People in the UK enjoy fewer years of good health before they die than the citizens of most comparable European countries as well as Australia and Canada, a major report shows.

The health secretary, Jeremy Hunt, said Britain's performance was "shocking" compared with that of other countries, and called for action to turn it around by local health commissioners, who are about to take up their new responsibilities.

The UK ranked 12th out of 19 countries of similar affluence in 2010 in terms of healthy life expectancy at birth, according to a detailed analysis from the Global Burden of Disease data collected by the Institute for Health Metrics and Evaluation (IHME) in Seattle.

Despite big increases in funding for the NHS in recent years and many reform initiatives, the UK was in exactly the same place as in the league table for 1990, according to the IHME report, published in the Lancet medical journal.

While life expectancy has improved by 4.2 years in the UK over the two decades, other countries have improved faster. In 2010, Spain topped the league. Its people could expect 70.9 years of healthy life – before disease and disability began to take a toll. Second came Italy, with 70.2 years and third was Australia, on 70.1 years. In the UK, we can expect 68.6 healthy years of life.

Hunt said the UK was a long way behind its global counterparts and called for action by local health commissioners to tackle the five big killers – cancer, heart disease, stroke, respiratory and liver diseases. He will on Tuesday announce a strategy to tackle cardiovascular disease, which he says could save 30,000 lives a year.

"Despite real progress in cutting deaths, we remain a poor relative to our global cousins on many measures of health, something I want to change," he said. "For too long we have been lagging behind and I want the reformed health system to take up this challenge and turn this shocking underperformance around."

But the problem is only in part to do with hospital care – much of it is about the way we live. Our diet, our drinking and continuing smoking habits all play a part, according to one of the report's authors, Prof John Newton, chief knowledge officer of Public Health England, which assumes its responsibilities on 1 April.

"I'd be very surprised if it was the healthcare factors that are making the difference," he said. "It is more to do with a culture of supportive communities, people's lifestyles and their diets."

It must be worth looking to see how Italy and Greece (at 11th, just ahead of the UK) can do better than us in spite of their economic and political problems, he said. It was not difficult to get fresh fruit and olive oil in the UK. "It is more the propensity not to stuff yourself with all the wrong things, which we are rather good at," he said.

The leading causes of death in the UK have changed very little over the last 20 years, says the report – with ischaemic heart disease the biggest killer (for which diet and smoking are big risk factors). Also in the top five over two decades are stroke, chronic obstructive pulmonary disease (COPD), lung cancer and lower respiratory infections. Smoking is a risk factor for all of these.

But there has been a startling increase, say the authors, in Alzheimer's disease, which is up by 137% to be the 10th leading cause of death; cirrhosis, which is up by 65% to ninth, and drug-use disorders – up 577% from 64th place to 21st.

Drinking and drug use have been the main issues behind the worsening of the UK's ranking in early deaths among adults aged 20-54. In 2010, drugs were the sixth leading cause of death in this age group and alcohol was 18th – up from 32nd and 43rd place respectively 20 years earlier.

The UK has lower-than-average premature death rates from diabetes, road injuries (the best of the whole group), liver cancer and chronic kidney diseases.

But it has not kept up with progress elsewhere in a number of areas, including heart disease, breast and oesophageal cancers and preterm birth complications.

"We found that the UK had made significant improvements in health overall, but those were masking serious problems in certain age groups," said Dr Alan Lopez, head of the School of Population Health at Queensland University and one of the founders of the Global Burden of Disease project. "If you look at adults aged 20-54, increases in deaths from alcohol and drugs overshadowed the substantial reductions in deaths from greater cervical cancer screenings and efforts to reduce road traffic injuries."

As people live longer, disability is becoming an ever-bigger issue. In 2010, mental and behavioural disorders (mainly depression, anxiety, drug and alcohol use, schizophrenia and bipolar disorder), and musculoskeletal disorders (mainly lower back pain and falls) were responsible for more than half of all years lived with disability in the UK.