect learning and productivity, such as wasting, stunting, anaemia, and infectious diseases. In this measure, India ranked below all other countries in the South Asian region, with a score of just 43 out of 100.

Data: Measuring human capital: a systematic analysis of 195 countries and territories, 1990–2016
Data: Measuring human capital: a systematic analysis of 195 countries and territories, 1990–2016

India has for long spent a minuscule proportion of its GDP on health care, and despite the recent launch of an ambitious national health insurance scheme, individual Indians continue to pay a high price for health care. In fact, previous research ranked India 145th out of 195 countries in terms of the access to and quality of its health care services, coming below neighbours such as Sri Lanka and Bangladesh. This is taking a toll on the productivity of its workforce, which is expected to be the largest in the world by 2027.

Adding to the productivity problem is the poor quality of education. To measure this, the researchers studied the performance of five-year age groups (from five to 19 years) on standardised tests of maths, reading, and science. In this, India received a score of 66 out of 100, ranking below all the other south Asian countries except Afghanistan.

Data: Measuring human capital: a systematic analysis of 195 countries and territories, 1990–2016
Data: Measuring human capital: a systematic analysis of 195 countries and territories, 1990–2016

This isn’t surprising considering that India’s education system has often been criticised for being archaic and focused on rote learning, while its teachers are poorly paid and trained. Along with the dire lack of infrastructure, these factors make it incredibly difficult for students to learn even basic skills.

The 2017 Annual Status of Education Report, released in January this year, showed that around 25% of students aged between 14 and 18 couldn’t read basic texts fluently in their own language, while over 40% struggled with division. Even among youth that had completed eight years of education, many lacked the foundational skills of reading and math. Another recent study, conducted by the non-profit Stones2Milestones, showed that even students at private schools in urban areas, long thought to be better off, can barely read.

This article first appeared on Quartz.