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Blogs | Expat Stories

How does physical activity affect your health?

How important is it to stay active as we age and what kind of activity brings the most benefits?

For an expat with a busy schedule, finding the time to exercise can be challenging.

However, there is an infinite wealth of evidence to show that finding that time is vital, especially for the over 50s.

As we all know, exercise is good for the body and the mind. But, there’s no one-size-fits-all approach and there are lots of factors that should influence a person’s approach.

What are the benefits of physical activity?

There is the obvious benefit of helping control weight, which becomes more difficult as you get older due to your metabolism slowing down.

A few hours of moderate-intensity physical exercise each week also lowers the risk of heart disease, type 2 diabetes, breast cancer and colon cancer.

The US-based Centers for Disease Control and Prevention (CDC) suggests that the risk of endometrial and lung cancer is lower in people who exercise regularly than in those who don’t.

This is backed up by the results of a long-term study by University of Minnesota researchers. They gave questionnaires to 36,929 cancer-free women from Iowa, and then followed them for 16 years. They found that the women with high exercise levels were less likely to develop lung cancer than those with low exercise levels.

The Australian study, published in the British Journal of Sports Medicine, found that aerobic exercises, resistance training and less-strenuous forms of exercise such as T’ai Chi, a traditional Chinese martial art, all had positive effects on different parts of the brain’s functions ranging from the ability to organise and plan, to reading and reasoning.

The authors of that study examined 36 wide-ranging studies and found that exercising moderately for around an hour on as many days as possible improved memory and thinking skills of those aged over 50.

Pilates

How long should I exercise for?

Britain’s National Health Service recommends different sorts of exercise for different ages. It says children under the age of five should be physically active for at least 3 hours a day; this includes walking, playing outside, chasing balls, playing in water or riding a bicycle.

However, healthy adults should do a minimum 150 minutes of moderate aerobic activity each week as well as strength exercises that focus on the major muscles such as in the leg and back.

According to the CDC, those who do seven hours of exercise a week have 40% less chance of an early death than those who do just half an hour a week.

What are moderate and intensive forms of exercise?

Moderate aerobic activity includes things such as fast walking and mowing the lawn; so this kind of activity can easily be incorporated into a normal day.

Your heart rate needs to be raised to have an affect on your health so shopping and slow walking unfortunately won’t count. Vigorous or intensive activities are running, hiking, swimming or playing sports such as tennis.

Do some activities bring particular benefits to over 50s?

Low impact aerobic exercise and bone-strengthening activities can slow down the natural decline in bone density which occurs as a person ages.

This reduces the risk of chronic conditions such as osteoporosis and arthritis, according to the CDC. The organisation says that doing just two hours of moderate exercise a week lowers the risk of hip fracture and improves the quality of life for people living with arthritis.

For the over 50s, these lower weight-bearing and impact options help to reduce the risk of bone injuries or breakages, which is often higher in the older generation.

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Antibiotics resistance: what you need to know

Many countries have strict rules governing the use of antibiotics. In the UK, Europe and US, they will only be prescribed if a doctor is confident the cause of an illness is bacterial and not caused by a virus or other pathogen. However, not all countries are so vigilant.

A 2016 study published by the Journal of the Medical Association of Thailand revealed that antibiotics in Thailand are “widely available and inappropriately sold and given by grocery stores and retails shops”.

The inevitable affect, the researchers note, is that antibiotic-resistant bacteria are commonly and freely circulating through the population, meaning some illnesses are no longer treatable.

The situation is similar in the UAE, where prescription-required medicines are routinely sold without an accompanying prescription.

The World Health Organisation (WHO) takes this issue very seriously: “Where antibiotics can be bought for human or animal use without a prescription, the emergence and spread of resistance is made worse.”

It warns that without urgent action, the world is heading for a “post-antibiotic era, in which common infections and minor injuries can once again kill.”

The more antibiotics that are prescribed inappropriately, says Dr Jace Clarke, Chief Medical Officer at William Russell, the more likely resistance is to develop.

What causes antibiotic resistance?

A common misconception is that it’s the individual who becomes resistant to antibiotics. In fact, it’s the bacteria that adapts and develops resistance, rendering certain antibiotics entirely useless.

Misuse and overuse of antibiotics is the biggest cause of antibiotic resistance and the rise of the so-called superbug (illnesses that no longer respond to treatment and are now potentially deadly).

Superbugs emerge when bacteria have not been properly treated with antibiotics and have learnt to become resistant; certain strains of tuberculosis and pneumonia have already developed resistance so can’t be treated easily, if at all.

The WHO calls antibiotic resistance “one of the biggest threats to global health, food security and development today.”

Doctor and Child

What do antibiotics treat?

Antibiotics should only be used to treat illnesses caused by susceptible infections, for example bacterial tonsillitis, urinary tract infections, respiratory tract infections, whooping cough and skin infections. Different types of antibiotics target specific bacteria.

For example, Amoxicillin (a sort of Penicillin) is often prescribed to treat ear infections, while Trimethoprim is commonly given to treat urinary tract infections caused by E.coli.

Dr Clarke stresses there isn’t a one-size-fits-all approach to antibiotics. “Some bacterial infections can be self-limiting in fit, healthy people” he says, “for example Salmonella, a common cause of food poisoning.” A doctor would therefore “establish sensitivity of the bacteria and allocate an appropriate antibiotic”.

Antibiotics are completely useless against viruses. A huge number of everyday illnesses are caused by viruses and therefore don’t need antibiotics. If you’re suffering with a cold at the change of season, chances are antibiotics won’t help.

 

pills

 

What to do if you think you need antibiotics

Even if you think your self-diagnosis is accurate, and as tempting as it might be to buy the tablets over the counter, you could do more harm than good. Antibiotics could interfere with other medicines you might be taking, or even damage your organs.

Dr Diab Maaruf Kurdi, head of pharmacy at Burjeel Hospital in the UAE, says: “It’s important that medication is not purchased without the doctor’s consultation, because the doctor will take into consideration your overall medical condition. Furthermore, the medication that you purchase may not be right for your condition and could cause further health complications.”

Dr Clarke also warns that a non-bacterial illness that goes undiagnosed, such as malaria, could get worse without formal identification and appropriate treatment from a doctor.

 

How to take antibiotics responsibly

Being prescribed a course of antibiotics by a medical professional is the first step, but there’s more that needs considering in order for the antibiotics to work effectively.

You must follow the instructions and finish the course even if you’re feeling better. It’s also important to note whether the medicine should be taken before or after food, or with water. Never share antibiotics and do not accept them if a pharmacist offers them without a prescription.

For all your global health insurance questions, go to the William Russell website, or call our dedicated team on +44 (0) 1276 486455.

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What is driving up the cost of global healthcare?

According to Willis Towers Watson’s 2017 Global Medical Trends Survey Report, the trend in average global medical investments went up 7.8% in 2017 and most countries expect it to continue to rise between 2.4 and 7.5% a year until 2020.

This article asks what factors are driving up the cost of healthcare globally. Understanding these can help you keep a clear view of how healthcare is set to change in the coming years.

Consumer demand

An emerging middle class in developing countries means there is an increasing global demand for high quality private health services.

The Brookings Institution report, The Unprecedented Expansion of the Global Middle Class, estimates that there were around 3.2 billion people in the middle class at the end of 2016, growing by around 140 million annually. This is set to increase to 170 million a year in five years’ time.

The overwhelming majority of the next billion – an estimated 88% – will live in Asia; with 380 million in India, 350 million in China and 210 million in other areas of Asia. Brookings predicts that by 2030, Asians could represent two-thirds of the global middle-class population.

The rise of the middle class has meant a general increase in wealth and life expectancy, which has created additional strain on governmental and private health services. Particularly in Asia, where high-fat diets and less active lifestyles have been associated with greater wealth and longer life expectancy, obesity levels are on the rise, leading to a surge in non-communicable chronic diseases, such as cardiovascular disease, some cancers and respiratory illnesses.

According to Iber Global, rates of cardiovascular disease are projected to at least double if not quadruple in several Asian countries over the next two to three decades.

“Cardiovascular disease, cancer and respiratory illness are all projected by insurers worldwide to be the top three diseases for at least the next five years.”

Willis Towers Watson’s 2017 Global Medical Trends Survey Report

Convenience, mobility and choice

Alongside this, the digital revolution is also having an impact on consumer demands. With the range of digital channels growing – from retail e.g. Amazon next day delivery, instant access to content e.g. Netflix, to instant means of communication e.g. social media, instant messaging – expectations on the healthcare industry for such things as 24/7 on-demand access to healthcare, are only going to increase.

The rising popularity of health-tracker apps and wearables (predicted to reach £14.8 billion in 2018) also means that patients are more connected to the state of their overall health and therefore expect their healthcare providers to match their levels of connectivity. Especially in the younger mobile-savvy ‘millennial’ generation, the need for convenience, mobility and choice are paramount.

Multi-pronged, collaborative and technology enabled approaches are one of the top considerations (and investment areas) for healthcare stakeholders

Deloitte 2018 Global Healthcare Outlook

Ageing and lifestyle factors 

The world’s population is ageing. This means that, as poverty decreases and access to medicines improve, life expectancies are increasing. According to Deloitte’s 2018 global healthcare sector outlook, the ageing population (those over 65 years old) is set to increase by eight percent, from 559 million in 2015 to 604 million in 2020.

The longer people live, the more care they may need, and the more chance they will have of contracting later life conditions and diseases, such as dementia. According to Deloitte, cases of dementia are forecast to increase in every region of the world, reaching 74.7 million by 2030.

Additionally, by 2020, Deloitte predicts that 50% of global healthcare expenditure – around $4 trillion – will be spent on the three leading causes of death: cardiovascular diseases, some cancers and respiratory diseases. Meanwhile, the number of diabetes sufferers will rise from 415 million to 642 million by 2040.

Regulatory landscape and fraud

The global healthcare regulatory landscape is complex and constantly evolving. In the future, healthcare providers will continue to face a highly complex and rapidly changing set of global, regional, country and industry-specific regulations, laws and directives.

These cover clinical quality and safety, regulations on counterfeit drugs, identifying and eliminating corruption, and the ever-increasing danger of cyber security.

Many regulations are in place to counteract the global problems of fraud and corruption in healthcare. The Global Health Care Anti-Fraud Network estimates that $260 billion – or around six percent of global healthcare spending – is lost to fraud each year, which can occur in several ways.

Health insurance fraud, whereby an insurer or government healthcare programme is targeted by a fake claimant, is a growing problem, while prescription drug diversion is anticipated to become more of a global problem than illicit drug production.

Tackling fraud and adhering to regulations all come with a price tag. Expensive security software must be purchased to protect confidential patient information from hackers. Healthcare costs must therefore rise to ensure data and patients are kept safe.

New healthcare approaches

According to McKinsey’s Digital Patient Survey, more than 75% of all patients expect to use digital services in the future. This means health services will have to embrace a ‘third wave of digitisation’, meaning using digital innovations to improve patient accessibility and experience, rather than just using it to consolidate HR and internal IT processes.

This third wave of digitisation covers an array of new technology: 3D-printed devices, the use of virtual reality and telehealth to communicate with patients, biosensors and trackers, and artificial intelligence in clinical diagnoses.

The emergence of new innovative approaches to healthcare and improved online services is certainly a way for traditional healthcare providers to meet increasing patient demands, but setting up these services comes with a cost.

In Southeast Asia, Singapore is leading the way with integration of its digital healthcare services by moving its national health information to the cloud. According to PwC Consulting, the project – named hCloud – will cost US$37 million for the first ten years.

“Singaporeans are among the most tech-savvy in the world, and that translates into their attitudes towards digital healthcare – it is not just the younger generation who are keen to adopt digital healthcare.”

Ivy Lai, country manager, Philips Singapore

Writing for Forbes, Maria Clemens of health sector technology provider, Management and Network Services, said that technological advances had been serving the healthcare industry very well over the last few decades, but the cost of some technical advances was now contributing to the overall increase in costs. “In fact, new medical tech is responsible for 40-50% in annual cost increases,” she wrote.

How does this all impact my health insurance?

As global healthcare costs go up, this increases how much it costs to provide health cover. However, if you are renewing your health insurance for 2018, there are a few options you can consider.

  1. Shop around and compare your options for the most competitive deal, making sure your policy meets your needs and consider the fact that pre-existing conditions may not be covered
  2. Stay with your current insurer, but check your policy meets your needs and provides access to the best health cover
  3. You may be able to change the level of your cover, for example, the level of plan, optional benefits or excess levels. Talk to your insurer to find out more about your level of cover.

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Take care of your family’s tomorrow, today

Help protect your family financially if something happens to you.

The decisions you make as a parent will span throughout your children’s lifetime. Your support and advice will guide them as individuals and stay with them forever – because your role as their guardian doesn’t stop after you are gone. Life insurance could provide you with the assurance that your loved one’s future is secured financially, should the worst happen.

Planning your legacy

The loss of a loved one is never easy and can be a very emotional time in our lives. The loss may be impossible to mitigate but the weight of picking up the pieces with banks, mortgage lenders, legal teams and health providers, especially as an expat, can be made to feel a little less daunting if you are set up financially. With a William Russell Life insurance plan you can protect what you have built and pass it onto your loved ones.

Life insurance designed for expats

We offer life insurance that’s designed with expats in mind; wherever your next step might take you. Your plan moves with you and the terms are communicated in a clear, unambiguous language. For 2018, our Life cover has been enhanced with you in mind….

Our 2018 enhanced international life cover plan offers

  • Lower rates for 18-54 year olds with no claims
    • Rate reductions of up to 30% if you’re under the age of 40
    • Increase in maximum benefit from $1.5m to $2m
    • Terminal illness cover – your plan pays out if you are diagnosed with a terminal illness with a prognosis of 12 months or less

Your job done

With our life plan, you can choose a level of cover that suits your lifestyle within the limits of the policy, giving you peace of mind that your family’s financial future is secure.

Start the conversation today

Speak to us today to start planning your life insurance to cover you and your family while you are living away from home.

Find out more >parent_and_child_at_beach

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Blogs | Health Tips

Ebola in Africa: what expats need to know

Dr Peter Salama, Executive Director of the World Health Organization (WHO) Health Emergencies Programme which coordinates outbreak responses, remarked that we have “learnt never, ever to underestimate the Ebola virus disease and we will be remaining vigilant.”

The Ebola outbreak in West Africa was finally declared over on the 13th of January 2016 by the WHO, but for expats in Africa it remains important to be aware of the disease and the risks it presents.

By the beginning of 2016, a disease that in less than two years had crossed borders and killed thousands of people – primarily in Guinea, Liberia and Sierra Leone – had finally been brought under control. WHO reported a total of 28,646 cases of Ebola and 11,323 deaths.

What is less well known, is that there was another Ebola outbreak in May 2017, this time in a remote area the Democratic Republic of the Congo (DRC). What is remarkable is that this outbreak of 8 reported cases was declared over in just under 2 months due to the efforts of local and international agencies that responded to the outbreak by setting up mobile diagnostic labs that allowed for onsite testing of patients.

WHO health professionals say although they are more experienced in dealing with Ebola, there is still no cure. This article presents the facts on Ebola and what you should do if you encounter it.

GUINEA-HEALTH-EPIDEMIC-EBOLA

What is Ebola?

Ebola was first discovered in 1976, with 2 reported outbreaks in South Sudan and along the Ebola River in the DRC. From here, the virus was subsequently named after the Ebola River.

It is transmitted from wild animals such as gorillas, fruit bats and antelopes to humans. It then spreads across the population through human-to-human transmission by way of bodily fluids coming into contact with broken skin or the mucus membrane. Ebola is part of a group of contagious infections called viral haemorrhagic fevers, which also includes Lassa and Marburg.

The virus can exist outside of the body for days and items that have been in contact with bodily fluids should be avoided. This is why medical professionals and family members are considered to be the most at risk of catching the disease.

What are the symptoms

Once someone is infected with Ebola, it begins to multiply in the body. Symptoms can vary but they start to appear after 4 to 6 days with a sudden onset of a fever, diarrhoea, vomiting, severe headache and a sore throat.

The period between infection with the virus and the start of symptoms is called the incubation period. For Ebola, this can be as short as 2 days or as long as 21 days.

Areas affected by Ebola

While outbreaks have been reported and maintained for years in the DRC, Sudan, Gabon, Guinea and Uganda – there have also been reported cases of Ebola crossing over into other countries like the US, Italy and the UK.

Tanzania and Botswana are two examples of countries that have managed to prevent Ebola from entering its borders through strict government measures to screen travellers arriving from Ebola-affected countries.

If you think you may have come into contact with Ebola

If you suspect you may have Ebola or have come into contact with someone suspected of having the virus, you should attend the nearest hospital or clinic immediately.

These facilities have a responsibility to report any cases that are thought to be Ebola and if any of the cases come back positive they are then reported at a government level.

Health care response

Dr Peter Salama says that they put a huge emphasis on getting as much information from the people who have been infected, to help manage the case and isolate it as quickly possible to prevent the spread of Ebola.

WHO health professionals say they are more experienced in dealing with Ebola but say there is still no cure and its thought that the only way to help prevent the spread of the disease is through 21 days of quarantine.

The US Centers for Disease Control and Prevention (CDC) have said ‘experimental vaccines and treatments for Ebola are under development, but they have not yet been fully tested for safety or effectiveness’.

Recovery from Ebola must be done carefully and patiently. The virus is known to persist in some areas of the body of those who have recovered from the disease, such as the testicles, the inside of the eye, and the central nervous system. In pregnant women, the virus can persist in the placenta, amniotic fluid and foetus. If you are breastfeeding the virus can also persist in the breast milk.

Studies have shown that a small percentage of survivors can still test positive for the Ebola virus for a period of more than 9 months.

What can you do about it?

  • Check if you are travelling to a region where Ebola may still exist
  • Remain vigilant of Ebola symptoms
  • Seek healthcare immediately if you suspect you may have come into contact with Ebola

To find out more about Ebola visit World Health Organization website.

WHO health professionals say although they are more experienced in dealing with Ebola, there is still no cure

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Tired all the time? How to get better sleep

Sleep deprivation is a key global issue that is having a particular impact in east Asian cities.

According to a 2014 profile of 43 cities, people in Singapore are getting an average of six hours and 32 minutes sleep, those in Seoul fewer than six hours, and Tokyo’s inhabitants are the most sleep deprived, with only five hours and 44 minutes.

These cities are widely associated with people working harder and achieving more, and as consequence people may be missing out on too much sleep. We take a closer look at how sleep deprivation can affect our everyday lives.

Sleep myth #1

We need less sleep as we age

Truth: While teenagers don’t require as much sleep compared to babies, adults require even less sleep.

A baby aged 6 months requires around 11 hours of sleep per day, as the child grows into a teenager they require even less; around 9 hours of sleep per day. Adults require 7-9 hours of sleep per day.

How bad is sleep deprivation for my health?

According to the National Health Service (NHS) in the UK, sleep boosts your mood and immunity, while increasing fertility and libido. Sleep deprivation, on the other hand, has been linked to long-term mood disorders such as depression and anxiety, type 2 diabetes, increased heart rate and higher blood pressure.

In 2013, the University of Surrey’s Sleep Research Centre in the UK studied the effects of reducing sleep by just one hour.

The results showed that sleep deprivation affects our genes, approximately 700 of them. Researchers found an increase in the activity of genes that govern body processes such as inflammation, immune response and stress, and also the genes associated with diabetes and cancer risk. The reverse happened when an hour of sleep was added.

Research by the University of Zurich found that male students – aged 18 to 28 years – sleeping for 5 hours a night made riskier decisions about money than if they had slept for 8 hours. The research concluded that lack of sleep can lead to an increase in what they call risk-seeking behaviour.

http://www.media.uzh.ch

Am I getting enough sleep?

There is no hard and fast rule about the number of hours you should be getting. Sleep scientist Patrick Fuller says that sleep should be restorative, leaving you feeling refreshed. On a basic level, if you struggle to wake up in the morning and it takes you a few hours, or several cups of coffee, to feel energised, you’re probably not getting enough sleep.

According to Nick Littlehales, an expert sleep coach, we sleep in cycles of 90 minutes rather than 60. Each restorative cycle takes us down into a deep sleep, where we place the day’s memories in our long-term storage, and then up into rapid eye movement sleep (REM), where we begin to process the emotions of the day.

Five cycles is the optimum amount to enable your body to recover, so if you need to get up at 7am you should be aiming to go to sleep at 11.30pm.

Sleep cycle

How can I get better sleep?

  • Sleep at regular times – your body craves routine, so don’t be tempted to lie in at the weekends.
  • Wind down before bed – as well as the baths and warm (de-caffeinated) drinks we had as children, it’s important to calm your mind. Try writing a to-do list to get the next day’s tasks off your mind.
  • Understand the impact of light – blue light – the kind emitted by phones, tablets and TVs – simulate day light, and will cause your body to start waking up. Avoid phones and TVs for an hour or so before bed, and seek daylight in the morning before the light of an electronic device.
  • Build the right environment – in your bedroom, avoid gadgets, bright lights and working. Make sure you have good curtains, a comfortable mattress and, if you find it hard to sleep in the heat, good air conditioning.
  • Nap if you need to – it’s OK to catch an extra cycle of sleep later in the day, but preferably not too late in the day in case it affects night-time sleep.
  • Keep a sleep diary – if you’re still experiencing problems, keep a journal of when you sleep well and when you don’t, taking into account factors such as diet, stress and bedtimes. If you regularly struggle to fall asleep, you may have insomnia and it’s important that you speak to your doctor.

Sleep myth #2

A glass of wine before bed helps you sleep

Truth: Sorry, alcohol may help you fall asleep but as little as two drinks can cause less restful sleep and lead you to wake up more frequently.

I’m still not sleeping well – what should I do?

If you are repeatedly finding it hard to fall asleep and stay asleep throughout the night to feel refreshed in the morning, you may be suffering from insomnia. Insomnia can be caused by stress and anxiety; lifestyle factors, such as mental or physical conditions; certain medications; or a poor sleeping environment.

While we may occasionally experience episodes of insomnia, a persistent lack of sleep can have a damaging effect on your mental and physical health, as well as your quality of life. Try following our better sleeping tips and if they don’t help, contact your doctor for a consultation.

Sleep myth #3

During sleep your brain rests

Truth: While the body rests during sleep, the brain remains active and still controls many body functions. The US National Sleep Foundation says the brain ‘recharges’ during sleep. It also sorts and processes information from the previous day, vital for learning and memory.

Sleep is vital to your wellbeing. A global health insurance plan can provide you and your family with access to GP consultations and wellbeing benefits, such as health checks, to help ensure you’re in the best possible health while overseas.

If you are living abroad and would like to know more about international health cover, go to the William Russell website, or call our dedicated team on +44 (0) 1276 486477.

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Your guide to malaria protection

Malaria prevention has always been a consideration for expats and travellers alike, but there have been reports of a treatment-resistant strain of the disease gradually sweeping through Southeast Asia.

First encountered in Cambodia in 2007, this so-called ‘super’ malaria – which is resistant to typical antimalarial treatment – has now been recorded in Thailand, Laos and, most recently, southern Vietnam, with over 19,000 cases reported in 2015.

Fears are that if the drug-resistant strain spreads to Africa, where the 92% of malaria deaths occur, it could worsen an already major crisis there.

Who is at risk?

According to the World Health Organisation (WHO), 1.5 million people in Southeast Asia are infected with malaria every year, with 620 reported deaths in 2015.

In a joint letter to The Lancet Infectious Diseases, Professor Arjen Dondrop and his research team at the Oxford Tropical Medicine Research Unit in Bangkok, highlighted increasing numbers of failures in malaria treatment, with the figure bordering on 60% in Cambodia.

With no vaccine available for malaria, taking measures to reduce the risk of contracting it continues to be the number one rule to follow in affected areas.

Malaria – the statistics

In 2015, 91 countries and areas had ongoing malaria transmission

Africa is home to 90% of malaria cases and 92% of malaria deaths, followed by Southeast Asia (7%) and the Eastern Mediterranean region (2%)

Three deaths were recorded in Vietnam from super malaria in 2015, with more than 19,000 cases reported

World Health Organisation Factsheet

What is super malaria?

Malaria is caused by a parasite that is transmitted through the bites of certain species of mosquitoes. It can be fatal if left untreated, especially in children.

The super malaria strain of the disease is so called because of its resistance to the typical antimalarial drugs, which treat and prevent the effects of malaria; these include fever, organ problems, and, in the most severe cases, death.

Your guide to malaria protection mosquito

 

What treatments are there?

The usual treatment for malaria includes using a combination of two powerful anti-malarial drugs –artemisinin and piperaquine. However, the super malaria strain has become resistant to both these drugs.

While the WHO continues to advocate the use of antimalarial tablets in recommended regions, it admits this resistance is making any necessary treatment more challenging – and increasing the need for close monitoring and prevention.

Before you travel

If you are travelling to an affected region, your doctor or health professional may advise carrying some emergency medication for malaria. Make sure you fully understand and record the correct dosages, as well as any side effects to look out for.

What can I do?

As there is no current treatment for the super malaria strain, it is important to follow best practice preventative measures. These include:

  • Taking antimalarial tablets – Always visit an approved city-based clinic or hospital for a thorough assessment. Provide healthcare professionals with as much detail as you can about any locations you will be based in/or plan to visit.
  • Using a powerful insect repellent – Spend some time researching the products available to you and what the ingredients will offer. Don’t assume it’s a one-size-fits-all scenario, as some compounds shouldn’t be used if you are pregnant or children under a certain age.

 

Your guide to malaria protection spray

Research from the US-based Consumer Reports Buying Guide suggests that Deet, Picardin and Oil of Lemon Eucalyptus offer the most protection – although it warns that in high concentrations (Deet and Eucalyptus over 30% and Picaridin over 20%) they can cause skin problems and such concentrations are not necessarily more effective.

Researchers found the following levels to be highly effective, noting that sprays are more effective than creams:

Deet –15-30% concentration

Picaridin – 20% concentration

Oil of Lemon Eucalyptus – 30% concentration

  • Keeping your arms and legs covered – Mosquitoes tend to be more active at dawn, dusk and overnight, so apply repellent and wear long-sleeved tops and long skirts or trousers. Opt for loose-fitting garments, as insects can still bite through tighter clothing. Mosquitoes are naturally drawn to darker shades, so wearing lighter colours should also help.
  • Closing doors and windows – Use air conditioning when available, so that you can keep windows and doors closed. Pedestal fans and screens will also decrease mosquito activity.
  • Using bed nets – Organisations working to reduce malaria risk around the world have achieved success using long-lasting insecticidal nets (LLINs). These nets, treated with a low level of insecticide, provide a physical and chemical barrier to mosquitos overnight, when bites often take place. There are many different types, so it helps to research the net you need in advance.

Your guide to malaria protection netting

 

 

  • Staying cool – A higher body temperature can attract unwelcome visitors, as can perfume and other scented products worn on the body.

How to spot malaria symptoms

high temperature

sweats and chills

headaches

vomiting

muscle pain

Malaria can begin to show just days after an infected mosquito bite, but commonly takes around 10 days to three weeks. In most cases, the illness starts with a fever, so always seek medical attention at the first sign of one.

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Keeping active in Southeast Asia

Southeast Asia has the highest activity level in the world according to the World Health Organization, but there are growing concerns that physical fitness levels in the region are on the wane. Westernised influence of high-fat, sugary foods and long, sedentary working hours in front of computer screens are the main reasons for this concern.

Keeping active doesn’t just keep your body in good shape, it reduces the risk of heart disease and diabetes, and it can lower blood pressure. What’s more, the endorphins released during exercise can help ease symptoms of depression and anxiety.

Here are just a few of the latest and emerging sports and activities taking Southeast Asia by storm:

  • Group workout sessions

Group workouts are growing in popularity, so says Joel Tan, founder of BBounce Studio, a high-energy exercise class that involves bouncing on a trampoline to loud music. Speaking recently to cyberpioneer, he explains, “Friends who work out together stay together.”

Zuu, in particular, a high-intensity group workout which mimics animal movements, is the latest group workout trend, according to Singapore-based Straits Times. Users take part in 45-minute sessions outside work or during lunchbreaks.

Southeast-Asia-martial-arts-1

  • Martial arts

With Asia’s deep-rooted heritage in the martial arts, it’s no surprise that the high-energy Muay Thai – sometimes called ‘the art of the eight limbs’ because it uses fists, elbows, knees and shins for full combat – has made an impact on fitness trends in the region.  Muay Thai along with T’ai Chi, it’s gentler cousin, continue to be popular activities in the region. T’ai chi, in particular, has long been part of the region’s workday culture. Its deep breathing and slow, deliberate movements can help reduce stress and improve balance and posture, and is a great way to start the day.

Heat exhaustion

You need to drink more water when exercising in the higher temperatures of Southeast Asia, especially during the humid months between May and October, to avoid heat exhaustion.

  • Yoga

The ancient Indian practice of yoga remains a firm favourite, however, Jolene Foo writing in Malaysian online fitness website, Health Works, says that aerial yoga is the latest trend among Malaysian fitness enthusiasts. Originating in New York, the practice combines traditional yoga techniques while balancing on suspended hammocks. “Aerial yoga is relatively low impact and will be great replacement for those who find traditional yoga difficult,” she says.

Southeast-Asia-yoga

 

  • Bootcamps

Residential fitness bootcamps are growing in popularity across the region, particularly in Thailand, where there are growing numbers of expats looking to kickstart their fitness regimes. These intensive fitness programmes are designed for all abilities and offer personal attention from expert trainers and fitness specialists, who lead a variety of activities such as circuit training, hill sprints and cycling days.

  • Outdoor gyms

Although not unique to Southeast Asia, outdoor gyms are becoming more widespread, as many are put off traditional gyms by the expensive membership fees and long waiting lists. Thailand-based fitness blogger Arnel Banawa recommends Bangkok Gym in Lumphini Park, Bangkok, which has a variety of fitness equipment and a 2.5km running path. In Hong Kong, Gymbox24 on Hong Kong Island is the area’s first and only 24-hour open-air gym.

Air pollution

Avoid exercising outdoors when there is a lot of traffic congestion. Extra care should be taken if you suffer with a respiratory illness or if you suffer from allergies.

  • Hiking

Hiking has always been popular and Southeast Asia is not short of spectacular scenery and incredible environments to explore. Indonesia is home to tropical forests and volcanic mountains, and there are plenty of hiking trails in and around the islands of Thailand. On Hong Kong Island, the 50km hiking trail is a particularly popular hotspot and offers walks of varying lengths and terrain depending on ability.

Southeast-Asia-Hiking

Swiping for fitness

Despite the sedentary lifestyle associated with technology, another growing trend means getting fit in Asia could result in more screen time, not less. According to Tiffany Ap, Asia correspondent for CNN, an increasingly tech-savvy population means more people are turning to technology to get fit as an alternative to gyms.

As Ap explains, considering that four of the top five countries who spend the most time looking at screens are in Asia (Indonesia, Philippines, China and Vietnam), it’s not surprising that the popularity of fitness apps is growing.

There are many apps available – such as the globally-popular FitBit or MyFitnessPal – which track activity levels, food, weight and sleep. ‘Portable trainers’, meanwhile, mean you can exercise without having to go to a class or gym. Yogaia, for example, allows you to livestream yoga classes to your living room.

Getting social

Now the market is starting to expand into more social media and even dating-style apps, all focused on encouraging people to become more mindful of their health.

Hong Kong-based start-up Jaha, for example, has been dubbed the ‘Tinder for fitness’. It allows users to browse and link up with similar-minded sports enthusiasts in their area and encourages users to share workout results, start challenges and compete against each other.

For those more into self-image, Healthy Selfie is an Instagram-like app that encourages you to ‘track your transformation’, to notice the incremental changes in your body, as well as record your healthy meals, and also share recipes and tips.

Southeast-Asia-Outdoor-gyms

Should I join a gym?

With the international gym chains expanding into Southeast Asia, there has never been more choice for consumers – but it comes at a cost. According to Business Insider, people are paying up to $24,000 a year for international top-end gyms.

Expect to pay between $100-200/month, plus a sign-up fee for global gym brands, or up to $100/month for local equivalents. Alternatively, there’s the KFit app which gives access to 10 fitness activities in any gym across SE Asia for RM139/month.

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How to relocate as an expat with children

We meet three expats who moved abroad and brought their kids with them. They share the challenges they faced and what they have learned.

Relocating to a new country is one of life´s great adventures, but it can also be daunting, especially if you have children to think about.

Whether you are making a permanent move or planning an extended stay, your family´s physical and mental wellbeing is the number one consideration.

We met some expats to find out what you should consider when taking your family to live abroad.

Preparing for change

One of the first steps is to ensure that your children have had the recommended immunisations for your destination. Online guides such as NHS Fit for Travel and Travel Health Pro offer country-by-country advice.

Other factors will depend on your children’s ages and the country you are relocating to, says Clara Wiggins, author of the Expat Partner’s Survival Guide.

Wiggins, along with her husband and their two daughters, have lived in a host of locations around the world. She suggests preparing your children by involving them in home searches and school visits.

Children with Ipad

“If you are not able to take children on a look-see, I would recommend doing a video for them or even a live Facetime or Skype so they can get an idea of where they are going.” Google Earth and Streetview can be useful too, she says.

You can also ease the transition by bringing familiar things from home on the plane, rather than waiting for them to arrive later.

“We brought my younger daughter’s fairy lights for her bedroom, and we also brought their duvet and pillow covers. The first few nights in a new place can be hard so making their rooms feel like home is one way to help.”

Jaimie Seaton is a journalist from the US. When her husband was offered a position with Citibank in Singapore, they jumped at the chance and relocated with their son and daughter – then aged two and five. After two years in Singapore, the family moved to Thailand.

“Frame the move as a great opportunity and adventure, not as a challenge,” she says. “Do research as a family of your new home, teach them about the culture, look up fun things to do in the new country.” Seaton also ensured that her children understood cultural differences before they moved to Thailand.

“The main things we had to discuss with them were the strict rules around the royal family. It’s against the law to insult the royals, especially the then-king, who has since passed away.”

Whether your company is providing a healthcare package or you are arranging your own expat medical insurance, it is important to understand what services will be available in your destination country.

Healthcare: know what to expect

If your child requires specific medication or access to ongoing treatments, research how accessible these will be. Call local hospitals or doctors, and seek advice from other expats via online forums and Facebook groups.

Theodora Sutcliffe is a travel writer and blogger. In 2014, after four years of travelling together, she and her son (now nine) settled in Bali.

“It’s important to be aware that medical care in Bali isn’t the best,” says Sutcliffe, “Most expats get medical insurance that covers them to be evacuated to home or a second country, typically Singapore, in emergencies.”

Facilities will vary widely across the world. Some countries, such as Hong Kong, have highly developed healthcare. Seaton found local services to be excellent.“The medical care in Singapore (and Thailand) is far superior to the US.”

But given the incredibly varied quality and availability of public healthcare from country to country, not all expats will move to a location that offers reliable local medical services. You may even be expected to foot the bill for private healthcare, so having international health insurance cover in place is vital before you go anywhere.

While her family were posted in St. Lucia, Wiggins knew that if there was a serious health incident, they would be medically evacuated under the terms of her private insurance plan. But she also suggests preparing for the unexpected. “I always recommend doing a ‘dry run’ to your local emergency department or hospital and making sure its location is in your GPS and number is in your phone,” she says.

She points out that it is also important to know what the procedure is when you arrive at hospital, for example, do you need to pay for treatments up front? Such procedures will vary greatly depending on whether you have an international private medical insurance (IPMI) plan, if it provides direct settlement to the hospital, or if you’re accessing care independently.

Ipad Video Conf

Settling in and enjoying your new life

Be aware that many health issues can be prevented by using common sense. Make sure that your children understand safety rules about drinking water, for example, can they brush their teeth with tap water or not? The same applies to food safety, especially at street stalls and markets.

While some children will adapt easily, others may need more time. If your child is missing friends back home, Skype and FaceTime are good ways of keeping in touch.

Writing letters helped Wiggins´ daughter. “Very few of these got sent, so what I actually think she was doing was just processing her feelings and this is the best way she could do it.”

To keep a familiar routine, Wiggins´ tip is to continue doing sports and hobbies your child already enjoys, “In our case this has been football and swimming, which has also given them a chance to meet children away from the school environment.”

In Bali, where Sutcliffe and her son are based, the beach is a great place to meet other kids but there are dangers to be aware of. “Make sure you and your children understand water safety: the currents in the sea are no laughing matter,” she says.

Living in Thailand and Singapore, Seaton found that live-in help made life easier. But while this can be a perk of relocation, it may be a cultural adjustment for your children, she says.

“It’s important to remind children that they are not superior and to instill your values, which can be challenging.”

And – go local! Do not assume that things are better in your home country and be open to how other cultures do things.

“Enjoy every moment. It’s a gift to live overseas, and will give your children a worldview that will carry them far in life.”

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Keeping insurance relevant to expats

In the 25 years William Russell has provided expat health, life and income protection insurance, the needs and expectations of global professionals have completely transformed.

Instead of moving to a certain country for a number of years then returning home, many expats now find themselves routinely on the move around the world.

Meanwhile, international health insurance has become more complicated. Costs can be high and the options available greater than ever.

Insurance for local needs

James Cooper, co-founder of William Russell, has described today’s health insurance as “quite unrecognisable” compared to the market when the company started.

“We have moved from a time, 25 years ago, when we could provide a simple, global policy,” he says. “Now, we are focused on products that are country specific and licensed locally.”

“The traditional expat is disappearing,” says Neil Raymond, CEO at leading brokerage Pacific Prime, which offers local insurance advice at popular expat destinations including Hong Kong and Dubai. “A lot of expats that would have gone home are not going home. We are also seeing continued growth of a high-net-worth population around Asia who want access to the best medical services into their own country, in their region, or globally.”

A changing industry

This is part of a key trend in health insurance. Additional benefits are now standard in international health cover plans, for example dental treatment, maternity and wellbeing. At the same time, medical inflation has increased at a fast rate, and the global population is aging. Help Age International says that by 2050, one in five people around the world will be over 60.

As a result, international healthcare costs have never been higher, and insurers need to be as flexible as the expats they cover.

One solution, alongside the more comprehensive plans, is to offer simple, no-frills polices. Inez Cooper, co-founder of William Russell, feels these policies have a valuable place in the market.

She says: “We offer these policies for those expats who don’t want to pay for complimentary and extensive benefits that are becoming ubiquitous in global healthcare insurance products.

“A no frills policy would allow people to reflect upon the cover they actually need.”

This is particularly important at a time when the market is changing – customers now want greater flexibility and local tailoring, as well as the feeling that their insurer understands them.

Flexibility for expats

For long-standing William Russell customer and Hong Kong resident Michael Haynes, the most important factor in insurance is flexibility, portability and being able to discuss his circumstances with a real person.

With two sons playing rugby at international level who have had injuries, Michael wanted to avoid a claim later in life being treated as a pre-existing condition that wouldn’t be covered.

Michael says: “I was able to inform William Russell of every injury and they accepted that as being informed, and so it wouldn’t rule out future cover. I think that is very flexible. That comes down to being able to explain all of that to a person.”

His policy is also flexible enough to keep him covered should he wish to relocate from Hong Kong.

Reliable service for nomadic professionals

As an independent insurer with 25 years of experience under their belt, William Russell is able to offer value and stability.

For Michael, “the continuity of people” in the organisation has been also important.

If you have been renewing your policy with William Russell for the last 25 years, then you will most likely have spoken to the same person each time. Most customers deal with the same claims handler throughout their treatment, giving them support through major life events.

What next?

It is likely that the next quarter-century will present as many challenges as the last, if not more.

Financial institutions are now investing hundreds of millions of dollars in customer technology, as well as internal systems and data security. The digital revolution is expected to greatly affect all financial industries, including insurance.

For William Russell, the future is about effectively combining technology with a personal service. It’s about getting the balance between those clients who are happy to self-serve, and those clients who don’t want to self-serve.”

“We may not be the biggest provider in the marketplace”, says Inez, “but we certainly work hardest to be the best”. That is a real statement of intent to the industry for the next 25 years.

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Is there a depression crisis in Asia’s cities?

How much of a problem is depression in Asia’s metropolises and how can it be identified and prevented?

Despite the stigma associated with mental health problems in Southeast Asia, depression is becoming a topic that is hard to ignore and even more difficult to discuss.

Depression is generally defined as an intense feeling of despair that goes beyond any normal degree of sadness encountered in everyday life.

The symptoms can be mild, moderate or severe. It can greatly disrupt a person’s life, work, relationships, eating and sleeping patterns, as well as the passions we enjoy in our spare time.

The condition, which can also be recurring or chronic, is said to affect a staggering 86 million people across Southeast Asia, with the World Health Organization (WHO) pointing to suicide as the second biggest cause of death among 15-29 year-olds in the region.

Women of childbearing age (particularly following childbirth) and adults over the age of 60 are also said to be at higher risk of depression.

Many believe the region is rapidly turning into a pressure cooker, with the stresses of modern living and cultural attitudes towards expressing such feelings leading to record numbers of suicide.

This was highlighted in 2016, when the South China Morning Post reported that education chiefs in Hong Kong were taking urgent measures to try and reverse a sharp increase in suicide among young people.

It followed the news that 22 students had taken their own lives since the start of the academic year alone – with four such deaths taking place in the space of just five days.

Woman on phone

Contributing factors

With almost 60% of the world’s population concentrated in Southeast Asia – mainly within Asian metropolises, many put the blame squarely on modern living.

For example, Delhi in India contains 25 million people, while Bangkok and Hong Kong boast a population density of 9.3 million and 7.3 million respectively, with hefty visitor numbers swelling this further each year.

A study conducted by the Central Institute of Mental Health in Mannheim, Germany, suggests that city-dwellers suffer more stress, fear and anxiety than their bucolic rural counterparts, thanks to more hyperactivity in the amygdala region of their brain, which is linked to depression and anxiety.

Regional commentators are also quick to point to cultural attitudes also play a large part in the suppression of such feelings.

The tendency across the Southeast Asian population is to try to conceal any depression, for fear that any such admission would be viewed as weakness or a taint on their family’s honour. In some cases, health professionals are also said not to view the symptoms of depression as ‘real’ or pathological.

Man and sunset

Taking steps

Governments appear to be waking up to the problem. In March, India passed a Mental Healthcare Bill – which decriminalises the act of suicide and aims to provider better care in terms of prevention and ongoing support.

Praising India for these steps, WHO is now calling on other nations in the region to make similar efforts to ramp up the quality of their services.

In 2017, it made mental wellbeing the focus of its annual World Health Day, putting the message out loud and clear that no one should have to suffer in silence.

“People experiencing depression often find a range of evidence-based coping mechanisms useful,” comments Dr Poonam Khetrapal Singh, Regional Director, WHO Southeast Asia.

“From talking to someone they trust to exercising regularly or staying connected with loved ones. Avoiding or restricting alcohol intake and refraining from using illicit drugs helps keep depression at bay. But many people also find professional help an important part of managing the condition, particularly in terms of exploring treatment options.”

WHO’s Mental Health Gap Action Programme (mhGAP) aims to help countries, particularly those with low to middle-incomes increase services for people with mental, neurological and substance use disorders.

Piggyback

Expat pressures

There’s little doubt that being an expat brings its own set of challenges – where feelings of trying to fit in, the need to succeed and coping with a sense of isolation from loved ones back home may all contribute to depression, which the WHO says now affects more than 300 million people globally.

Stay-at-home parents, in particular, can face a difficult task in juggling their own needs with the demands of their family.

Worries about accessing local services or knowing who to trust can make it difficult for people to open up. This can make online forums another good way to connect with others experiencing the same feelings.

Remote counselling is widely available for those looking to access more tailored support, with the International Therapy Directory offering detailed information on services. Local embassies should also be able to provide a list of accredited experts based in the area.

 

Take care of you

The UK-based Mental Health Foundation offers its 10 top recommendations for preserving your wellbeing:

1  Talk about your feelings

 

2  Keep active

 

3  Eat well

 

4  Drink sensibly

 

5  Stay in touch

 

6  Ask for help

 

7  Take a break

 

8  Do something you’re good at

 

9  Accept who you are

 

10  Take care of others

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How does physical activity affect your health?

How important is it to stay active as we age and what kind of activity brings the most benefits?

For an expat with a busy schedule, finding the time to exercise can be challenging.

However, there is an infinite wealth of evidence to show that finding that time is vital, especially for the over 50s.

As we all know, exercise is good for the body and the mind. But, there’s no one-size-fits-all approach and there are lots of factors that should influence a person’s approach.

What are the benefits of physical activity?

There is the obvious benefit of helping control weight, which becomes more difficult as you get older due to your metabolism slowing down.

A few hours of moderate-intensity physical exercise each week also lowers the risk of heart disease, type 2 diabetes, breast cancer and colon cancer.

The US-based Centers for Disease Control and Prevention (CDC) suggests that the risk of endometrial and lung cancer is lower in people who exercise regularly than in those who don’t.

This is backed up by the results of a long-term study by University of Minnesota researchers. They gave questionnaires to 36,929 cancer-free women from Iowa, and then followed them for 16 years. They found that the women with high exercise levels were less likely to develop lung cancer than those with low exercise levels.

The Australian study, published in the British Journal of Sports Medicine, found that aerobic exercises, resistance training and less-strenuous forms of exercise such as T’ai Chi, a traditional Chinese martial art, all had positive effects on different parts of the brain’s functions ranging from the ability to organise and plan, to reading and reasoning.

The authors of that study examined 36 wide-ranging studies and found that exercising moderately for around an hour on as many days as possible improved memory and thinking skills of those aged over 50.

Pilates

How long should I exercise for?

Britain’s National Health Service recommends different sorts of exercise for different ages. It says children under the age of five should be physically active for at least 3 hours a day; this includes walking, playing outside, chasing balls, playing in water or riding a bicycle.

However, healthy adults should do a minimum 150 minutes of moderate aerobic activity each week as well as strength exercises that focus on the major muscles such as in the leg and back.

According to the CDC, those who do seven hours of exercise a week have 40% less chance of an early death than those who do just half an hour a week.

What are moderate and intensive forms of exercise?

Moderate aerobic activity includes things such as fast walking and mowing the lawn; so this kind of activity can easily be incorporated into a normal day.

Your heart rate needs to be raised to have an affect on your health so shopping and slow walking unfortunately won’t count. Vigorous or intensive activities are running, hiking, swimming or playing sports such as tennis.

Do some activities bring particular benefits to over 50s?

Low impact aerobic exercise and bone-strengthening activities can slow down the natural decline in bone density which occurs as a person ages.

This reduces the risk of chronic conditions such as osteoporosis and arthritis, according to the CDC. The organisation says that doing just two hours of moderate exercise a week lowers the risk of hip fracture and improves the quality of life for people living with arthritis.

For the over 50s, these lower weight-bearing and impact options help to reduce the risk of bone injuries or breakages, which is often higher in the older generation.

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Antibiotics resistance: what you need to know

Many countries have strict rules governing the use of antibiotics. In the UK, Europe and US, they will only be prescribed if a doctor is confident the cause of an illness is bacterial and not caused by a virus or other pathogen. However, not all countries are so vigilant.

A 2016 study published by the Journal of the Medical Association of Thailand revealed that antibiotics in Thailand are “widely available and inappropriately sold and given by grocery stores and retails shops”.

The inevitable affect, the researchers note, is that antibiotic-resistant bacteria are commonly and freely circulating through the population, meaning some illnesses are no longer treatable.

The situation is similar in the UAE, where prescription-required medicines are routinely sold without an accompanying prescription.

The World Health Organisation (WHO) takes this issue very seriously: “Where antibiotics can be bought for human or animal use without a prescription, the emergence and spread of resistance is made worse.”

It warns that without urgent action, the world is heading for a “post-antibiotic era, in which common infections and minor injuries can once again kill.”

The more antibiotics that are prescribed inappropriately, says Dr Jace Clarke, Chief Medical Officer at William Russell, the more likely resistance is to develop.

What causes antibiotic resistance?

A common misconception is that it’s the individual who becomes resistant to antibiotics. In fact, it’s the bacteria that adapts and develops resistance, rendering certain antibiotics entirely useless.

Misuse and overuse of antibiotics is the biggest cause of antibiotic resistance and the rise of the so-called superbug (illnesses that no longer respond to treatment and are now potentially deadly).

Superbugs emerge when bacteria have not been properly treated with antibiotics and have learnt to become resistant; certain strains of tuberculosis and pneumonia have already developed resistance so can’t be treated easily, if at all.

The WHO calls antibiotic resistance “one of the biggest threats to global health, food security and development today.”

Doctor and Child

What do antibiotics treat?

Antibiotics should only be used to treat illnesses caused by susceptible infections, for example bacterial tonsillitis, urinary tract infections, respiratory tract infections, whooping cough and skin infections. Different types of antibiotics target specific bacteria.

For example, Amoxicillin (a sort of Penicillin) is often prescribed to treat ear infections, while Trimethoprim is commonly given to treat urinary tract infections caused by E.coli.

Dr Clarke stresses there isn’t a one-size-fits-all approach to antibiotics. “Some bacterial infections can be self-limiting in fit, healthy people” he says, “for example Salmonella, a common cause of food poisoning.” A doctor would therefore “establish sensitivity of the bacteria and allocate an appropriate antibiotic”.

Antibiotics are completely useless against viruses. A huge number of everyday illnesses are caused by viruses and therefore don’t need antibiotics. If you’re suffering with a cold at the change of season, chances are antibiotics won’t help.

 

pills

 

What to do if you think you need antibiotics

Even if you think your self-diagnosis is accurate, and as tempting as it might be to buy the tablets over the counter, you could do more harm than good. Antibiotics could interfere with other medicines you might be taking, or even damage your organs.

Dr Diab Maaruf Kurdi, head of pharmacy at Burjeel Hospital in the UAE, says: “It’s important that medication is not purchased without the doctor’s consultation, because the doctor will take into consideration your overall medical condition. Furthermore, the medication that you purchase may not be right for your condition and could cause further health complications.”

Dr Clarke also warns that a non-bacterial illness that goes undiagnosed, such as malaria, could get worse without formal identification and appropriate treatment from a doctor.

 

How to take antibiotics responsibly

Being prescribed a course of antibiotics by a medical professional is the first step, but there’s more that needs considering in order for the antibiotics to work effectively.

You must follow the instructions and finish the course even if you’re feeling better. It’s also important to note whether the medicine should be taken before or after food, or with water. Never share antibiotics and do not accept them if a pharmacist offers them without a prescription.

For all your global health insurance questions, go to the William Russell website, or call our dedicated team on +44 (0) 1276 486455.

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What is driving up the cost of global healthcare?

According to Willis Towers Watson’s 2017 Global Medical Trends Survey Report, the trend in average global medical investments went up 7.8% in 2017 and most countries expect it to continue to rise between 2.4 and 7.5% a year until 2020.

This article asks what factors are driving up the cost of healthcare globally. Understanding these can help you keep a clear view of how healthcare is set to change in the coming years.

Consumer demand

An emerging middle class in developing countries means there is an increasing global demand for high quality private health services.

The Brookings Institution report, The Unprecedented Expansion of the Global Middle Class, estimates that there were around 3.2 billion people in the middle class at the end of 2016, growing by around 140 million annually. This is set to increase to 170 million a year in five years’ time.

The overwhelming majority of the next billion – an estimated 88% – will live in Asia; with 380 million in India, 350 million in China and 210 million in other areas of Asia. Brookings predicts that by 2030, Asians could represent two-thirds of the global middle-class population.

The rise of the middle class has meant a general increase in wealth and life expectancy, which has created additional strain on governmental and private health services. Particularly in Asia, where high-fat diets and less active lifestyles have been associated with greater wealth and longer life expectancy, obesity levels are on the rise, leading to a surge in non-communicable chronic diseases, such as cardiovascular disease, some cancers and respiratory illnesses.

According to Iber Global, rates of cardiovascular disease are projected to at least double if not quadruple in several Asian countries over the next two to three decades.

“Cardiovascular disease, cancer and respiratory illness are all projected by insurers worldwide to be the top three diseases for at least the next five years.”

Willis Towers Watson’s 2017 Global Medical Trends Survey Report

Convenience, mobility and choice

Alongside this, the digital revolution is also having an impact on consumer demands. With the range of digital channels growing – from retail e.g. Amazon next day delivery, instant access to content e.g. Netflix, to instant means of communication e.g. social media, instant messaging – expectations on the healthcare industry for such things as 24/7 on-demand access to healthcare, are only going to increase.

The rising popularity of health-tracker apps and wearables (predicted to reach £14.8 billion in 2018) also means that patients are more connected to the state of their overall health and therefore expect their healthcare providers to match their levels of connectivity. Especially in the younger mobile-savvy ‘millennial’ generation, the need for convenience, mobility and choice are paramount.

Multi-pronged, collaborative and technology enabled approaches are one of the top considerations (and investment areas) for healthcare stakeholders

Deloitte 2018 Global Healthcare Outlook

Ageing and lifestyle factors 

The world’s population is ageing. This means that, as poverty decreases and access to medicines improve, life expectancies are increasing. According to Deloitte’s 2018 global healthcare sector outlook, the ageing population (those over 65 years old) is set to increase by eight percent, from 559 million in 2015 to 604 million in 2020.

The longer people live, the more care they may need, and the more chance they will have of contracting later life conditions and diseases, such as dementia. According to Deloitte, cases of dementia are forecast to increase in every region of the world, reaching 74.7 million by 2030.

Additionally, by 2020, Deloitte predicts that 50% of global healthcare expenditure – around $4 trillion – will be spent on the three leading causes of death: cardiovascular diseases, some cancers and respiratory diseases. Meanwhile, the number of diabetes sufferers will rise from 415 million to 642 million by 2040.

Regulatory landscape and fraud

The global healthcare regulatory landscape is complex and constantly evolving. In the future, healthcare providers will continue to face a highly complex and rapidly changing set of global, regional, country and industry-specific regulations, laws and directives.

These cover clinical quality and safety, regulations on counterfeit drugs, identifying and eliminating corruption, and the ever-increasing danger of cyber security.

Many regulations are in place to counteract the global problems of fraud and corruption in healthcare. The Global Health Care Anti-Fraud Network estimates that $260 billion – or around six percent of global healthcare spending – is lost to fraud each year, which can occur in several ways.

Health insurance fraud, whereby an insurer or government healthcare programme is targeted by a fake claimant, is a growing problem, while prescription drug diversion is anticipated to become more of a global problem than illicit drug production.

Tackling fraud and adhering to regulations all come with a price tag. Expensive security software must be purchased to protect confidential patient information from hackers. Healthcare costs must therefore rise to ensure data and patients are kept safe.

New healthcare approaches

According to McKinsey’s Digital Patient Survey, more than 75% of all patients expect to use digital services in the future. This means health services will have to embrace a ‘third wave of digitisation’, meaning using digital innovations to improve patient accessibility and experience, rather than just using it to consolidate HR and internal IT processes.

This third wave of digitisation covers an array of new technology: 3D-printed devices, the use of virtual reality and telehealth to communicate with patients, biosensors and trackers, and artificial intelligence in clinical diagnoses.

The emergence of new innovative approaches to healthcare and improved online services is certainly a way for traditional healthcare providers to meet increasing patient demands, but setting up these services comes with a cost.

In Southeast Asia, Singapore is leading the way with integration of its digital healthcare services by moving its national health information to the cloud. According to PwC Consulting, the project – named hCloud – will cost US$37 million for the first ten years.

“Singaporeans are among the most tech-savvy in the world, and that translates into their attitudes towards digital healthcare – it is not just the younger generation who are keen to adopt digital healthcare.”

Ivy Lai, country manager, Philips Singapore

Writing for Forbes, Maria Clemens of health sector technology provider, Management and Network Services, said that technological advances had been serving the healthcare industry very well over the last few decades, but the cost of some technical advances was now contributing to the overall increase in costs. “In fact, new medical tech is responsible for 40-50% in annual cost increases,” she wrote.

How does this all impact my health insurance?

As global healthcare costs go up, this increases how much it costs to provide health cover. However, if you are renewing your health insurance for 2018, there are a few options you can consider.

  1. Shop around and compare your options for the most competitive deal, making sure your policy meets your needs and consider the fact that pre-existing conditions may not be covered
  2. Stay with your current insurer, but check your policy meets your needs and provides access to the best health cover
  3. You may be able to change the level of your cover, for example, the level of plan, optional benefits or excess levels. Talk to your insurer to find out more about your level of cover.

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Take care of your family’s tomorrow, today

Help protect your family financially if something happens to you.

The decisions you make as a parent will span throughout your children’s lifetime. Your support and advice will guide them as individuals and stay with them forever – because your role as their guardian doesn’t stop after you are gone. Life insurance could provide you with the assurance that your loved one’s future is secured financially, should the worst happen.

Planning your legacy

The loss of a loved one is never easy and can be a very emotional time in our lives. The loss may be impossible to mitigate but the weight of picking up the pieces with banks, mortgage lenders, legal teams and health providers, especially as an expat, can be made to feel a little less daunting if you are set up financially. With a William Russell Life insurance plan you can protect what you have built and pass it onto your loved ones.

Life insurance designed for expats

We offer life insurance that’s designed with expats in mind; wherever your next step might take you. Your plan moves with you and the terms are communicated in a clear, unambiguous language. For 2018, our Life cover has been enhanced with you in mind….

Our 2018 enhanced international life cover plan offers

  • Lower rates for 18-54 year olds with no claims
    • Rate reductions of up to 30% if you’re under the age of 40
    • Increase in maximum benefit from $1.5m to $2m
    • Terminal illness cover – your plan pays out if you are diagnosed with a terminal illness with a prognosis of 12 months or less

Your job done

With our life plan, you can choose a level of cover that suits your lifestyle within the limits of the policy, giving you peace of mind that your family’s financial future is secure.

Start the conversation today

Speak to us today to start planning your life insurance to cover you and your family while you are living away from home.

Find out more >parent_and_child_at_beach

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Ebola in Africa: what expats need to know

Dr Peter Salama, Executive Director of the World Health Organization (WHO) Health Emergencies Programme which coordinates outbreak responses, remarked that we have “learnt never, ever to underestimate the Ebola virus disease and we will be remaining vigilant.”

The Ebola outbreak in West Africa was finally declared over on the 13th of January 2016 by the WHO, but for expats in Africa it remains important to be aware of the disease and the risks it presents.

By the beginning of 2016, a disease that in less than two years had crossed borders and killed thousands of people – primarily in Guinea, Liberia and Sierra Leone – had finally been brought under control. WHO reported a total of 28,646 cases of Ebola and 11,323 deaths.

What is less well known, is that there was another Ebola outbreak in May 2017, this time in a remote area the Democratic Republic of the Congo (DRC). What is remarkable is that this outbreak of 8 reported cases was declared over in just under 2 months due to the efforts of local and international agencies that responded to the outbreak by setting up mobile diagnostic labs that allowed for onsite testing of patients.

WHO health professionals say although they are more experienced in dealing with Ebola, there is still no cure. This article presents the facts on Ebola and what you should do if you encounter it.

GUINEA-HEALTH-EPIDEMIC-EBOLA

What is Ebola?

Ebola was first discovered in 1976, with 2 reported outbreaks in South Sudan and along the Ebola River in the DRC. From here, the virus was subsequently named after the Ebola River.

It is transmitted from wild animals such as gorillas, fruit bats and antelopes to humans. It then spreads across the population through human-to-human transmission by way of bodily fluids coming into contact with broken skin or the mucus membrane. Ebola is part of a group of contagious infections called viral haemorrhagic fevers, which also includes Lassa and Marburg.

The virus can exist outside of the body for days and items that have been in contact with bodily fluids should be avoided. This is why medical professionals and family members are considered to be the most at risk of catching the disease.

What are the symptoms

Once someone is infected with Ebola, it begins to multiply in the body. Symptoms can vary but they start to appear after 4 to 6 days with a sudden onset of a fever, diarrhoea, vomiting, severe headache and a sore throat.

The period between infection with the virus and the start of symptoms is called the incubation period. For Ebola, this can be as short as 2 days or as long as 21 days.

Areas affected by Ebola

While outbreaks have been reported and maintained for years in the DRC, Sudan, Gabon, Guinea and Uganda – there have also been reported cases of Ebola crossing over into other countries like the US, Italy and the UK.

Tanzania and Botswana are two examples of countries that have managed to prevent Ebola from entering its borders through strict government measures to screen travellers arriving from Ebola-affected countries.

If you think you may have come into contact with Ebola

If you suspect you may have Ebola or have come into contact with someone suspected of having the virus, you should attend the nearest hospital or clinic immediately.

These facilities have a responsibility to report any cases that are thought to be Ebola and if any of the cases come back positive they are then reported at a government level.

Health care response

Dr Peter Salama says that they put a huge emphasis on getting as much information from the people who have been infected, to help manage the case and isolate it as quickly possible to prevent the spread of Ebola.

WHO health professionals say they are more experienced in dealing with Ebola but say there is still no cure and its thought that the only way to help prevent the spread of the disease is through 21 days of quarantine.

The US Centers for Disease Control and Prevention (CDC) have said ‘experimental vaccines and treatments for Ebola are under development, but they have not yet been fully tested for safety or effectiveness’.

Recovery from Ebola must be done carefully and patiently. The virus is known to persist in some areas of the body of those who have recovered from the disease, such as the testicles, the inside of the eye, and the central nervous system. In pregnant women, the virus can persist in the placenta, amniotic fluid and foetus. If you are breastfeeding the virus can also persist in the breast milk.

Studies have shown that a small percentage of survivors can still test positive for the Ebola virus for a period of more than 9 months.

What can you do about it?

  • Check if you are travelling to a region where Ebola may still exist
  • Remain vigilant of Ebola symptoms
  • Seek healthcare immediately if you suspect you may have come into contact with Ebola

To find out more about Ebola visit World Health Organization website.

WHO health professionals say although they are more experienced in dealing with Ebola, there is still no cure

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Tired all the time? How to get better sleep

Sleep deprivation is a key global issue that is having a particular impact in east Asian cities.

According to a 2014 profile of 43 cities, people in Singapore are getting an average of six hours and 32 minutes sleep, those in Seoul fewer than six hours, and Tokyo’s inhabitants are the most sleep deprived, with only five hours and 44 minutes.

These cities are widely associated with people working harder and achieving more, and as consequence people may be missing out on too much sleep. We take a closer look at how sleep deprivation can affect our everyday lives.

Sleep myth #1

We need less sleep as we age

Truth: While teenagers don’t require as much sleep compared to babies, adults require even less sleep.

A baby aged 6 months requires around 11 hours of sleep per day, as the child grows into a teenager they require even less; around 9 hours of sleep per day. Adults require 7-9 hours of sleep per day.

How bad is sleep deprivation for my health?

According to the National Health Service (NHS) in the UK, sleep boosts your mood and immunity, while increasing fertility and libido. Sleep deprivation, on the other hand, has been linked to long-term mood disorders such as depression and anxiety, type 2 diabetes, increased heart rate and higher blood pressure.

In 2013, the University of Surrey’s Sleep Research Centre in the UK studied the effects of reducing sleep by just one hour.

The results showed that sleep deprivation affects our genes, approximately 700 of them. Researchers found an increase in the activity of genes that govern body processes such as inflammation, immune response and stress, and also the genes associated with diabetes and cancer risk. The reverse happened when an hour of sleep was added.

Research by the University of Zurich found that male students – aged 18 to 28 years – sleeping for 5 hours a night made riskier decisions about money than if they had slept for 8 hours. The research concluded that lack of sleep can lead to an increase in what they call risk-seeking behaviour.

http://www.media.uzh.ch

Am I getting enough sleep?

There is no hard and fast rule about the number of hours you should be getting. Sleep scientist Patrick Fuller says that sleep should be restorative, leaving you feeling refreshed. On a basic level, if you struggle to wake up in the morning and it takes you a few hours, or several cups of coffee, to feel energised, you’re probably not getting enough sleep.

According to Nick Littlehales, an expert sleep coach, we sleep in cycles of 90 minutes rather than 60. Each restorative cycle takes us down into a deep sleep, where we place the day’s memories in our long-term storage, and then up into rapid eye movement sleep (REM), where we begin to process the emotions of the day.

Five cycles is the optimum amount to enable your body to recover, so if you need to get up at 7am you should be aiming to go to sleep at 11.30pm.

Sleep cycle

How can I get better sleep?

  • Sleep at regular times – your body craves routine, so don’t be tempted to lie in at the weekends.
  • Wind down before bed – as well as the baths and warm (de-caffeinated) drinks we had as children, it’s important to calm your mind. Try writing a to-do list to get the next day’s tasks off your mind.
  • Understand the impact of light – blue light – the kind emitted by phones, tablets and TVs – simulate day light, and will cause your body to start waking up. Avoid phones and TVs for an hour or so before bed, and seek daylight in the morning before the light of an electronic device.
  • Build the right environment – in your bedroom, avoid gadgets, bright lights and working. Make sure you have good curtains, a comfortable mattress and, if you find it hard to sleep in the heat, good air conditioning.
  • Nap if you need to – it’s OK to catch an extra cycle of sleep later in the day, but preferably not too late in the day in case it affects night-time sleep.
  • Keep a sleep diary – if you’re still experiencing problems, keep a journal of when you sleep well and when you don’t, taking into account factors such as diet, stress and bedtimes. If you regularly struggle to fall asleep, you may have insomnia and it’s important that you speak to your doctor.

Sleep myth #2

A glass of wine before bed helps you sleep

Truth: Sorry, alcohol may help you fall asleep but as little as two drinks can cause less restful sleep and lead you to wake up more frequently.

I’m still not sleeping well – what should I do?

If you are repeatedly finding it hard to fall asleep and stay asleep throughout the night to feel refreshed in the morning, you may be suffering from insomnia. Insomnia can be caused by stress and anxiety; lifestyle factors, such as mental or physical conditions; certain medications; or a poor sleeping environment.

While we may occasionally experience episodes of insomnia, a persistent lack of sleep can have a damaging effect on your mental and physical health, as well as your quality of life. Try following our better sleeping tips and if they don’t help, contact your doctor for a consultation.

Sleep myth #3

During sleep your brain rests

Truth: While the body rests during sleep, the brain remains active and still controls many body functions. The US National Sleep Foundation says the brain ‘recharges’ during sleep. It also sorts and processes information from the previous day, vital for learning and memory.

Sleep is vital to your wellbeing. A global health insurance plan can provide you and your family with access to GP consultations and wellbeing benefits, such as health checks, to help ensure you’re in the best possible health while overseas.

If you are living abroad and would like to know more about international health cover, go to the William Russell website, or call our dedicated team on +44 (0) 1276 486477.

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Your guide to malaria protection

Malaria prevention has always been a consideration for expats and travellers alike, but there have been reports of a treatment-resistant strain of the disease gradually sweeping through Southeast Asia.

First encountered in Cambodia in 2007, this so-called ‘super’ malaria – which is resistant to typical antimalarial treatment – has now been recorded in Thailand, Laos and, most recently, southern Vietnam, with over 19,000 cases reported in 2015.

Fears are that if the drug-resistant strain spreads to Africa, where the 92% of malaria deaths occur, it could worsen an already major crisis there.

Who is at risk?

According to the World Health Organisation (WHO), 1.5 million people in Southeast Asia are infected with malaria every year, with 620 reported deaths in 2015.

In a joint letter to The Lancet Infectious Diseases, Professor Arjen Dondrop and his research team at the Oxford Tropical Medicine Research Unit in Bangkok, highlighted increasing numbers of failures in malaria treatment, with the figure bordering on 60% in Cambodia.

With no vaccine available for malaria, taking measures to reduce the risk of contracting it continues to be the number one rule to follow in affected areas.

Malaria – the statistics

In 2015, 91 countries and areas had ongoing malaria transmission

Africa is home to 90% of malaria cases and 92% of malaria deaths, followed by Southeast Asia (7%) and the Eastern Mediterranean region (2%)

Three deaths were recorded in Vietnam from super malaria in 2015, with more than 19,000 cases reported

World Health Organisation Factsheet

What is super malaria?

Malaria is caused by a parasite that is transmitted through the bites of certain species of mosquitoes. It can be fatal if left untreated, especially in children.

The super malaria strain of the disease is so called because of its resistance to the typical antimalarial drugs, which treat and prevent the effects of malaria; these include fever, organ problems, and, in the most severe cases, death.

Your guide to malaria protection mosquito

 

What treatments are there?

The usual treatment for malaria includes using a combination of two powerful anti-malarial drugs –artemisinin and piperaquine. However, the super malaria strain has become resistant to both these drugs.

While the WHO continues to advocate the use of antimalarial tablets in recommended regions, it admits this resistance is making any necessary treatment more challenging – and increasing the need for close monitoring and prevention.

Before you travel

If you are travelling to an affected region, your doctor or health professional may advise carrying some emergency medication for malaria. Make sure you fully understand and record the correct dosages, as well as any side effects to look out for.

What can I do?

As there is no current treatment for the super malaria strain, it is important to follow best practice preventative measures. These include:

  • Taking antimalarial tablets – Always visit an approved city-based clinic or hospital for a thorough assessment. Provide healthcare professionals with as much detail as you can about any locations you will be based in/or plan to visit.
  • Using a powerful insect repellent – Spend some time researching the products available to you and what the ingredients will offer. Don’t assume it’s a one-size-fits-all scenario, as some compounds shouldn’t be used if you are pregnant or children under a certain age.

 

Your guide to malaria protection spray

Research from the US-based Consumer Reports Buying Guide suggests that Deet, Picardin and Oil of Lemon Eucalyptus offer the most protection – although it warns that in high concentrations (Deet and Eucalyptus over 30% and Picaridin over 20%) they can cause skin problems and such concentrations are not necessarily more effective.

Researchers found the following levels to be highly effective, noting that sprays are more effective than creams:

Deet –15-30% concentration

Picaridin – 20% concentration

Oil of Lemon Eucalyptus – 30% concentration

  • Keeping your arms and legs covered – Mosquitoes tend to be more active at dawn, dusk and overnight, so apply repellent and wear long-sleeved tops and long skirts or trousers. Opt for loose-fitting garments, as insects can still bite through tighter clothing. Mosquitoes are naturally drawn to darker shades, so wearing lighter colours should also help.
  • Closing doors and windows – Use air conditioning when available, so that you can keep windows and doors closed. Pedestal fans and screens will also decrease mosquito activity.
  • Using bed nets – Organisations working to reduce malaria risk around the world have achieved success using long-lasting insecticidal nets (LLINs). These nets, treated with a low level of insecticide, provide a physical and chemical barrier to mosquitos overnight, when bites often take place. There are many different types, so it helps to research the net you need in advance.

Your guide to malaria protection netting

 

 

  • Staying cool – A higher body temperature can attract unwelcome visitors, as can perfume and other scented products worn on the body.

How to spot malaria symptoms

high temperature

sweats and chills

headaches

vomiting

muscle pain

Malaria can begin to show just days after an infected mosquito bite, but commonly takes around 10 days to three weeks. In most cases, the illness starts with a fever, so always seek medical attention at the first sign of one.

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Keeping active in Southeast Asia

Southeast Asia has the highest activity level in the world according to the World Health Organization, but there are growing concerns that physical fitness levels in the region are on the wane. Westernised influence of high-fat, sugary foods and long, sedentary working hours in front of computer screens are the main reasons for this concern.

Keeping active doesn’t just keep your body in good shape, it reduces the risk of heart disease and diabetes, and it can lower blood pressure. What’s more, the endorphins released during exercise can help ease symptoms of depression and anxiety.

Here are just a few of the latest and emerging sports and activities taking Southeast Asia by storm:

  • Group workout sessions

Group workouts are growing in popularity, so says Joel Tan, founder of BBounce Studio, a high-energy exercise class that involves bouncing on a trampoline to loud music. Speaking recently to cyberpioneer, he explains, “Friends who work out together stay together.”

Zuu, in particular, a high-intensity group workout which mimics animal movements, is the latest group workout trend, according to Singapore-based Straits Times. Users take part in 45-minute sessions outside work or during lunchbreaks.

Southeast-Asia-martial-arts-1

  • Martial arts

With Asia’s deep-rooted heritage in the martial arts, it’s no surprise that the high-energy Muay Thai – sometimes called ‘the art of the eight limbs’ because it uses fists, elbows, knees and shins for full combat – has made an impact on fitness trends in the region.  Muay Thai along with T’ai Chi, it’s gentler cousin, continue to be popular activities in the region. T’ai chi, in particular, has long been part of the region’s workday culture. Its deep breathing and slow, deliberate movements can help reduce stress and improve balance and posture, and is a great way to start the day.

Heat exhaustion

You need to drink more water when exercising in the higher temperatures of Southeast Asia, especially during the humid months between May and October, to avoid heat exhaustion.

  • Yoga

The ancient Indian practice of yoga remains a firm favourite, however, Jolene Foo writing in Malaysian online fitness website, Health Works, says that aerial yoga is the latest trend among Malaysian fitness enthusiasts. Originating in New York, the practice combines traditional yoga techniques while balancing on suspended hammocks. “Aerial yoga is relatively low impact and will be great replacement for those who find traditional yoga difficult,” she says.

Southeast-Asia-yoga

 

  • Bootcamps

Residential fitness bootcamps are growing in popularity across the region, particularly in Thailand, where there are growing numbers of expats looking to kickstart their fitness regimes. These intensive fitness programmes are designed for all abilities and offer personal attention from expert trainers and fitness specialists, who lead a variety of activities such as circuit training, hill sprints and cycling days.

  • Outdoor gyms

Although not unique to Southeast Asia, outdoor gyms are becoming more widespread, as many are put off traditional gyms by the expensive membership fees and long waiting lists. Thailand-based fitness blogger Arnel Banawa recommends Bangkok Gym in Lumphini Park, Bangkok, which has a variety of fitness equipment and a 2.5km running path. In Hong Kong, Gymbox24 on Hong Kong Island is the area’s first and only 24-hour open-air gym.

Air pollution

Avoid exercising outdoors when there is a lot of traffic congestion. Extra care should be taken if you suffer with a respiratory illness or if you suffer from allergies.

  • Hiking

Hiking has always been popular and Southeast Asia is not short of spectacular scenery and incredible environments to explore. Indonesia is home to tropical forests and volcanic mountains, and there are plenty of hiking trails in and around the islands of Thailand. On Hong Kong Island, the 50km hiking trail is a particularly popular hotspot and offers walks of varying lengths and terrain depending on ability.

Southeast-Asia-Hiking

Swiping for fitness

Despite the sedentary lifestyle associated with technology, another growing trend means getting fit in Asia could result in more screen time, not less. According to Tiffany Ap, Asia correspondent for CNN, an increasingly tech-savvy population means more people are turning to technology to get fit as an alternative to gyms.

As Ap explains, considering that four of the top five countries who spend the most time looking at screens are in Asia (Indonesia, Philippines, China and Vietnam), it’s not surprising that the popularity of fitness apps is growing.

There are many apps available – such as the globally-popular FitBit or MyFitnessPal – which track activity levels, food, weight and sleep. ‘Portable trainers’, meanwhile, mean you can exercise without having to go to a class or gym. Yogaia, for example, allows you to livestream yoga classes to your living room.

Getting social

Now the market is starting to expand into more social media and even dating-style apps, all focused on encouraging people to become more mindful of their health.

Hong Kong-based start-up Jaha, for example, has been dubbed the ‘Tinder for fitness’. It allows users to browse and link up with similar-minded sports enthusiasts in their area and encourages users to share workout results, start challenges and compete against each other.

For those more into self-image, Healthy Selfie is an Instagram-like app that encourages you to ‘track your transformation’, to notice the incremental changes in your body, as well as record your healthy meals, and also share recipes and tips.

Southeast-Asia-Outdoor-gyms

Should I join a gym?

With the international gym chains expanding into Southeast Asia, there has never been more choice for consumers – but it comes at a cost. According to Business Insider, people are paying up to $24,000 a year for international top-end gyms.

Expect to pay between $100-200/month, plus a sign-up fee for global gym brands, or up to $100/month for local equivalents. Alternatively, there’s the KFit app which gives access to 10 fitness activities in any gym across SE Asia for RM139/month.

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How to relocate as an expat with children

We meet three expats who moved abroad and brought their kids with them. They share the challenges they faced and what they have learned.

Relocating to a new country is one of life´s great adventures, but it can also be daunting, especially if you have children to think about.

Whether you are making a permanent move or planning an extended stay, your family´s physical and mental wellbeing is the number one consideration.

We met some expats to find out what you should consider when taking your family to live abroad.

Preparing for change

One of the first steps is to ensure that your children have had the recommended immunisations for your destination. Online guides such as NHS Fit for Travel and Travel Health Pro offer country-by-country advice.

Other factors will depend on your children’s ages and the country you are relocating to, says Clara Wiggins, author of the Expat Partner’s Survival Guide.

Wiggins, along with her husband and their two daughters, have lived in a host of locations around the world. She suggests preparing your children by involving them in home searches and school visits.

Children with Ipad

“If you are not able to take children on a look-see, I would recommend doing a video for them or even a live Facetime or Skype so they can get an idea of where they are going.” Google Earth and Streetview can be useful too, she says.

You can also ease the transition by bringing familiar things from home on the plane, rather than waiting for them to arrive later.

“We brought my younger daughter’s fairy lights for her bedroom, and we also brought their duvet and pillow covers. The first few nights in a new place can be hard so making their rooms feel like home is one way to help.”

Jaimie Seaton is a journalist from the US. When her husband was offered a position with Citibank in Singapore, they jumped at the chance and relocated with their son and daughter – then aged two and five. After two years in Singapore, the family moved to Thailand.

“Frame the move as a great opportunity and adventure, not as a challenge,” she says. “Do research as a family of your new home, teach them about the culture, look up fun things to do in the new country.” Seaton also ensured that her children understood cultural differences before they moved to Thailand.

“The main things we had to discuss with them were the strict rules around the royal family. It’s against the law to insult the royals, especially the then-king, who has since passed away.”

Whether your company is providing a healthcare package or you are arranging your own expat medical insurance, it is important to understand what services will be available in your destination country.

Healthcare: know what to expect

If your child requires specific medication or access to ongoing treatments, research how accessible these will be. Call local hospitals or doctors, and seek advice from other expats via online forums and Facebook groups.

Theodora Sutcliffe is a travel writer and blogger. In 2014, after four years of travelling together, she and her son (now nine) settled in Bali.

“It’s important to be aware that medical care in Bali isn’t the best,” says Sutcliffe, “Most expats get medical insurance that covers them to be evacuated to home or a second country, typically Singapore, in emergencies.”

Facilities will vary widely across the world. Some countries, such as Hong Kong, have highly developed healthcare. Seaton found local services to be excellent.“The medical care in Singapore (and Thailand) is far superior to the US.”

But given the incredibly varied quality and availability of public healthcare from country to country, not all expats will move to a location that offers reliable local medical services. You may even be expected to foot the bill for private healthcare, so having international health insurance cover in place is vital before you go anywhere.

While her family were posted in St. Lucia, Wiggins knew that if there was a serious health incident, they would be medically evacuated under the terms of her private insurance plan. But she also suggests preparing for the unexpected. “I always recommend doing a ‘dry run’ to your local emergency department or hospital and making sure its location is in your GPS and number is in your phone,” she says.

She points out that it is also important to know what the procedure is when you arrive at hospital, for example, do you need to pay for treatments up front? Such procedures will vary greatly depending on whether you have an international private medical insurance (IPMI) plan, if it provides direct settlement to the hospital, or if you’re accessing care independently.

Ipad Video Conf

Settling in and enjoying your new life

Be aware that many health issues can be prevented by using common sense. Make sure that your children understand safety rules about drinking water, for example, can they brush their teeth with tap water or not? The same applies to food safety, especially at street stalls and markets.

While some children will adapt easily, others may need more time. If your child is missing friends back home, Skype and FaceTime are good ways of keeping in touch.

Writing letters helped Wiggins´ daughter. “Very few of these got sent, so what I actually think she was doing was just processing her feelings and this is the best way she could do it.”

To keep a familiar routine, Wiggins´ tip is to continue doing sports and hobbies your child already enjoys, “In our case this has been football and swimming, which has also given them a chance to meet children away from the school environment.”

In Bali, where Sutcliffe and her son are based, the beach is a great place to meet other kids but there are dangers to be aware of. “Make sure you and your children understand water safety: the currents in the sea are no laughing matter,” she says.

Living in Thailand and Singapore, Seaton found that live-in help made life easier. But while this can be a perk of relocation, it may be a cultural adjustment for your children, she says.

“It’s important to remind children that they are not superior and to instill your values, which can be challenging.”

And – go local! Do not assume that things are better in your home country and be open to how other cultures do things.

“Enjoy every moment. It’s a gift to live overseas, and will give your children a worldview that will carry them far in life.”

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Keeping insurance relevant to expats

In the 25 years William Russell has provided expat health, life and income protection insurance, the needs and expectations of global professionals have completely transformed.

Instead of moving to a certain country for a number of years then returning home, many expats now find themselves routinely on the move around the world.

Meanwhile, international health insurance has become more complicated. Costs can be high and the options available greater than ever.

Insurance for local needs

James Cooper, co-founder of William Russell, has described today’s health insurance as “quite unrecognisable” compared to the market when the company started.

“We have moved from a time, 25 years ago, when we could provide a simple, global policy,” he says. “Now, we are focused on products that are country specific and licensed locally.”

“The traditional expat is disappearing,” says Neil Raymond, CEO at leading brokerage Pacific Prime, which offers local insurance advice at popular expat destinations including Hong Kong and Dubai. “A lot of expats that would have gone home are not going home. We are also seeing continued growth of a high-net-worth population around Asia who want access to the best medical services into their own country, in their region, or globally.”

A changing industry

This is part of a key trend in health insurance. Additional benefits are now standard in international health cover plans, for example dental treatment, maternity and wellbeing. At the same time, medical inflation has increased at a fast rate, and the global population is aging. Help Age International says that by 2050, one in five people around the world will be over 60.

As a result, international healthcare costs have never been higher, and insurers need to be as flexible as the expats they cover.

One solution, alongside the more comprehensive plans, is to offer simple, no-frills polices. Inez Cooper, co-founder of William Russell, feels these policies have a valuable place in the market.

She says: “We offer these policies for those expats who don’t want to pay for complimentary and extensive benefits that are becoming ubiquitous in global healthcare insurance products.

“A no frills policy would allow people to reflect upon the cover they actually need.”

This is particularly important at a time when the market is changing – customers now want greater flexibility and local tailoring, as well as the feeling that their insurer understands them.

Flexibility for expats

For long-standing William Russell customer and Hong Kong resident Michael Haynes, the most important factor in insurance is flexibility, portability and being able to discuss his circumstances with a real person.

With two sons playing rugby at international level who have had injuries, Michael wanted to avoid a claim later in life being treated as a pre-existing condition that wouldn’t be covered.

Michael says: “I was able to inform William Russell of every injury and they accepted that as being informed, and so it wouldn’t rule out future cover. I think that is very flexible. That comes down to being able to explain all of that to a person.”

His policy is also flexible enough to keep him covered should he wish to relocate from Hong Kong.

Reliable service for nomadic professionals

As an independent insurer with 25 years of experience under their belt, William Russell is able to offer value and stability.

For Michael, “the continuity of people” in the organisation has been also important.

If you have been renewing your policy with William Russell for the last 25 years, then you will most likely have spoken to the same person each time. Most customers deal with the same claims handler throughout their treatment, giving them support through major life events.

What next?

It is likely that the next quarter-century will present as many challenges as the last, if not more.

Financial institutions are now investing hundreds of millions of dollars in customer technology, as well as internal systems and data security. The digital revolution is expected to greatly affect all financial industries, including insurance.

For William Russell, the future is about effectively combining technology with a personal service. It’s about getting the balance between those clients who are happy to self-serve, and those clients who don’t want to self-serve.”

“We may not be the biggest provider in the marketplace”, says Inez, “but we certainly work hardest to be the best”. That is a real statement of intent to the industry for the next 25 years.

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Is there a depression crisis in Asia’s cities?

How much of a problem is depression in Asia’s metropolises and how can it be identified and prevented?

Despite the stigma associated with mental health problems in Southeast Asia, depression is becoming a topic that is hard to ignore and even more difficult to discuss.

Depression is generally defined as an intense feeling of despair that goes beyond any normal degree of sadness encountered in everyday life.

The symptoms can be mild, moderate or severe. It can greatly disrupt a person’s life, work, relationships, eating and sleeping patterns, as well as the passions we enjoy in our spare time.

The condition, which can also be recurring or chronic, is said to affect a staggering 86 million people across Southeast Asia, with the World Health Organization (WHO) pointing to suicide as the second biggest cause of death among 15-29 year-olds in the region.

Women of childbearing age (particularly following childbirth) and adults over the age of 60 are also said to be at higher risk of depression.

Many believe the region is rapidly turning into a pressure cooker, with the stresses of modern living and cultural attitudes towards expressing such feelings leading to record numbers of suicide.

This was highlighted in 2016, when the South China Morning Post reported that education chiefs in Hong Kong were taking urgent measures to try and reverse a sharp increase in suicide among young people.

It followed the news that 22 students had taken their own lives since the start of the academic year alone – with four such deaths taking place in the space of just five days.

Woman on phone

Contributing factors

With almost 60% of the world’s population concentrated in Southeast Asia – mainly within Asian metropolises, many put the blame squarely on modern living.

For example, Delhi in India contains 25 million people, while Bangkok and Hong Kong boast a population density of 9.3 million and 7.3 million respectively, with hefty visitor numbers swelling this further each year.

A study conducted by the Central Institute of Mental Health in Mannheim, Germany, suggests that city-dwellers suffer more stress, fear and anxiety than their bucolic rural counterparts, thanks to more hyperactivity in the amygdala region of their brain, which is linked to depression and anxiety.

Regional commentators are also quick to point to cultural attitudes also play a large part in the suppression of such feelings.

The tendency across the Southeast Asian population is to try to conceal any depression, for fear that any such admission would be viewed as weakness or a taint on their family’s honour. In some cases, health professionals are also said not to view the symptoms of depression as ‘real’ or pathological.

Man and sunset

Taking steps

Governments appear to be waking up to the problem. In March, India passed a Mental Healthcare Bill – which decriminalises the act of suicide and aims to provider better care in terms of prevention and ongoing support.

Praising India for these steps, WHO is now calling on other nations in the region to make similar efforts to ramp up the quality of their services.

In 2017, it made mental wellbeing the focus of its annual World Health Day, putting the message out loud and clear that no one should have to suffer in silence.

“People experiencing depression often find a range of evidence-based coping mechanisms useful,” comments Dr Poonam Khetrapal Singh, Regional Director, WHO Southeast Asia.

“From talking to someone they trust to exercising regularly or staying connected with loved ones. Avoiding or restricting alcohol intake and refraining from using illicit drugs helps keep depression at bay. But many people also find professional help an important part of managing the condition, particularly in terms of exploring treatment options.”

WHO’s Mental Health Gap Action Programme (mhGAP) aims to help countries, particularly those with low to middle-incomes increase services for people with mental, neurological and substance use disorders.

Piggyback

Expat pressures

There’s little doubt that being an expat brings its own set of challenges – where feelings of trying to fit in, the need to succeed and coping with a sense of isolation from loved ones back home may all contribute to depression, which the WHO says now affects more than 300 million people globally.

Stay-at-home parents, in particular, can face a difficult task in juggling their own needs with the demands of their family.

Worries about accessing local services or knowing who to trust can make it difficult for people to open up. This can make online forums another good way to connect with others experiencing the same feelings.

Remote counselling is widely available for those looking to access more tailored support, with the International Therapy Directory offering detailed information on services. Local embassies should also be able to provide a list of accredited experts based in the area.

 

Take care of you

The UK-based Mental Health Foundation offers its 10 top recommendations for preserving your wellbeing:

1  Talk about your feelings

 

2  Keep active

 

3  Eat well

 

4  Drink sensibly

 

5  Stay in touch

 

6  Ask for help

 

7  Take a break

 

8  Do something you’re good at

 

9  Accept who you are

 

10  Take care of others

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How does physical activity affect your health?

How important is it to stay active as we age and what kind of activity brings the most benefits?

For an expat with a busy schedule, finding the time to exercise can be challenging.

However, there is an infinite wealth of evidence to show that finding that time is vital, especially for the over 50s.

As we all know, exercise is good for the body and the mind. But, there’s no one-size-fits-all approach and there are lots of factors that should influence a person’s approach.

What are the benefits of physical activity?

There is the obvious benefit of helping control weight, which becomes more difficult as you get older due to your metabolism slowing down.

A few hours of moderate-intensity physical exercise each week also lowers the risk of heart disease, type 2 diabetes, breast cancer and colon cancer.

The US-based Centers for Disease Control and Prevention (CDC) suggests that the risk of endometrial and lung cancer is lower in people who exercise regularly than in those who don’t.

This is backed up by the results of a long-term study by University of Minnesota researchers. They gave questionnaires to 36,929 cancer-free women from Iowa, and then followed them for 16 years. They found that the women with high exercise levels were less likely to develop lung cancer than those with low exercise levels.

The Australian study, published in the British Journal of Sports Medicine, found that aerobic exercises, resistance training and less-strenuous forms of exercise such as T’ai Chi, a traditional Chinese martial art, all had positive effects on different parts of the brain’s functions ranging from the ability to organise and plan, to reading and reasoning.

The authors of that study examined 36 wide-ranging studies and found that exercising moderately for around an hour on as many days as possible improved memory and thinking skills of those aged over 50.

Pilates

How long should I exercise for?

Britain’s National Health Service recommends different sorts of exercise for different ages. It says children under the age of five should be physically active for at least 3 hours a day; this includes walking, playing outside, chasing balls, playing in water or riding a bicycle.

However, healthy adults should do a minimum 150 minutes of moderate aerobic activity each week as well as strength exercises that focus on the major muscles such as in the leg and back.

According to the CDC, those who do seven hours of exercise a week have 40% less chance of an early death than those who do just half an hour a week.

What are moderate and intensive forms of exercise?

Moderate aerobic activity includes things such as fast walking and mowing the lawn; so this kind of activity can easily be incorporated into a normal day.

Your heart rate needs to be raised to have an affect on your health so shopping and slow walking unfortunately won’t count. Vigorous or intensive activities are running, hiking, swimming or playing sports such as tennis.

Do some activities bring particular benefits to over 50s?

Low impact aerobic exercise and bone-strengthening activities can slow down the natural decline in bone density which occurs as a person ages.

This reduces the risk of chronic conditions such as osteoporosis and arthritis, according to the CDC. The organisation says that doing just two hours of moderate exercise a week lowers the risk of hip fracture and improves the quality of life for people living with arthritis.

For the over 50s, these lower weight-bearing and impact options help to reduce the risk of bone injuries or breakages, which is often higher in the older generation.

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Antibiotics resistance: what you need to know

Many countries have strict rules governing the use of antibiotics. In the UK, Europe and US, they will only be prescribed if a doctor is confident the cause of an illness is bacterial and not caused by a virus or other pathogen. However, not all countries are so vigilant.

A 2016 study published by the Journal of the Medical Association of Thailand revealed that antibiotics in Thailand are “widely available and inappropriately sold and given by grocery stores and retails shops”.

The inevitable affect, the researchers note, is that antibiotic-resistant bacteria are commonly and freely circulating through the population, meaning some illnesses are no longer treatable.

The situation is similar in the UAE, where prescription-required medicines are routinely sold without an accompanying prescription.

The World Health Organisation (WHO) takes this issue very seriously: “Where antibiotics can be bought for human or animal use without a prescription, the emergence and spread of resistance is made worse.”

It warns that without urgent action, the world is heading for a “post-antibiotic era, in which common infections and minor injuries can once again kill.”

The more antibiotics that are prescribed inappropriately, says Dr Jace Clarke, Chief Medical Officer at William Russell, the more likely resistance is to develop.

What causes antibiotic resistance?

A common misconception is that it’s the individual who becomes resistant to antibiotics. In fact, it’s the bacteria that adapts and develops resistance, rendering certain antibiotics entirely useless.

Misuse and overuse of antibiotics is the biggest cause of antibiotic resistance and the rise of the so-called superbug (illnesses that no longer respond to treatment and are now potentially deadly).

Superbugs emerge when bacteria have not been properly treated with antibiotics and have learnt to become resistant; certain strains of tuberculosis and pneumonia have already developed resistance so can’t be treated easily, if at all.

The WHO calls antibiotic resistance “one of the biggest threats to global health, food security and development today.”

Doctor and Child

What do antibiotics treat?

Antibiotics should only be used to treat illnesses caused by susceptible infections, for example bacterial tonsillitis, urinary tract infections, respiratory tract infections, whooping cough and skin infections. Different types of antibiotics target specific bacteria.

For example, Amoxicillin (a sort of Penicillin) is often prescribed to treat ear infections, while Trimethoprim is commonly given to treat urinary tract infections caused by E.coli.

Dr Clarke stresses there isn’t a one-size-fits-all approach to antibiotics. “Some bacterial infections can be self-limiting in fit, healthy people” he says, “for example Salmonella, a common cause of food poisoning.” A doctor would therefore “establish sensitivity of the bacteria and allocate an appropriate antibiotic”.

Antibiotics are completely useless against viruses. A huge number of everyday illnesses are caused by viruses and therefore don’t need antibiotics. If you’re suffering with a cold at the change of season, chances are antibiotics won’t help.

 

pills

 

What to do if you think you need antibiotics

Even if you think your self-diagnosis is accurate, and as tempting as it might be to buy the tablets over the counter, you could do more harm than good. Antibiotics could interfere with other medicines you might be taking, or even damage your organs.

Dr Diab Maaruf Kurdi, head of pharmacy at Burjeel Hospital in the UAE, says: “It’s important that medication is not purchased without the doctor’s consultation, because the doctor will take into consideration your overall medical condition. Furthermore, the medication that you purchase may not be right for your condition and could cause further health complications.”

Dr Clarke also warns that a non-bacterial illness that goes undiagnosed, such as malaria, could get worse without formal identification and appropriate treatment from a doctor.

 

How to take antibiotics responsibly

Being prescribed a course of antibiotics by a medical professional is the first step, but there’s more that needs considering in order for the antibiotics to work effectively.

You must follow the instructions and finish the course even if you’re feeling better. It’s also important to note whether the medicine should be taken before or after food, or with water. Never share antibiotics and do not accept them if a pharmacist offers them without a prescription.

For all your global health insurance questions, go to the William Russell website, or call our dedicated team on +44 (0) 1276 486455.

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What is driving up the cost of global healthcare?

According to Willis Towers Watson’s 2017 Global Medical Trends Survey Report, the trend in average global medical investments went up 7.8% in 2017 and most countries expect it to continue to rise between 2.4 and 7.5% a year until 2020.

This article asks what factors are driving up the cost of healthcare globally. Understanding these can help you keep a clear view of how healthcare is set to change in the coming years.

Consumer demand

An emerging middle class in developing countries means there is an increasing global demand for high quality private health services.

The Brookings Institution report, The Unprecedented Expansion of the Global Middle Class, estimates that there were around 3.2 billion people in the middle class at the end of 2016, growing by around 140 million annually. This is set to increase to 170 million a year in five years’ time.

The overwhelming majority of the next billion – an estimated 88% – will live in Asia; with 380 million in India, 350 million in China and 210 million in other areas of Asia. Brookings predicts that by 2030, Asians could represent two-thirds of the global middle-class population.

The rise of the middle class has meant a general increase in wealth and life expectancy, which has created additional strain on governmental and private health services. Particularly in Asia, where high-fat diets and less active lifestyles have been associated with greater wealth and longer life expectancy, obesity levels are on the rise, leading to a surge in non-communicable chronic diseases, such as cardiovascular disease, some cancers and respiratory illnesses.

According to Iber Global, rates of cardiovascular disease are projected to at least double if not quadruple in several Asian countries over the next two to three decades.

“Cardiovascular disease, cancer and respiratory illness are all projected by insurers worldwide to be the top three diseases for at least the next five years.”

Willis Towers Watson’s 2017 Global Medical Trends Survey Report

Convenience, mobility and choice

Alongside this, the digital revolution is also having an impact on consumer demands. With the range of digital channels growing – from retail e.g. Amazon next day delivery, instant access to content e.g. Netflix, to instant means of communication e.g. social media, instant messaging – expectations on the healthcare industry for such things as 24/7 on-demand access to healthcare, are only going to increase.

The rising popularity of health-tracker apps and wearables (predicted to reach £14.8 billion in 2018) also means that patients are more connected to the state of their overall health and therefore expect their healthcare providers to match their levels of connectivity. Especially in the younger mobile-savvy ‘millennial’ generation, the need for convenience, mobility and choice are paramount.

Multi-pronged, collaborative and technology enabled approaches are one of the top considerations (and investment areas) for healthcare stakeholders

Deloitte 2018 Global Healthcare Outlook

Ageing and lifestyle factors 

The world’s population is ageing. This means that, as poverty decreases and access to medicines improve, life expectancies are increasing. According to Deloitte’s 2018 global healthcare sector outlook, the ageing population (those over 65 years old) is set to increase by eight percent, from 559 million in 2015 to 604 million in 2020.

The longer people live, the more care they may need, and the more chance they will have of contracting later life conditions and diseases, such as dementia. According to Deloitte, cases of dementia are forecast to increase in every region of the world, reaching 74.7 million by 2030.

Additionally, by 2020, Deloitte predicts that 50% of global healthcare expenditure – around $4 trillion – will be spent on the three leading causes of death: cardiovascular diseases, some cancers and respiratory diseases. Meanwhile, the number of diabetes sufferers will rise from 415 million to 642 million by 2040.

Regulatory landscape and fraud

The global healthcare regulatory landscape is complex and constantly evolving. In the future, healthcare providers will continue to face a highly complex and rapidly changing set of global, regional, country and industry-specific regulations, laws and directives.

These cover clinical quality and safety, regulations on counterfeit drugs, identifying and eliminating corruption, and the ever-increasing danger of cyber security.

Many regulations are in place to counteract the global problems of fraud and corruption in healthcare. The Global Health Care Anti-Fraud Network estimates that $260 billion – or around six percent of global healthcare spending – is lost to fraud each year, which can occur in several ways.

Health insurance fraud, whereby an insurer or government healthcare programme is targeted by a fake claimant, is a growing problem, while prescription drug diversion is anticipated to become more of a global problem than illicit drug production.

Tackling fraud and adhering to regulations all come with a price tag. Expensive security software must be purchased to protect confidential patient information from hackers. Healthcare costs must therefore rise to ensure data and patients are kept safe.

New healthcare approaches

According to McKinsey’s Digital Patient Survey, more than 75% of all patients expect to use digital services in the future. This means health services will have to embrace a ‘third wave of digitisation’, meaning using digital innovations to improve patient accessibility and experience, rather than just using it to consolidate HR and internal IT processes.

This third wave of digitisation covers an array of new technology: 3D-printed devices, the use of virtual reality and telehealth to communicate with patients, biosensors and trackers, and artificial intelligence in clinical diagnoses.

The emergence of new innovative approaches to healthcare and improved online services is certainly a way for traditional healthcare providers to meet increasing patient demands, but setting up these services comes with a cost.

In Southeast Asia, Singapore is leading the way with integration of its digital healthcare services by moving its national health information to the cloud. According to PwC Consulting, the project – named hCloud – will cost US$37 million for the first ten years.

“Singaporeans are among the most tech-savvy in the world, and that translates into their attitudes towards digital healthcare – it is not just the younger generation who are keen to adopt digital healthcare.”

Ivy Lai, country manager, Philips Singapore

Writing for Forbes, Maria Clemens of health sector technology provider, Management and Network Services, said that technological advances had been serving the healthcare industry very well over the last few decades, but the cost of some technical advances was now contributing to the overall increase in costs. “In fact, new medical tech is responsible for 40-50% in annual cost increases,” she wrote.

How does this all impact my health insurance?

As global healthcare costs go up, this increases how much it costs to provide health cover. However, if you are renewing your health insurance for 2018, there are a few options you can consider.

  1. Shop around and compare your options for the most competitive deal, making sure your policy meets your needs and consider the fact that pre-existing conditions may not be covered
  2. Stay with your current insurer, but check your policy meets your needs and provides access to the best health cover
  3. You may be able to change the level of your cover, for example, the level of plan, optional benefits or excess levels. Talk to your insurer to find out more about your level of cover.

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Take care of your family’s tomorrow, today

Help protect your family financially if something happens to you.

The decisions you make as a parent will span throughout your children’s lifetime. Your support and advice will guide them as individuals and stay with them forever – because your role as their guardian doesn’t stop after you are gone. Life insurance could provide you with the assurance that your loved one’s future is secured financially, should the worst happen.

Planning your legacy

The loss of a loved one is never easy and can be a very emotional time in our lives. The loss may be impossible to mitigate but the weight of picking up the pieces with banks, mortgage lenders, legal teams and health providers, especially as an expat, can be made to feel a little less daunting if you are set up financially. With a William Russell Life insurance plan you can protect what you have built and pass it onto your loved ones.

Life insurance designed for expats

We offer life insurance that’s designed with expats in mind; wherever your next step might take you. Your plan moves with you and the terms are communicated in a clear, unambiguous language. For 2018, our Life cover has been enhanced with you in mind….

Our 2018 enhanced international life cover plan offers

  • Lower rates for 18-54 year olds with no claims
    • Rate reductions of up to 30% if you’re under the age of 40
    • Increase in maximum benefit from $1.5m to $2m
    • Terminal illness cover – your plan pays out if you are diagnosed with a terminal illness with a prognosis of 12 months or less

Your job done

With our life plan, you can choose a level of cover that suits your lifestyle within the limits of the policy, giving you peace of mind that your family’s financial future is secure.

Start the conversation today

Speak to us today to start planning your life insurance to cover you and your family while you are living away from home.

Find out more >parent_and_child_at_beach

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Ebola in Africa: what expats need to know

Dr Peter Salama, Executive Director of the World Health Organization (WHO) Health Emergencies Programme which coordinates outbreak responses, remarked that we have “learnt never, ever to underestimate the Ebola virus disease and we will be remaining vigilant.”

The Ebola outbreak in West Africa was finally declared over on the 13th of January 2016 by the WHO, but for expats in Africa it remains important to be aware of the disease and the risks it presents.

By the beginning of 2016, a disease that in less than two years had crossed borders and killed thousands of people – primarily in Guinea, Liberia and Sierra Leone – had finally been brought under control. WHO reported a total of 28,646 cases of Ebola and 11,323 deaths.

What is less well known, is that there was another Ebola outbreak in May 2017, this time in a remote area the Democratic Republic of the Congo (DRC). What is remarkable is that this outbreak of 8 reported cases was declared over in just under 2 months due to the efforts of local and international agencies that responded to the outbreak by setting up mobile diagnostic labs that allowed for onsite testing of patients.

WHO health professionals say although they are more experienced in dealing with Ebola, there is still no cure. This article presents the facts on Ebola and what you should do if you encounter it.

GUINEA-HEALTH-EPIDEMIC-EBOLA

What is Ebola?

Ebola was first discovered in 1976, with 2 reported outbreaks in South Sudan and along the Ebola River in the DRC. From here, the virus was subsequently named after the Ebola River.

It is transmitted from wild animals such as gorillas, fruit bats and antelopes to humans. It then spreads across the population through human-to-human transmission by way of bodily fluids coming into contact with broken skin or the mucus membrane. Ebola is part of a group of contagious infections called viral haemorrhagic fevers, which also includes Lassa and Marburg.

The virus can exist outside of the body for days and items that have been in contact with bodily fluids should be avoided. This is why medical professionals and family members are considered to be the most at risk of catching the disease.

What are the symptoms

Once someone is infected with Ebola, it begins to multiply in the body. Symptoms can vary but they start to appear after 4 to 6 days with a sudden onset of a fever, diarrhoea, vomiting, severe headache and a sore throat.

The period between infection with the virus and the start of symptoms is called the incubation period. For Ebola, this can be as short as 2 days or as long as 21 days.

Areas affected by Ebola

While outbreaks have been reported and maintained for years in the DRC, Sudan, Gabon, Guinea and Uganda – there have also been reported cases of Ebola crossing over into other countries like the US, Italy and the UK.

Tanzania and Botswana are two examples of countries that have managed to prevent Ebola from entering its borders through strict government measures to screen travellers arriving from Ebola-affected countries.

If you think you may have come into contact with Ebola

If you suspect you may have Ebola or have come into contact with someone suspected of having the virus, you should attend the nearest hospital or clinic immediately.

These facilities have a responsibility to report any cases that are thought to be Ebola and if any of the cases come back positive they are then reported at a government level.

Health care response

Dr Peter Salama says that they put a huge emphasis on getting as much information from the people who have been infected, to help manage the case and isolate it as quickly possible to prevent the spread of Ebola.

WHO health professionals say they are more experienced in dealing with Ebola but say there is still no cure and its thought that the only way to help prevent the spread of the disease is through 21 days of quarantine.

The US Centers for Disease Control and Prevention (CDC) have said ‘experimental vaccines and treatments for Ebola are under development, but they have not yet been fully tested for safety or effectiveness’.

Recovery from Ebola must be done carefully and patiently. The virus is known to persist in some areas of the body of those who have recovered from the disease, such as the testicles, the inside of the eye, and the central nervous system. In pregnant women, the virus can persist in the placenta, amniotic fluid and foetus. If you are breastfeeding the virus can also persist in the breast milk.

Studies have shown that a small percentage of survivors can still test positive for the Ebola virus for a period of more than 9 months.

What can you do about it?

  • Check if you are travelling to a region where Ebola may still exist
  • Remain vigilant of Ebola symptoms
  • Seek healthcare immediately if you suspect you may have come into contact with Ebola

To find out more about Ebola visit World Health Organization website.

WHO health professionals say although they are more experienced in dealing with Ebola, there is still no cure

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Tired all the time? How to get better sleep

Sleep deprivation is a key global issue that is having a particular impact in east Asian cities.

According to a 2014 profile of 43 cities, people in Singapore are getting an average of six hours and 32 minutes sleep, those in Seoul fewer than six hours, and Tokyo’s inhabitants are the most sleep deprived, with only five hours and 44 minutes.

These cities are widely associated with people working harder and achieving more, and as consequence people may be missing out on too much sleep. We take a closer look at how sleep deprivation can affect our everyday lives.

Sleep myth #1

We need less sleep as we age

Truth: While teenagers don’t require as much sleep compared to babies, adults require even less sleep.

A baby aged 6 months requires around 11 hours of sleep per day, as the child grows into a teenager they require even less; around 9 hours of sleep per day. Adults require 7-9 hours of sleep per day.

How bad is sleep deprivation for my health?

According to the National Health Service (NHS) in the UK, sleep boosts your mood and immunity, while increasing fertility and libido. Sleep deprivation, on the other hand, has been linked to long-term mood disorders such as depression and anxiety, type 2 diabetes, increased heart rate and higher blood pressure.

In 2013, the University of Surrey’s Sleep Research Centre in the UK studied the effects of reducing sleep by just one hour.

The results showed that sleep deprivation affects our genes, approximately 700 of them. Researchers found an increase in the activity of genes that govern body processes such as inflammation, immune response and stress, and also the genes associated with diabetes and cancer risk. The reverse happened when an hour of sleep was added.

Research by the University of Zurich found that male students – aged 18 to 28 years – sleeping for 5 hours a night made riskier decisions about money than if they had slept for 8 hours. The research concluded that lack of sleep can lead to an increase in what they call risk-seeking behaviour.

http://www.media.uzh.ch

Am I getting enough sleep?

There is no hard and fast rule about the number of hours you should be getting. Sleep scientist Patrick Fuller says that sleep should be restorative, leaving you feeling refreshed. On a basic level, if you struggle to wake up in the morning and it takes you a few hours, or several cups of coffee, to feel energised, you’re probably not getting enough sleep.

According to Nick Littlehales, an expert sleep coach, we sleep in cycles of 90 minutes rather than 60. Each restorative cycle takes us down into a deep sleep, where we place the day’s memories in our long-term storage, and then up into rapid eye movement sleep (REM), where we begin to process the emotions of the day.

Five cycles is the optimum amount to enable your body to recover, so if you need to get up at 7am you should be aiming to go to sleep at 11.30pm.

Sleep cycle

How can I get better sleep?

  • Sleep at regular times – your body craves routine, so don’t be tempted to lie in at the weekends.
  • Wind down before bed – as well as the baths and warm (de-caffeinated) drinks we had as children, it’s important to calm your mind. Try writing a to-do list to get the next day’s tasks off your mind.
  • Understand the impact of light – blue light – the kind emitted by phones, tablets and TVs – simulate day light, and will cause your body to start waking up. Avoid phones and TVs for an hour or so before bed, and seek daylight in the morning before the light of an electronic device.
  • Build the right environment – in your bedroom, avoid gadgets, bright lights and working. Make sure you have good curtains, a comfortable mattress and, if you find it hard to sleep in the heat, good air conditioning.
  • Nap if you need to – it’s OK to catch an extra cycle of sleep later in the day, but preferably not too late in the day in case it affects night-time sleep.
  • Keep a sleep diary – if you’re still experiencing problems, keep a journal of when you sleep well and when you don’t, taking into account factors such as diet, stress and bedtimes. If you regularly struggle to fall asleep, you may have insomnia and it’s important that you speak to your doctor.

Sleep myth #2

A glass of wine before bed helps you sleep

Truth: Sorry, alcohol may help you fall asleep but as little as two drinks can cause less restful sleep and lead you to wake up more frequently.

I’m still not sleeping well – what should I do?

If you are repeatedly finding it hard to fall asleep and stay asleep throughout the night to feel refreshed in the morning, you may be suffering from insomnia. Insomnia can be caused by stress and anxiety; lifestyle factors, such as mental or physical conditions; certain medications; or a poor sleeping environment.

While we may occasionally experience episodes of insomnia, a persistent lack of sleep can have a damaging effect on your mental and physical health, as well as your quality of life. Try following our better sleeping tips and if they don’t help, contact your doctor for a consultation.

Sleep myth #3

During sleep your brain rests

Truth: While the body rests during sleep, the brain remains active and still controls many body functions. The US National Sleep Foundation says the brain ‘recharges’ during sleep. It also sorts and processes information from the previous day, vital for learning and memory.

Sleep is vital to your wellbeing. A global health insurance plan can provide you and your family with access to GP consultations and wellbeing benefits, such as health checks, to help ensure you’re in the best possible health while overseas.

If you are living abroad and would like to know more about international health cover, go to the William Russell website, or call our dedicated team on +44 (0) 1276 486477.

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Your guide to malaria protection

Malaria prevention has always been a consideration for expats and travellers alike, but there have been reports of a treatment-resistant strain of the disease gradually sweeping through Southeast Asia.

First encountered in Cambodia in 2007, this so-called ‘super’ malaria – which is resistant to typical antimalarial treatment – has now been recorded in Thailand, Laos and, most recently, southern Vietnam, with over 19,000 cases reported in 2015.

Fears are that if the drug-resistant strain spreads to Africa, where the 92% of malaria deaths occur, it could worsen an already major crisis there.

Who is at risk?

According to the World Health Organisation (WHO), 1.5 million people in Southeast Asia are infected with malaria every year, with 620 reported deaths in 2015.

In a joint letter to The Lancet Infectious Diseases, Professor Arjen Dondrop and his research team at the Oxford Tropical Medicine Research Unit in Bangkok, highlighted increasing numbers of failures in malaria treatment, with the figure bordering on 60% in Cambodia.

With no vaccine available for malaria, taking measures to reduce the risk of contracting it continues to be the number one rule to follow in affected areas.

Malaria – the statistics

In 2015, 91 countries and areas had ongoing malaria transmission

Africa is home to 90% of malaria cases and 92% of malaria deaths, followed by Southeast Asia (7%) and the Eastern Mediterranean region (2%)

Three deaths were recorded in Vietnam from super malaria in 2015, with more than 19,000 cases reported

World Health Organisation Factsheet

What is super malaria?

Malaria is caused by a parasite that is transmitted through the bites of certain species of mosquitoes. It can be fatal if left untreated, especially in children.

The super malaria strain of the disease is so called because of its resistance to the typical antimalarial drugs, which treat and prevent the effects of malaria; these include fever, organ problems, and, in the most severe cases, death.

Your guide to malaria protection mosquito

 

What treatments are there?

The usual treatment for malaria includes using a combination of two powerful anti-malarial drugs –artemisinin and piperaquine. However, the super malaria strain has become resistant to both these drugs.

While the WHO continues to advocate the use of antimalarial tablets in recommended regions, it admits this resistance is making any necessary treatment more challenging – and increasing the need for close monitoring and prevention.

Before you travel

If you are travelling to an affected region, your doctor or health professional may advise carrying some emergency medication for malaria. Make sure you fully understand and record the correct dosages, as well as any side effects to look out for.

What can I do?

As there is no current treatment for the super malaria strain, it is important to follow best practice preventative measures. These include:

  • Taking antimalarial tablets – Always visit an approved city-based clinic or hospital for a thorough assessment. Provide healthcare professionals with as much detail as you can about any locations you will be based in/or plan to visit.
  • Using a powerful insect repellent – Spend some time researching the products available to you and what the ingredients will offer. Don’t assume it’s a one-size-fits-all scenario, as some compounds shouldn’t be used if you are pregnant or children under a certain age.

 

Your guide to malaria protection spray

Research from the US-based Consumer Reports Buying Guide suggests that Deet, Picardin and Oil of Lemon Eucalyptus offer the most protection – although it warns that in high concentrations (Deet and Eucalyptus over 30% and Picaridin over 20%) they can cause skin problems and such concentrations are not necessarily more effective.

Researchers found the following levels to be highly effective, noting that sprays are more effective than creams:

Deet –15-30% concentration

Picaridin – 20% concentration

Oil of Lemon Eucalyptus – 30% concentration

  • Keeping your arms and legs covered – Mosquitoes tend to be more active at dawn, dusk and overnight, so apply repellent and wear long-sleeved tops and long skirts or trousers. Opt for loose-fitting garments, as insects can still bite through tighter clothing. Mosquitoes are naturally drawn to darker shades, so wearing lighter colours should also help.
  • Closing doors and windows – Use air conditioning when available, so that you can keep windows and doors closed. Pedestal fans and screens will also decrease mosquito activity.
  • Using bed nets – Organisations working to reduce malaria risk around the world have achieved success using long-lasting insecticidal nets (LLINs). These nets, treated with a low level of insecticide, provide a physical and chemical barrier to mosquitos overnight, when bites often take place. There are many different types, so it helps to research the net you need in advance.

Your guide to malaria protection netting

 

 

  • Staying cool – A higher body temperature can attract unwelcome visitors, as can perfume and other scented products worn on the body.

How to spot malaria symptoms

high temperature

sweats and chills

headaches

vomiting

muscle pain

Malaria can begin to show just days after an infected mosquito bite, but commonly takes around 10 days to three weeks. In most cases, the illness starts with a fever, so always seek medical attention at the first sign of one.

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Keeping active in Southeast Asia

Southeast Asia has the highest activity level in the world according to the World Health Organization, but there are growing concerns that physical fitness levels in the region are on the wane. Westernised influence of high-fat, sugary foods and long, sedentary working hours in front of computer screens are the main reasons for this concern.

Keeping active doesn’t just keep your body in good shape, it reduces the risk of heart disease and diabetes, and it can lower blood pressure. What’s more, the endorphins released during exercise can help ease symptoms of depression and anxiety.

Here are just a few of the latest and emerging sports and activities taking Southeast Asia by storm:

  • Group workout sessions

Group workouts are growing in popularity, so says Joel Tan, founder of BBounce Studio, a high-energy exercise class that involves bouncing on a trampoline to loud music. Speaking recently to cyberpioneer, he explains, “Friends who work out together stay together.”

Zuu, in particular, a high-intensity group workout which mimics animal movements, is the latest group workout trend, according to Singapore-based Straits Times. Users take part in 45-minute sessions outside work or during lunchbreaks.

Southeast-Asia-martial-arts-1

  • Martial arts

With Asia’s deep-rooted heritage in the martial arts, it’s no surprise that the high-energy Muay Thai – sometimes called ‘the art of the eight limbs’ because it uses fists, elbows, knees and shins for full combat – has made an impact on fitness trends in the region.  Muay Thai along with T’ai Chi, it’s gentler cousin, continue to be popular activities in the region. T’ai chi, in particular, has long been part of the region’s workday culture. Its deep breathing and slow, deliberate movements can help reduce stress and improve balance and posture, and is a great way to start the day.

Heat exhaustion

You need to drink more water when exercising in the higher temperatures of Southeast Asia, especially during the humid months between May and October, to avoid heat exhaustion.

  • Yoga

The ancient Indian practice of yoga remains a firm favourite, however, Jolene Foo writing in Malaysian online fitness website, Health Works, says that aerial yoga is the latest trend among Malaysian fitness enthusiasts. Originating in New York, the practice combines traditional yoga techniques while balancing on suspended hammocks. “Aerial yoga is relatively low impact and will be great replacement for those who find traditional yoga difficult,” she says.

Southeast-Asia-yoga

 

  • Bootcamps

Residential fitness bootcamps are growing in popularity across the region, particularly in Thailand, where there are growing numbers of expats looking to kickstart their fitness regimes. These intensive fitness programmes are designed for all abilities and offer personal attention from expert trainers and fitness specialists, who lead a variety of activities such as circuit training, hill sprints and cycling days.

  • Outdoor gyms

Although not unique to Southeast Asia, outdoor gyms are becoming more widespread, as many are put off traditional gyms by the expensive membership fees and long waiting lists. Thailand-based fitness blogger Arnel Banawa recommends Bangkok Gym in Lumphini Park, Bangkok, which has a variety of fitness equipment and a 2.5km running path. In Hong Kong, Gymbox24 on Hong Kong Island is the area’s first and only 24-hour open-air gym.

Air pollution

Avoid exercising outdoors when there is a lot of traffic congestion. Extra care should be taken if you suffer with a respiratory illness or if you suffer from allergies.

  • Hiking

Hiking has always been popular and Southeast Asia is not short of spectacular scenery and incredible environments to explore. Indonesia is home to tropical forests and volcanic mountains, and there are plenty of hiking trails in and around the islands of Thailand. On Hong Kong Island, the 50km hiking trail is a particularly popular hotspot and offers walks of varying lengths and terrain depending on ability.

Southeast-Asia-Hiking

Swiping for fitness

Despite the sedentary lifestyle associated with technology, another growing trend means getting fit in Asia could result in more screen time, not less. According to Tiffany Ap, Asia correspondent for CNN, an increasingly tech-savvy population means more people are turning to technology to get fit as an alternative to gyms.

As Ap explains, considering that four of the top five countries who spend the most time looking at screens are in Asia (Indonesia, Philippines, China and Vietnam), it’s not surprising that the popularity of fitness apps is growing.

There are many apps available – such as the globally-popular FitBit or MyFitnessPal – which track activity levels, food, weight and sleep. ‘Portable trainers’, meanwhile, mean you can exercise without having to go to a class or gym. Yogaia, for example, allows you to livestream yoga classes to your living room.

Getting social

Now the market is starting to expand into more social media and even dating-style apps, all focused on encouraging people to become more mindful of their health.

Hong Kong-based start-up Jaha, for example, has been dubbed the ‘Tinder for fitness’. It allows users to browse and link up with similar-minded sports enthusiasts in their area and encourages users to share workout results, start challenges and compete against each other.

For those more into self-image, Healthy Selfie is an Instagram-like app that encourages you to ‘track your transformation’, to notice the incremental changes in your body, as well as record your healthy meals, and also share recipes and tips.

Southeast-Asia-Outdoor-gyms

Should I join a gym?

With the international gym chains expanding into Southeast Asia, there has never been more choice for consumers – but it comes at a cost. According to Business Insider, people are paying up to $24,000 a year for international top-end gyms.

Expect to pay between $100-200/month, plus a sign-up fee for global gym brands, or up to $100/month for local equivalents. Alternatively, there’s the KFit app which gives access to 10 fitness activities in any gym across SE Asia for RM139/month.

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How to relocate as an expat with children

We meet three expats who moved abroad and brought their kids with them. They share the challenges they faced and what they have learned.

Relocating to a new country is one of life´s great adventures, but it can also be daunting, especially if you have children to think about.

Whether you are making a permanent move or planning an extended stay, your family´s physical and mental wellbeing is the number one consideration.

We met some expats to find out what you should consider when taking your family to live abroad.

Preparing for change

One of the first steps is to ensure that your children have had the recommended immunisations for your destination. Online guides such as NHS Fit for Travel and Travel Health Pro offer country-by-country advice.

Other factors will depend on your children’s ages and the country you are relocating to, says Clara Wiggins, author of the Expat Partner’s Survival Guide.

Wiggins, along with her husband and their two daughters, have lived in a host of locations around the world. She suggests preparing your children by involving them in home searches and school visits.

Children with Ipad

“If you are not able to take children on a look-see, I would recommend doing a video for them or even a live Facetime or Skype so they can get an idea of where they are going.” Google Earth and Streetview can be useful too, she says.

You can also ease the transition by bringing familiar things from home on the plane, rather than waiting for them to arrive later.

“We brought my younger daughter’s fairy lights for her bedroom, and we also brought their duvet and pillow covers. The first few nights in a new place can be hard so making their rooms feel like home is one way to help.”

Jaimie Seaton is a journalist from the US. When her husband was offered a position with Citibank in Singapore, they jumped at the chance and relocated with their son and daughter – then aged two and five. After two years in Singapore, the family moved to Thailand.

“Frame the move as a great opportunity and adventure, not as a challenge,” she says. “Do research as a family of your new home, teach them about the culture, look up fun things to do in the new country.” Seaton also ensured that her children understood cultural differences before they moved to Thailand.

“The main things we had to discuss with them were the strict rules around the royal family. It’s against the law to insult the royals, especially the then-king, who has since passed away.”

Whether your company is providing a healthcare package or you are arranging your own expat medical insurance, it is important to understand what services will be available in your destination country.

Healthcare: know what to expect

If your child requires specific medication or access to ongoing treatments, research how accessible these will be. Call local hospitals or doctors, and seek advice from other expats via online forums and Facebook groups.

Theodora Sutcliffe is a travel writer and blogger. In 2014, after four years of travelling together, she and her son (now nine) settled in Bali.

“It’s important to be aware that medical care in Bali isn’t the best,” says Sutcliffe, “Most expats get medical insurance that covers them to be evacuated to home or a second country, typically Singapore, in emergencies.”

Facilities will vary widely across the world. Some countries, such as Hong Kong, have highly developed healthcare. Seaton found local services to be excellent.“The medical care in Singapore (and Thailand) is far superior to the US.”

But given the incredibly varied quality and availability of public healthcare from country to country, not all expats will move to a location that offers reliable local medical services. You may even be expected to foot the bill for private healthcare, so having international health insurance cover in place is vital before you go anywhere.

While her family were posted in St. Lucia, Wiggins knew that if there was a serious health incident, they would be medically evacuated under the terms of her private insurance plan. But she also suggests preparing for the unexpected. “I always recommend doing a ‘dry run’ to your local emergency department or hospital and making sure its location is in your GPS and number is in your phone,” she says.

She points out that it is also important to know what the procedure is when you arrive at hospital, for example, do you need to pay for treatments up front? Such procedures will vary greatly depending on whether you have an international private medical insurance (IPMI) plan, if it provides direct settlement to the hospital, or if you’re accessing care independently.

Ipad Video Conf

Settling in and enjoying your new life

Be aware that many health issues can be prevented by using common sense. Make sure that your children understand safety rules about drinking water, for example, can they brush their teeth with tap water or not? The same applies to food safety, especially at street stalls and markets.

While some children will adapt easily, others may need more time. If your child is missing friends back home, Skype and FaceTime are good ways of keeping in touch.

Writing letters helped Wiggins´ daughter. “Very few of these got sent, so what I actually think she was doing was just processing her feelings and this is the best way she could do it.”

To keep a familiar routine, Wiggins´ tip is to continue doing sports and hobbies your child already enjoys, “In our case this has been football and swimming, which has also given them a chance to meet children away from the school environment.”

In Bali, where Sutcliffe and her son are based, the beach is a great place to meet other kids but there are dangers to be aware of. “Make sure you and your children understand water safety: the currents in the sea are no laughing matter,” she says.

Living in Thailand and Singapore, Seaton found that live-in help made life easier. But while this can be a perk of relocation, it may be a cultural adjustment for your children, she says.

“It’s important to remind children that they are not superior and to instill your values, which can be challenging.”

And – go local! Do not assume that things are better in your home country and be open to how other cultures do things.

“Enjoy every moment. It’s a gift to live overseas, and will give your children a worldview that will carry them far in life.”

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Keeping insurance relevant to expats

In the 25 years William Russell has provided expat health, life and income protection insurance, the needs and expectations of global professionals have completely transformed.

Instead of moving to a certain country for a number of years then returning home, many expats now find themselves routinely on the move around the world.

Meanwhile, international health insurance has become more complicated. Costs can be high and the options available greater than ever.

Insurance for local needs

James Cooper, co-founder of William Russell, has described today’s health insurance as “quite unrecognisable” compared to the market when the company started.

“We have moved from a time, 25 years ago, when we could provide a simple, global policy,” he says. “Now, we are focused on products that are country specific and licensed locally.”

“The traditional expat is disappearing,” says Neil Raymond, CEO at leading brokerage Pacific Prime, which offers local insurance advice at popular expat destinations including Hong Kong and Dubai. “A lot of expats that would have gone home are not going home. We are also seeing continued growth of a high-net-worth population around Asia who want access to the best medical services into their own country, in their region, or globally.”

A changing industry

This is part of a key trend in health insurance. Additional benefits are now standard in international health cover plans, for example dental treatment, maternity and wellbeing. At the same time, medical inflation has increased at a fast rate, and the global population is aging. Help Age International says that by 2050, one in five people around the world will be over 60.

As a result, international healthcare costs have never been higher, and insurers need to be as flexible as the expats they cover.

One solution, alongside the more comprehensive plans, is to offer simple, no-frills polices. Inez Cooper, co-founder of William Russell, feels these policies have a valuable place in the market.

She says: “We offer these policies for those expats who don’t want to pay for complimentary and extensive benefits that are becoming ubiquitous in global healthcare insurance products.

“A no frills policy would allow people to reflect upon the cover they actually need.”

This is particularly important at a time when the market is changing – customers now want greater flexibility and local tailoring, as well as the feeling that their insurer understands them.

Flexibility for expats

For long-standing William Russell customer and Hong Kong resident Michael Haynes, the most important factor in insurance is flexibility, portability and being able to discuss his circumstances with a real person.

With two sons playing rugby at international level who have had injuries, Michael wanted to avoid a claim later in life being treated as a pre-existing condition that wouldn’t be covered.

Michael says: “I was able to inform William Russell of every injury and they accepted that as being informed, and so it wouldn’t rule out future cover. I think that is very flexible. That comes down to being able to explain all of that to a person.”

His policy is also flexible enough to keep him covered should he wish to relocate from Hong Kong.

Reliable service for nomadic professionals

As an independent insurer with 25 years of experience under their belt, William Russell is able to offer value and stability.

For Michael, “the continuity of people” in the organisation has been also important.

If you have been renewing your policy with William Russell for the last 25 years, then you will most likely have spoken to the same person each time. Most customers deal with the same claims handler throughout their treatment, giving them support through major life events.

What next?

It is likely that the next quarter-century will present as many challenges as the last, if not more.

Financial institutions are now investing hundreds of millions of dollars in customer technology, as well as internal systems and data security. The digital revolution is expected to greatly affect all financial industries, including insurance.

For William Russell, the future is about effectively combining technology with a personal service. It’s about getting the balance between those clients who are happy to self-serve, and those clients who don’t want to self-serve.”

“We may not be the biggest provider in the marketplace”, says Inez, “but we certainly work hardest to be the best”. That is a real statement of intent to the industry for the next 25 years.

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Is there a depression crisis in Asia’s cities?

How much of a problem is depression in Asia’s metropolises and how can it be identified and prevented?

Despite the stigma associated with mental health problems in Southeast Asia, depression is becoming a topic that is hard to ignore and even more difficult to discuss.

Depression is generally defined as an intense feeling of despair that goes beyond any normal degree of sadness encountered in everyday life.

The symptoms can be mild, moderate or severe. It can greatly disrupt a person’s life, work, relationships, eating and sleeping patterns, as well as the passions we enjoy in our spare time.

The condition, which can also be recurring or chronic, is said to affect a staggering 86 million people across Southeast Asia, with the World Health Organization (WHO) pointing to suicide as the second biggest cause of death among 15-29 year-olds in the region.

Women of childbearing age (particularly following childbirth) and adults over the age of 60 are also said to be at higher risk of depression.

Many believe the region is rapidly turning into a pressure cooker, with the stresses of modern living and cultural attitudes towards expressing such feelings leading to record numbers of suicide.

This was highlighted in 2016, when the South China Morning Post reported that education chiefs in Hong Kong were taking urgent measures to try and reverse a sharp increase in suicide among young people.

It followed the news that 22 students had taken their own lives since the start of the academic year alone – with four such deaths taking place in the space of just five days.

Woman on phone

Contributing factors

With almost 60% of the world’s population concentrated in Southeast Asia – mainly within Asian metropolises, many put the blame squarely on modern living.

For example, Delhi in India contains 25 million people, while Bangkok and Hong Kong boast a population density of 9.3 million and 7.3 million respectively, with hefty visitor numbers swelling this further each year.

A study conducted by the Central Institute of Mental Health in Mannheim, Germany, suggests that city-dwellers suffer more stress, fear and anxiety than their bucolic rural counterparts, thanks to more hyperactivity in the amygdala region of their brain, which is linked to depression and anxiety.

Regional commentators are also quick to point to cultural attitudes also play a large part in the suppression of such feelings.

The tendency across the Southeast Asian population is to try to conceal any depression, for fear that any such admission would be viewed as weakness or a taint on their family’s honour. In some cases, health professionals are also said not to view the symptoms of depression as ‘real’ or pathological.

Man and sunset

Taking steps

Governments appear to be waking up to the problem. In March, India passed a Mental Healthcare Bill – which decriminalises the act of suicide and aims to provider better care in terms of prevention and ongoing support.

Praising India for these steps, WHO is now calling on other nations in the region to make similar efforts to ramp up the quality of their services.

In 2017, it made mental wellbeing the focus of its annual World Health Day, putting the message out loud and clear that no one should have to suffer in silence.

“People experiencing depression often find a range of evidence-based coping mechanisms useful,” comments Dr Poonam Khetrapal Singh, Regional Director, WHO Southeast Asia.

“From talking to someone they trust to exercising regularly or staying connected with loved ones. Avoiding or restricting alcohol intake and refraining from using illicit drugs helps keep depression at bay. But many people also find professional help an important part of managing the condition, particularly in terms of exploring treatment options.”

WHO’s Mental Health Gap Action Programme (mhGAP) aims to help countries, particularly those with low to middle-incomes increase services for people with mental, neurological and substance use disorders.

Piggyback

Expat pressures

There’s little doubt that being an expat brings its own set of challenges – where feelings of trying to fit in, the need to succeed and coping with a sense of isolation from loved ones back home may all contribute to depression, which the WHO says now affects more than 300 million people globally.

Stay-at-home parents, in particular, can face a difficult task in juggling their own needs with the demands of their family.

Worries about accessing local services or knowing who to trust can make it difficult for people to open up. This can make online forums another good way to connect with others experiencing the same feelings.

Remote counselling is widely available for those looking to access more tailored support, with the International Therapy Directory offering detailed information on services. Local embassies should also be able to provide a list of accredited experts based in the area.

 

Take care of you

The UK-based Mental Health Foundation offers its 10 top recommendations for preserving your wellbeing:

1  Talk about your feelings

 

2  Keep active

 

3  Eat well

 

4  Drink sensibly

 

5  Stay in touch

 

6  Ask for help

 

7  Take a break

 

8  Do something you’re good at

 

9  Accept who you are

 

10  Take care of others

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