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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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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 | Expat Stories

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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Health tips for Ramadan

Preparation is the key to maintaining a healthy mind and body during the Muslim fast

Ramadan is one of the most important events for Muslims everywhere, occurring in the ninth month of the Islamic calendar.

Being held from May 26 to June 24 this year, this traditional time of reflection is observed by a strict fast from dawn until dusk.

According to Dr Javid Ahmed Shah, Physician and Medical Director at the Lotus Group Of Medical Centres based in Dubai, dehydration is one of the most serious problems that can occur during this period – especially in Dubai and other parts of the Middle East, thanks to the hot and humid conditions that characterise the region.

While young children, the elderly, pregnant (and menstruating) women and those suffering from illness are not required to fast during Ramadan, Dr Shah reveals that many of his patients still choose to do so.

This can be particularly problematic for insulin-dependent diabetics, who must fine-tune their dosage during this period.

Preparing the body for fast

Good planning is the key to a healthy fast, says Dr Shah. He advises his patients to gradually reduce their intake of caffeine-based drinks such as cola, coffee or tea around three to five days before Ramadan is due to begin.

“A sudden decrease in caffeine prompts headaches, mood swings and irritability,” he says, ”while smoking also negatively affects the body’s utilisation of various vitamins, metabolites and enzyme systems.

“So if my patients are unable to quit entirely, I recommend they begin reducing their number of cigarettes a few weeks before the fast.”

An overhead bowl of dates on a rough wooden background

Eating right

Sahur (dawn break of fast) is important for all, according to Dr Shah, as it provides the body with the necessary food and energy for the day and helps individuals endure long periods of fasting.

As a rule, delaying the Sahur is better than taking it early, Dr Shah advises, as it diminishes the feeling of hunger or thirst.

At Iftar (the dusk break of fast), the body’s immediate need is for an easily available energy source in the form of glucose for every living cell, particularly the brain and nerves.

“Dates and juices are good sources of energy,” says Dr Shah. “Dates represent an excellent source of sugar, fibre, carbohydrates, potassium and magnesium. In general, three dates and a four-fluid ounce glass of juice would be sufficient to bring low blood glucose levels to normal.”

In order to best benefit the body, both the Sahur and Iftar meals should be balanced – with any high-fat/sugar foods best avoided.

 

While any reports of headaches and other symptoms must be carefully assessed, Dr Shah says that such issues tend to subside in healthy people once they have grown accustomed to the fasting pattern – with the body beginning to thrive.

 

Key tips for healthy eating:

  • Drink lots of water and fluids after the Sahur
  • Get enough sleep to avoid dehydration
  • Balance Sahur with different nutrients – preferably low-calorie, easily digestible and low-fat foods
  • Ensure meals are thoroughly cooked to aid digestion
  • Eat green salad for essential vitamins, minerals and salts, and fibre to avoid constipation
  • Ensure the Sahur meal contains fluids and dairy products such as yoghurt and cheese, as well as fruit
  • Avoid sugary foods
  • Make sure your Iftar includes complex carbohydrates and other slow-digesting foods – such as barley, wheat, oats, semolina, beans, lentils and wholemeal flour
  • Avoid spicy foods and caffeine-based drinks

 

Positive effects

“Many studies have shown that fasting helps improve blood pressure, cholesterol levels and insulin sensitivity – as well as weight loss,” he says.

Detoxification is another important benefit of fasting, with the body transitioning into self-cleansing mode. “This occurs because the energy normally used in digestion can get to work elsewhere,” Dr Shah explains, “removing built-up toxins, healing old wounds and building new cells.”

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What questions should I ask my surgeon?

Asking the right questions can not only bring peace of mind, but help ensure the surgery goes smoothly

Surgery can be a daunting prospect for anybody, even if it is for something minor. And for an expat working overseas, it opens up an extra layer of complications.

However, being prepared and asking the right questions will boost your peace of mind, while also helping the surgical team in the process.

“This is such a vital issue,” says Dr Jace Clarke of William Russell. “People often have surgery without really being aware of the risks involved.”

Here are some questions you can ask your surgeon.

Why am I having surgery?

This is pertinent for expats who may not be able to visit their regular doctor, who knows them well.

“The first thing is diagnosis,” says Dr Clarke. “Why am I having surgery? Do I need it? Then if I do need it, in the surgeon’s experience, where is the best medical facility to have it done?”

Is the surgery proposed definitely necessary?

“What are the risks of not having surgery? This is important, because maybe nothing significant will happen,” says Dr Clarke.

Although surgeons will only recommend a procedure that they feel will be of benefit to you, it may be the case that you feel a second opinion might be helpful in making your final decision.

You should also try to find out how long the benefits of surgery will last for, or if you will need any further treatment. If the benefits are only going to last a couple of years, talk to your surgeon to understand if the surgery is actually worth having.

Expats have many of their own considerations. Living in another location around the world could mean you are very close to another country with a great reputation for the surgery you need.

Getting to know the surgery team

When you have decided to have the surgery, knowing that the team contains the right people with the appropriate qualifications is vital to your peace of mind.

Find out the reputation of the hospital for this particular type of surgery. One can research the surgical team’s success and complication rates. These may all be good indicators to how your surgery will go.

“Ask the surgeon about their experience in carrying out the recommended procedure,” says Dr Clarke. “What technique are they going to use? Is that their preferred technique? At what point, if at all, will other, more junior doctors be involved?”

It’s vital to know the anaesthetist as well. They play a key role in the operation and ensuring the safety of patients. Will the procedure be carried out under local or general anaesthetic?

Expats have many of their own considerations. Living in another location around the world could mean you are very close to another country with a great reputation for the surgery you need.

“Obviously the quality of the hospital is vital,” says Dr Clarke. “If you need to go to a hospital in a neighbouring country, who pays for the travel and post-operative accommodation? Is it worth travelling long distances and perhaps being away from your family and social support systems?”

How can I help make the surgery go well?

Your surgeon will be able to advise on some steps you could take to make yourself more prepared for the effects of surgery. Stopping smoking, losing weight, doing more exercise – all of these things may help get you into the right shape physically.

“You also need to prepare yourself psychologically,” says Dr Clarke. “If you’re having major cardiac surgery, for example, then it can be very mentally demanding for both you and your family.”

Life after surgery

The effects on your life afterwards can vary, both physically and socially, so never feel apprehensive about asking too many questions.

For example, how long will you have to stay in hospital afterwards, how long will you be off work, or how long will your movement be impaired? Also, will you need assistance, such as a wheelchair or walking stick, or rehabilitation?

The surgeon should be able to advise on what activities you can or can’t do afterwards, and for how long. These questions could include driving, flying, eating, exercise, or sexual intercourse.

And for career-driven expats, there are questions to be asked about the impact on your ability to work. If you travel somewhere, when will you be able to fly afterwards? This could create complications in getting home. How will this affect your employment?

“You need to have the complete picture before deciding on surgery,” says Dr Clarke.

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Tackling type 2 diabetes in Dubai

Rising numbers of sufferers in the UAE are highlighting the risks for all.

For people living in Dubai, the growing trend towards wellness couldn’t have come at a better time, as figures show that areas within the United Arab Emirates are experiencing a marked increase in the numbers of type 2 diabetics.

According to the International Diabetes Federation Atlas, 19.3% of adults aged 20 to 79 in the UAE are diabetic, with the rate of diabetes in parts of the Arabian Peninsula over twice the global average. Cases of type 2 diabetes now outnumber type 1 by a ratio of 10:1 in the region.

While there’s little doubt that the two main triggers of type 2 – obesity and more sedentary lifestyles – are playing their part, recent research also suggests that the Arab population could actually be more susceptible on a genetic level.

Conducted by Manipal University in Dubai and Khalifa University in Abu Dhabi, the joint study reportedly made links between the disease and genes that cause obesity and high blood pressure in 500 Emiratis.

Glucose sticks are a quick and inexpensive method of monitoring your sugar levels via urine – and can be done at home. If type 2 diabetes is known to be in the family, Dr Clarke recommends having a urine test for sugar on an annual basis.

“We’ve known for some years that one’s genetic profile can be a factor causing type 2 Diabetes,” says Dr Jace Clarke, Chief Medical Officer at William Russell. “I would caution any expats in Dubai and across the UAE against viewing this merely as a problem for the local population. Instead, they should be treating this as an opportunity to discover what they can do to reduce their own risk of contracting a condition that is having a big impact on people the world over.”

Diabetes is a serious disease that in the worst cases can lead to cardiovascular problems, renal failure, blindness and even amputations. Learning how to monitor and manage your glucose levels is a critical part of staying healthy.

donughts

Understanding the condition

There are two types of diabetes:

Type 1 (insulin dependent) – Stemming from childhood in most cases, but typically before the age of 40, it occurs when the body is unable to produce a hormone known as insulin. Sufferers are required to take a daily dose of insulin to avoid a build up of glucose in the blood.

Type 2 (non-insulin dependent) – The most common form of diabetes, type 2 now accounts for between 85 and 95% of all diagnoses. It is typically associated with the over-40s, but is affecting growing numbers of younger people – including children. Type 2 occurs when the body becomes unable to produce enough insulin or is unable to use it properly (insulin resistance). It is treated with a healthy diet and increased physical activity, as well as any required medication.
In recent years, type 2 diabetes has attracted some fairly bad press – with its known links to obesity and more sedentary lifestyles prompting many to label it as a preventable or man-made disease, with some experts suggesting it should even be renamed ‘Walking Deficiency Syndrome’.

“This is vastly over-simplifying the disease,” insists Dr Clarke. “While being obese and inactive is certainly known to exacerbate the risk and severity of type 2, the fact is that anyone with a genetic predisposition to diabetes can develop the condition – even those with an ideal BMI and fitness levels.”

Recognising the symptoms

While the symptoms can be hard to spot, things to look out for include:

  • Tiredness
  • Thirst
  • Weight loss
  • Frequent urination

 

Prevention and treatment

The good news about type 2 diabetes is that, for the most part, it responds well to diet and lifestyle changes, so if you’re beginning to display some of the signs of the disease – or have been given an official diagnosis, there’s still a lot you can do.

“If it is caught in its early stages, type 2 can be managed far more effectively,” Dr Clarke continues, “with the need for medication much reduced. In some cases, it may even be reversible. Unfortunately, we are seeing an increasing trend towards insulin dependence – when taking action in the early stages could have helped avoid this.”

Some of these key measures include:

  • Reducing your carbohydrate intake to control blood glucose levels
  • Examining your diet as a whole
  • Getting more exercise
  • If applicable, aiming for a normal bodyweight

In the UAE, metabolic surgery is also being considered as an option, with specialists from King’s College Hospital, London, reportedly interested in extending their research to Emirati patients.

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Cancer care for expats living abroad

A cancer diagnosis can come at any stage in life and if you’re living abroad you’ll want to know what help is available

Getting a cancer diagnosis is a scary experience, and can be more so when you’re not living in your home country. No two health systems are the same and working out what you need and where you can get it can be complicated.

As well as seeking out the standard medical cancer treatments, there are other services you may want to find, and having a good expat health insurance plan can make your journey a lot easier. Here are some of the main points to consider:

Genome testing

A major medical advance in cancer care has come from the study of genomics in recent years, which is the gathering and examination of genetic information from cancerous cells. This helps medical professionals diagnose the type of cancer affecting a patient and potentially opens up different treatment approaches.

Doctors now know there’s no one-size-fits-all formula for cancer treatment, and each case requires a tailored approach. Genome testing of the cancer cells after diagnosis can help medics create a more tailored treatment plan for each patient, with the aim of being able to provide the most effective treatment and best prognosis. So, make sure you talk to your doctor or consultant to find out more.

Emotional support

Facebook can be a useful tool when you’re living abroad. Whether you’re in Thailand, the UAE, Hong Kong or anywhere else in the world, there’ll be dozens of expatriate groups active on Facebook, including ones created specifically to connect people living with cancer to share tips, advice and local support.

Searching on Facebook for groups that are relevant to your circumstances can include Cancer Connect in Hong Kong, a Facebook Bangkok Breast Cancer group, and the general Expat Focus UAE group.

Most hospitals with oncology departments have internal cancer support groups, so make sure you ask your doctor for recommendations. In Thailand, for example, there’s the Bangkok Breast Cancer Support Group, run by expatriate volunteers, at the Queen Sirikit Center for Breast Cancer, Chulalongkorn Hospital.

Professional counselling with a registered psychologist or counsellor following the cancer treatment can also help provide you with essential practical and emotional tools to cope with the experience.

Senior couple holding hands in nature

Getting a tailored diet plan

Unsurprisingly, what you consume during your cancer treatment is very important. The American Cancer Society advises: “you might need to change your diet to help build up your strength and withstand the effects of the cancer and its treatment.”

Consultations with a dietician mean you can have a diet plan tailored specifically for you and your type of cancer and treatment, boosting your wellbeing.

Hair loss and wigs

Some chemotherapy causes hair loss and it’s comforting for some cancer patients to purchase wigs during treatment or after it ends. Cancer Research UK recommends researching your ideal wig before you start treatment so it can be matched to your natural hair colour and texture.

Reconstructive and restorative surgery

Depending on the type of cancer, you maybe eligible for reconstructive surgery. For example, reconstructive surgery may be required after a mastectomy during breast cancer treatment, or to replace tissue removed in treatment for skin cancer.

Support and cover

While a cancer diagnosis can be a scary experience, survival rates are higher and more improved cancer treatments are being brought out each year. For peace of mind, make sure your global health insurance plan will cover your treatment for a cancer diagnosis while living overseas, and provides the reassurance of a strong support network at home and work so you have the support you need at a challenging time.

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Diabetes: Healthy eating tips for expats living abroad

As the number of people affected by diabetes globally is set to rise by 227 million over the next 20 years, find out how you can stay healthy by reading these tips.

According to the International Diabetes Federation (IDF) Atlas, the number of people with diabetes is on the rise. In the Middle East and North Africa, 35.4 million adults aged 20-79 are diabetic and this number is expected to double by 2040.

In Southeast Asia 78.3 million adults are affected by diabetes, which is over twice as many as in the Middle East and North Africa, and is set to rise by 79% by 2040.

It is important to remember that there are two types of diabetes, type 1 and type 2. Type 1 diabetes is autoimmune condition – where the body destroys cells creating insulin – and is not caused by lifestyle, but lifestyle choices can affect it. Type 2 diabetes usually develops later in life, with lifestyle factors – particularly diet – playing a large part in its development and how it is managed.

While genetics does have an impact, expats often face additional health challenges of living and working in a country where cultural differences make it harder to source a diet that can help control both types of diabetes and avoid the onset of type 2 diabetes.

Access to a better standard of living where you may find it easier to eat out, and being at times too busy to exercise, can exacerbate these challenges.

Solve the diet puzzle

In terms of diet, consuming less alcohol, eating more balanced meals at home, and avoiding late-night eating can all control the possibility of putting on weight, which is one of the main risk factors for developing type 2 diabetes.

Zeina Soueidan, a clinical dietician at The Right Bite Nutrition Centre based in Dubai, says it’s important for expats to look for ways to reduce their intake of processed foods that have a high sugar and fat content, particularly desserts and sugary drinks, if they want to minimise their risk of type 2 diabetes.

Couple shopping in outdoor market, Bangkok, Bangkok, Thailand
“Couple shopping in outdoor market, Bangkok, Bangkok, Thailand”

Zeina’s advice is to reduce the temptation for snacking on high fat and sugary foods by learning to control portion sizes and eat to satisfaction, not fullness.

“Eat smaller meals at intervals of no more than 3-4 hours and aim for more fruits and vegetables, plus high-fibre products such as beans and grains,” she says.

Did you know?

In a 330-350ml portion:

Coca Cola contains approximately 40 grams of sugar (10 teaspoons)

Apple juice contains approximately 39 grams of sugar (9.8 teaspoons)

Coconut water contains approximately 15 grams of sugar (3 teaspoons)

Heathline.com & BBC Good Food

A more consistent approach to eating teaches your body to avoid sugar cravings which, when supplemented with regular exercise, can help shed any excess weight.

Zeina suggests even a minimum of 2.5 hours a week exercise can make a difference, along with getting enough sleep and rest to balance hormones.

One way of staying informed about what you are eating is using the glycaemic index (GI). This is a scale that ranks food from 1 to 100 to tell you how slowly or quickly they will increase your blood glucose levels. You should try to avoid food with high GI numbers and replace them with food with low GI numbers, which are better for you.

A separate measure, glycaemic load, tells you both how quickly glucose will be absorbed and how much glucose is in a certain food, per serving.

Cultural differences can make it tougher for expats to structure their diet to tackle diabetes. For example, if you are moving to China then it may be tough to avoid white rice, given it is a staple of many dishes. But it is widely regarded as key to the country’s diabetes epidemic. Replacing white rice with brown rice reduces the risk of diabetes by 16%, according to a Harvard study, as brown rice has a lower glycaemic index and glycaemic load.

Did you know?

White rice glycaemic index = 72

Brown rice glycaemic index = 50

Harvard Health Publishing, Harvard Medical School

Health complications from diabetes

It’s important to realise that long-term complications associated with diabetes can include heart problems, strokes, kidney failure, eyesight issues and loss of limbs. So make sure you take care of your eating habits, exercise regularly and it should go a long way to help avoid the onset of type 2 diabetes and other health complications in the future, wherever you are in the world.

Thailand, Ratchaburi province, Damnoen Saduak, floating market
Thailand, Ratchaburi province, Damnoen Saduak, flotting market

Are you covered?

Knowing you have global health insurance that suits your circumstances and gives you access to the best possible care overseas can give you peace of mind. But it’s essential to check cover limits carefully, as not all global health insurance plans offer the same benefits, particularly for pre-existing conditions.

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What affects the cost of health insurance?

For those without inside knowledge of the actuary industry, health insurance premiums can seem something of a minefield.

But the calculations behind them can just depend on a few key factors, the rate of claims being one of the most important.

The insurance premiums need to be high enough to cover the cost of claims. This doesn’t mean your own insurance premium needs to cover the exact cost of your own claims, it means the total cost of those premiums need to cover the total cost of claims by people with those premiums.

If the cost of healthcare increases year on year, and the number of people making claims increases, this will push up the cost of health insurance.

Net effect of hospital visits cost and frequency:

2016 1 hospital visit at US$50 = US$50

2017 2 hospital visits at US$55 = US$110

So even though the healthcare cost hasn’t increased significantly, the increased number of visits pushed the total cost up by 120%. Insurance companies need to take these increases into account, however small they might appear to the individual.

Claim trends

In recent years, countries such as Hong Kong and Dubai have seen increases in their populations, alongside significant investment in their health infrastructure. There’s a wider range of treatments available, as well as a more expensive range of treatments.

Statistics have shown that medical trend – the term used to describe the change in claims cost per insured person – is rising, pushing up the insurance premiums that need to cover these costs.

According to risk management consultancy Aon Hewitt’s 2016 Global Medical Trend Report, the gross global medical trend rate was 8.7% in 2015, and 9.1% in 2016. This demonstrates the increase in claim costs around the world.

 

Factors that affect the cost of health insurance

 

Cost of healthcare

Number of insurance claims

Fraudulent claims

Regulations and taxes

Chronic diseases

Ageing population

Cost factors

As well as the increasing cost of healthcare and greater number of claims, there are a number of other factors that influence insurance premiums: fraud, regulation and taxes, ageing populations and chronic diseases.

Fraudulent claims give a false impression to insurance companies of the rate of claims, contributing to a misleading – and ultimately more costly – medical trend prediction.

Changing regulations and taxes also affects medical insurance companies. New rules (such as mandatory coverage of chronic conditions in Dubai) can make it much more costly to insure people in a particular country or region because the claim costs are likely to be much, much higher.

 

Countries with the highest health insurance costs in 2016

(shows average cost)

 

Impact of chronic conditions

The International Diabetes Federation estimates that the cost of treating someone with diabetes is up to four times the cost of treating a healthy person. If an insurance company must shoulder this cost and a significant portion of the population has diabetes, it increases premium costs for everyone.

There has been a significant increase in these type of illnesses, and this has a corresponding impact on the cost of healthcare.

You will also pay more for your insurance premium as you get older and your healthcare needs increase. The older an individual is, the more likely they are to suffer from certain conditions – such as cancer, cardiovascular disease and respiratory problems – that are expensive to treat.

The premium is calculated in age brackets for example: 25 to 30 years, 30 to 35 years etcetera. So the premium will therefore increase each year to reflect health cost inflation and, when the member’s age reaches the next age band, it will go up to reflect the additional risk of age.

Sources:

Pacific Prime – Cost of International Health Insurance Report – 2016 – https://www.pacificprime.com/cohi-2016/

Aon Hewitt – 2016 Global Medical Trend Report – www.aon.com

International Diabetes Federation – www.idf.org

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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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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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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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Health tips for Ramadan

Preparation is the key to maintaining a healthy mind and body during the Muslim fast

Ramadan is one of the most important events for Muslims everywhere, occurring in the ninth month of the Islamic calendar.

Being held from May 26 to June 24 this year, this traditional time of reflection is observed by a strict fast from dawn until dusk.

According to Dr Javid Ahmed Shah, Physician and Medical Director at the Lotus Group Of Medical Centres based in Dubai, dehydration is one of the most serious problems that can occur during this period – especially in Dubai and other parts of the Middle East, thanks to the hot and humid conditions that characterise the region.

While young children, the elderly, pregnant (and menstruating) women and those suffering from illness are not required to fast during Ramadan, Dr Shah reveals that many of his patients still choose to do so.

This can be particularly problematic for insulin-dependent diabetics, who must fine-tune their dosage during this period.

Preparing the body for fast

Good planning is the key to a healthy fast, says Dr Shah. He advises his patients to gradually reduce their intake of caffeine-based drinks such as cola, coffee or tea around three to five days before Ramadan is due to begin.

“A sudden decrease in caffeine prompts headaches, mood swings and irritability,” he says, ”while smoking also negatively affects the body’s utilisation of various vitamins, metabolites and enzyme systems.

“So if my patients are unable to quit entirely, I recommend they begin reducing their number of cigarettes a few weeks before the fast.”

An overhead bowl of dates on a rough wooden background

Eating right

Sahur (dawn break of fast) is important for all, according to Dr Shah, as it provides the body with the necessary food and energy for the day and helps individuals endure long periods of fasting.

As a rule, delaying the Sahur is better than taking it early, Dr Shah advises, as it diminishes the feeling of hunger or thirst.

At Iftar (the dusk break of fast), the body’s immediate need is for an easily available energy source in the form of glucose for every living cell, particularly the brain and nerves.

“Dates and juices are good sources of energy,” says Dr Shah. “Dates represent an excellent source of sugar, fibre, carbohydrates, potassium and magnesium. In general, three dates and a four-fluid ounce glass of juice would be sufficient to bring low blood glucose levels to normal.”

In order to best benefit the body, both the Sahur and Iftar meals should be balanced – with any high-fat/sugar foods best avoided.

 

While any reports of headaches and other symptoms must be carefully assessed, Dr Shah says that such issues tend to subside in healthy people once they have grown accustomed to the fasting pattern – with the body beginning to thrive.

 

Key tips for healthy eating:

  • Drink lots of water and fluids after the Sahur
  • Get enough sleep to avoid dehydration
  • Balance Sahur with different nutrients – preferably low-calorie, easily digestible and low-fat foods
  • Ensure meals are thoroughly cooked to aid digestion
  • Eat green salad for essential vitamins, minerals and salts, and fibre to avoid constipation
  • Ensure the Sahur meal contains fluids and dairy products such as yoghurt and cheese, as well as fruit
  • Avoid sugary foods
  • Make sure your Iftar includes complex carbohydrates and other slow-digesting foods – such as barley, wheat, oats, semolina, beans, lentils and wholemeal flour
  • Avoid spicy foods and caffeine-based drinks

 

Positive effects

“Many studies have shown that fasting helps improve blood pressure, cholesterol levels and insulin sensitivity – as well as weight loss,” he says.

Detoxification is another important benefit of fasting, with the body transitioning into self-cleansing mode. “This occurs because the energy normally used in digestion can get to work elsewhere,” Dr Shah explains, “removing built-up toxins, healing old wounds and building new cells.”

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What questions should I ask my surgeon?

Asking the right questions can not only bring peace of mind, but help ensure the surgery goes smoothly

Surgery can be a daunting prospect for anybody, even if it is for something minor. And for an expat working overseas, it opens up an extra layer of complications.

However, being prepared and asking the right questions will boost your peace of mind, while also helping the surgical team in the process.

“This is such a vital issue,” says Dr Jace Clarke of William Russell. “People often have surgery without really being aware of the risks involved.”

Here are some questions you can ask your surgeon.

Why am I having surgery?

This is pertinent for expats who may not be able to visit their regular doctor, who knows them well.

“The first thing is diagnosis,” says Dr Clarke. “Why am I having surgery? Do I need it? Then if I do need it, in the surgeon’s experience, where is the best medical facility to have it done?”

Is the surgery proposed definitely necessary?

“What are the risks of not having surgery? This is important, because maybe nothing significant will happen,” says Dr Clarke.

Although surgeons will only recommend a procedure that they feel will be of benefit to you, it may be the case that you feel a second opinion might be helpful in making your final decision.

You should also try to find out how long the benefits of surgery will last for, or if you will need any further treatment. If the benefits are only going to last a couple of years, talk to your surgeon to understand if the surgery is actually worth having.

Expats have many of their own considerations. Living in another location around the world could mean you are very close to another country with a great reputation for the surgery you need.

Getting to know the surgery team

When you have decided to have the surgery, knowing that the team contains the right people with the appropriate qualifications is vital to your peace of mind.

Find out the reputation of the hospital for this particular type of surgery. One can research the surgical team’s success and complication rates. These may all be good indicators to how your surgery will go.

“Ask the surgeon about their experience in carrying out the recommended procedure,” says Dr Clarke. “What technique are they going to use? Is that their preferred technique? At what point, if at all, will other, more junior doctors be involved?”

It’s vital to know the anaesthetist as well. They play a key role in the operation and ensuring the safety of patients. Will the procedure be carried out under local or general anaesthetic?

Expats have many of their own considerations. Living in another location around the world could mean you are very close to another country with a great reputation for the surgery you need.

“Obviously the quality of the hospital is vital,” says Dr Clarke. “If you need to go to a hospital in a neighbouring country, who pays for the travel and post-operative accommodation? Is it worth travelling long distances and perhaps being away from your family and social support systems?”

How can I help make the surgery go well?

Your surgeon will be able to advise on some steps you could take to make yourself more prepared for the effects of surgery. Stopping smoking, losing weight, doing more exercise – all of these things may help get you into the right shape physically.

“You also need to prepare yourself psychologically,” says Dr Clarke. “If you’re having major cardiac surgery, for example, then it can be very mentally demanding for both you and your family.”

Life after surgery

The effects on your life afterwards can vary, both physically and socially, so never feel apprehensive about asking too many questions.

For example, how long will you have to stay in hospital afterwards, how long will you be off work, or how long will your movement be impaired? Also, will you need assistance, such as a wheelchair or walking stick, or rehabilitation?

The surgeon should be able to advise on what activities you can or can’t do afterwards, and for how long. These questions could include driving, flying, eating, exercise, or sexual intercourse.

And for career-driven expats, there are questions to be asked about the impact on your ability to work. If you travel somewhere, when will you be able to fly afterwards? This could create complications in getting home. How will this affect your employment?

“You need to have the complete picture before deciding on surgery,” says Dr Clarke.

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Tackling type 2 diabetes in Dubai

Rising numbers of sufferers in the UAE are highlighting the risks for all.

For people living in Dubai, the growing trend towards wellness couldn’t have come at a better time, as figures show that areas within the United Arab Emirates are experiencing a marked increase in the numbers of type 2 diabetics.

According to the International Diabetes Federation Atlas, 19.3% of adults aged 20 to 79 in the UAE are diabetic, with the rate of diabetes in parts of the Arabian Peninsula over twice the global average. Cases of type 2 diabetes now outnumber type 1 by a ratio of 10:1 in the region.

While there’s little doubt that the two main triggers of type 2 – obesity and more sedentary lifestyles – are playing their part, recent research also suggests that the Arab population could actually be more susceptible on a genetic level.

Conducted by Manipal University in Dubai and Khalifa University in Abu Dhabi, the joint study reportedly made links between the disease and genes that cause obesity and high blood pressure in 500 Emiratis.

Glucose sticks are a quick and inexpensive method of monitoring your sugar levels via urine – and can be done at home. If type 2 diabetes is known to be in the family, Dr Clarke recommends having a urine test for sugar on an annual basis.

“We’ve known for some years that one’s genetic profile can be a factor causing type 2 Diabetes,” says Dr Jace Clarke, Chief Medical Officer at William Russell. “I would caution any expats in Dubai and across the UAE against viewing this merely as a problem for the local population. Instead, they should be treating this as an opportunity to discover what they can do to reduce their own risk of contracting a condition that is having a big impact on people the world over.”

Diabetes is a serious disease that in the worst cases can lead to cardiovascular problems, renal failure, blindness and even amputations. Learning how to monitor and manage your glucose levels is a critical part of staying healthy.

donughts

Understanding the condition

There are two types of diabetes:

Type 1 (insulin dependent) – Stemming from childhood in most cases, but typically before the age of 40, it occurs when the body is unable to produce a hormone known as insulin. Sufferers are required to take a daily dose of insulin to avoid a build up of glucose in the blood.

Type 2 (non-insulin dependent) – The most common form of diabetes, type 2 now accounts for between 85 and 95% of all diagnoses. It is typically associated with the over-40s, but is affecting growing numbers of younger people – including children. Type 2 occurs when the body becomes unable to produce enough insulin or is unable to use it properly (insulin resistance). It is treated with a healthy diet and increased physical activity, as well as any required medication.
In recent years, type 2 diabetes has attracted some fairly bad press – with its known links to obesity and more sedentary lifestyles prompting many to label it as a preventable or man-made disease, with some experts suggesting it should even be renamed ‘Walking Deficiency Syndrome’.

“This is vastly over-simplifying the disease,” insists Dr Clarke. “While being obese and inactive is certainly known to exacerbate the risk and severity of type 2, the fact is that anyone with a genetic predisposition to diabetes can develop the condition – even those with an ideal BMI and fitness levels.”

Recognising the symptoms

While the symptoms can be hard to spot, things to look out for include:

  • Tiredness
  • Thirst
  • Weight loss
  • Frequent urination

 

Prevention and treatment

The good news about type 2 diabetes is that, for the most part, it responds well to diet and lifestyle changes, so if you’re beginning to display some of the signs of the disease – or have been given an official diagnosis, there’s still a lot you can do.

“If it is caught in its early stages, type 2 can be managed far more effectively,” Dr Clarke continues, “with the need for medication much reduced. In some cases, it may even be reversible. Unfortunately, we are seeing an increasing trend towards insulin dependence – when taking action in the early stages could have helped avoid this.”

Some of these key measures include:

  • Reducing your carbohydrate intake to control blood glucose levels
  • Examining your diet as a whole
  • Getting more exercise
  • If applicable, aiming for a normal bodyweight

In the UAE, metabolic surgery is also being considered as an option, with specialists from King’s College Hospital, London, reportedly interested in extending their research to Emirati patients.

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Cancer care for expats living abroad

A cancer diagnosis can come at any stage in life and if you’re living abroad you’ll want to know what help is available

Getting a cancer diagnosis is a scary experience, and can be more so when you’re not living in your home country. No two health systems are the same and working out what you need and where you can get it can be complicated.

As well as seeking out the standard medical cancer treatments, there are other services you may want to find, and having a good expat health insurance plan can make your journey a lot easier. Here are some of the main points to consider:

Genome testing

A major medical advance in cancer care has come from the study of genomics in recent years, which is the gathering and examination of genetic information from cancerous cells. This helps medical professionals diagnose the type of cancer affecting a patient and potentially opens up different treatment approaches.

Doctors now know there’s no one-size-fits-all formula for cancer treatment, and each case requires a tailored approach. Genome testing of the cancer cells after diagnosis can help medics create a more tailored treatment plan for each patient, with the aim of being able to provide the most effective treatment and best prognosis. So, make sure you talk to your doctor or consultant to find out more.

Emotional support

Facebook can be a useful tool when you’re living abroad. Whether you’re in Thailand, the UAE, Hong Kong or anywhere else in the world, there’ll be dozens of expatriate groups active on Facebook, including ones created specifically to connect people living with cancer to share tips, advice and local support.

Searching on Facebook for groups that are relevant to your circumstances can include Cancer Connect in Hong Kong, a Facebook Bangkok Breast Cancer group, and the general Expat Focus UAE group.

Most hospitals with oncology departments have internal cancer support groups, so make sure you ask your doctor for recommendations. In Thailand, for example, there’s the Bangkok Breast Cancer Support Group, run by expatriate volunteers, at the Queen Sirikit Center for Breast Cancer, Chulalongkorn Hospital.

Professional counselling with a registered psychologist or counsellor following the cancer treatment can also help provide you with essential practical and emotional tools to cope with the experience.

Senior couple holding hands in nature

Getting a tailored diet plan

Unsurprisingly, what you consume during your cancer treatment is very important. The American Cancer Society advises: “you might need to change your diet to help build up your strength and withstand the effects of the cancer and its treatment.”

Consultations with a dietician mean you can have a diet plan tailored specifically for you and your type of cancer and treatment, boosting your wellbeing.

Hair loss and wigs

Some chemotherapy causes hair loss and it’s comforting for some cancer patients to purchase wigs during treatment or after it ends. Cancer Research UK recommends researching your ideal wig before you start treatment so it can be matched to your natural hair colour and texture.

Reconstructive and restorative surgery

Depending on the type of cancer, you maybe eligible for reconstructive surgery. For example, reconstructive surgery may be required after a mastectomy during breast cancer treatment, or to replace tissue removed in treatment for skin cancer.

Support and cover

While a cancer diagnosis can be a scary experience, survival rates are higher and more improved cancer treatments are being brought out each year. For peace of mind, make sure your global health insurance plan will cover your treatment for a cancer diagnosis while living overseas, and provides the reassurance of a strong support network at home and work so you have the support you need at a challenging time.

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Diabetes: Healthy eating tips for expats living abroad

As the number of people affected by diabetes globally is set to rise by 227 million over the next 20 years, find out how you can stay healthy by reading these tips.

According to the International Diabetes Federation (IDF) Atlas, the number of people with diabetes is on the rise. In the Middle East and North Africa, 35.4 million adults aged 20-79 are diabetic and this number is expected to double by 2040.

In Southeast Asia 78.3 million adults are affected by diabetes, which is over twice as many as in the Middle East and North Africa, and is set to rise by 79% by 2040.

It is important to remember that there are two types of diabetes, type 1 and type 2. Type 1 diabetes is autoimmune condition – where the body destroys cells creating insulin – and is not caused by lifestyle, but lifestyle choices can affect it. Type 2 diabetes usually develops later in life, with lifestyle factors – particularly diet – playing a large part in its development and how it is managed.

While genetics does have an impact, expats often face additional health challenges of living and working in a country where cultural differences make it harder to source a diet that can help control both types of diabetes and avoid the onset of type 2 diabetes.

Access to a better standard of living where you may find it easier to eat out, and being at times too busy to exercise, can exacerbate these challenges.

Solve the diet puzzle

In terms of diet, consuming less alcohol, eating more balanced meals at home, and avoiding late-night eating can all control the possibility of putting on weight, which is one of the main risk factors for developing type 2 diabetes.

Zeina Soueidan, a clinical dietician at The Right Bite Nutrition Centre based in Dubai, says it’s important for expats to look for ways to reduce their intake of processed foods that have a high sugar and fat content, particularly desserts and sugary drinks, if they want to minimise their risk of type 2 diabetes.

Couple shopping in outdoor market, Bangkok, Bangkok, Thailand
“Couple shopping in outdoor market, Bangkok, Bangkok, Thailand”

Zeina’s advice is to reduce the temptation for snacking on high fat and sugary foods by learning to control portion sizes and eat to satisfaction, not fullness.

“Eat smaller meals at intervals of no more than 3-4 hours and aim for more fruits and vegetables, plus high-fibre products such as beans and grains,” she says.

Did you know?

In a 330-350ml portion:

Coca Cola contains approximately 40 grams of sugar (10 teaspoons)

Apple juice contains approximately 39 grams of sugar (9.8 teaspoons)

Coconut water contains approximately 15 grams of sugar (3 teaspoons)

Heathline.com & BBC Good Food

A more consistent approach to eating teaches your body to avoid sugar cravings which, when supplemented with regular exercise, can help shed any excess weight.

Zeina suggests even a minimum of 2.5 hours a week exercise can make a difference, along with getting enough sleep and rest to balance hormones.

One way of staying informed about what you are eating is using the glycaemic index (GI). This is a scale that ranks food from 1 to 100 to tell you how slowly or quickly they will increase your blood glucose levels. You should try to avoid food with high GI numbers and replace them with food with low GI numbers, which are better for you.

A separate measure, glycaemic load, tells you both how quickly glucose will be absorbed and how much glucose is in a certain food, per serving.

Cultural differences can make it tougher for expats to structure their diet to tackle diabetes. For example, if you are moving to China then it may be tough to avoid white rice, given it is a staple of many dishes. But it is widely regarded as key to the country’s diabetes epidemic. Replacing white rice with brown rice reduces the risk of diabetes by 16%, according to a Harvard study, as brown rice has a lower glycaemic index and glycaemic load.

Did you know?

White rice glycaemic index = 72

Brown rice glycaemic index = 50

Harvard Health Publishing, Harvard Medical School

Health complications from diabetes

It’s important to realise that long-term complications associated with diabetes can include heart problems, strokes, kidney failure, eyesight issues and loss of limbs. So make sure you take care of your eating habits, exercise regularly and it should go a long way to help avoid the onset of type 2 diabetes and other health complications in the future, wherever you are in the world.

Thailand, Ratchaburi province, Damnoen Saduak, floating market
Thailand, Ratchaburi province, Damnoen Saduak, flotting market

Are you covered?

Knowing you have global health insurance that suits your circumstances and gives you access to the best possible care overseas can give you peace of mind. But it’s essential to check cover limits carefully, as not all global health insurance plans offer the same benefits, particularly for pre-existing conditions.

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What affects the cost of health insurance?

For those without inside knowledge of the actuary industry, health insurance premiums can seem something of a minefield.

But the calculations behind them can just depend on a few key factors, the rate of claims being one of the most important.

The insurance premiums need to be high enough to cover the cost of claims. This doesn’t mean your own insurance premium needs to cover the exact cost of your own claims, it means the total cost of those premiums need to cover the total cost of claims by people with those premiums.

If the cost of healthcare increases year on year, and the number of people making claims increases, this will push up the cost of health insurance.

Net effect of hospital visits cost and frequency:

2016 1 hospital visit at US$50 = US$50

2017 2 hospital visits at US$55 = US$110

So even though the healthcare cost hasn’t increased significantly, the increased number of visits pushed the total cost up by 120%. Insurance companies need to take these increases into account, however small they might appear to the individual.

Claim trends

In recent years, countries such as Hong Kong and Dubai have seen increases in their populations, alongside significant investment in their health infrastructure. There’s a wider range of treatments available, as well as a more expensive range of treatments.

Statistics have shown that medical trend – the term used to describe the change in claims cost per insured person – is rising, pushing up the insurance premiums that need to cover these costs.

According to risk management consultancy Aon Hewitt’s 2016 Global Medical Trend Report, the gross global medical trend rate was 8.7% in 2015, and 9.1% in 2016. This demonstrates the increase in claim costs around the world.

 

Factors that affect the cost of health insurance

 

Cost of healthcare

Number of insurance claims

Fraudulent claims

Regulations and taxes

Chronic diseases

Ageing population

Cost factors

As well as the increasing cost of healthcare and greater number of claims, there are a number of other factors that influence insurance premiums: fraud, regulation and taxes, ageing populations and chronic diseases.

Fraudulent claims give a false impression to insurance companies of the rate of claims, contributing to a misleading – and ultimately more costly – medical trend prediction.

Changing regulations and taxes also affects medical insurance companies. New rules (such as mandatory coverage of chronic conditions in Dubai) can make it much more costly to insure people in a particular country or region because the claim costs are likely to be much, much higher.

 

Countries with the highest health insurance costs in 2016

(shows average cost)

 

Impact of chronic conditions

The International Diabetes Federation estimates that the cost of treating someone with diabetes is up to four times the cost of treating a healthy person. If an insurance company must shoulder this cost and a significant portion of the population has diabetes, it increases premium costs for everyone.

There has been a significant increase in these type of illnesses, and this has a corresponding impact on the cost of healthcare.

You will also pay more for your insurance premium as you get older and your healthcare needs increase. The older an individual is, the more likely they are to suffer from certain conditions – such as cancer, cardiovascular disease and respiratory problems – that are expensive to treat.

The premium is calculated in age brackets for example: 25 to 30 years, 30 to 35 years etcetera. So the premium will therefore increase each year to reflect health cost inflation and, when the member’s age reaches the next age band, it will go up to reflect the additional risk of age.

Sources:

Pacific Prime – Cost of International Health Insurance Report – 2016 – https://www.pacificprime.com/cohi-2016/

Aon Hewitt – 2016 Global Medical Trend Report – www.aon.com

International Diabetes Federation – www.idf.org

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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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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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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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Health tips for Ramadan

Preparation is the key to maintaining a healthy mind and body during the Muslim fast

Ramadan is one of the most important events for Muslims everywhere, occurring in the ninth month of the Islamic calendar.

Being held from May 26 to June 24 this year, this traditional time of reflection is observed by a strict fast from dawn until dusk.

According to Dr Javid Ahmed Shah, Physician and Medical Director at the Lotus Group Of Medical Centres based in Dubai, dehydration is one of the most serious problems that can occur during this period – especially in Dubai and other parts of the Middle East, thanks to the hot and humid conditions that characterise the region.

While young children, the elderly, pregnant (and menstruating) women and those suffering from illness are not required to fast during Ramadan, Dr Shah reveals that many of his patients still choose to do so.

This can be particularly problematic for insulin-dependent diabetics, who must fine-tune their dosage during this period.

Preparing the body for fast

Good planning is the key to a healthy fast, says Dr Shah. He advises his patients to gradually reduce their intake of caffeine-based drinks such as cola, coffee or tea around three to five days before Ramadan is due to begin.

“A sudden decrease in caffeine prompts headaches, mood swings and irritability,” he says, ”while smoking also negatively affects the body’s utilisation of various vitamins, metabolites and enzyme systems.

“So if my patients are unable to quit entirely, I recommend they begin reducing their number of cigarettes a few weeks before the fast.”

An overhead bowl of dates on a rough wooden background

Eating right

Sahur (dawn break of fast) is important for all, according to Dr Shah, as it provides the body with the necessary food and energy for the day and helps individuals endure long periods of fasting.

As a rule, delaying the Sahur is better than taking it early, Dr Shah advises, as it diminishes the feeling of hunger or thirst.

At Iftar (the dusk break of fast), the body’s immediate need is for an easily available energy source in the form of glucose for every living cell, particularly the brain and nerves.

“Dates and juices are good sources of energy,” says Dr Shah. “Dates represent an excellent source of sugar, fibre, carbohydrates, potassium and magnesium. In general, three dates and a four-fluid ounce glass of juice would be sufficient to bring low blood glucose levels to normal.”

In order to best benefit the body, both the Sahur and Iftar meals should be balanced – with any high-fat/sugar foods best avoided.

 

While any reports of headaches and other symptoms must be carefully assessed, Dr Shah says that such issues tend to subside in healthy people once they have grown accustomed to the fasting pattern – with the body beginning to thrive.

 

Key tips for healthy eating:

  • Drink lots of water and fluids after the Sahur
  • Get enough sleep to avoid dehydration
  • Balance Sahur with different nutrients – preferably low-calorie, easily digestible and low-fat foods
  • Ensure meals are thoroughly cooked to aid digestion
  • Eat green salad for essential vitamins, minerals and salts, and fibre to avoid constipation
  • Ensure the Sahur meal contains fluids and dairy products such as yoghurt and cheese, as well as fruit
  • Avoid sugary foods
  • Make sure your Iftar includes complex carbohydrates and other slow-digesting foods – such as barley, wheat, oats, semolina, beans, lentils and wholemeal flour
  • Avoid spicy foods and caffeine-based drinks

 

Positive effects

“Many studies have shown that fasting helps improve blood pressure, cholesterol levels and insulin sensitivity – as well as weight loss,” he says.

Detoxification is another important benefit of fasting, with the body transitioning into self-cleansing mode. “This occurs because the energy normally used in digestion can get to work elsewhere,” Dr Shah explains, “removing built-up toxins, healing old wounds and building new cells.”

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What questions should I ask my surgeon?

Asking the right questions can not only bring peace of mind, but help ensure the surgery goes smoothly

Surgery can be a daunting prospect for anybody, even if it is for something minor. And for an expat working overseas, it opens up an extra layer of complications.

However, being prepared and asking the right questions will boost your peace of mind, while also helping the surgical team in the process.

“This is such a vital issue,” says Dr Jace Clarke of William Russell. “People often have surgery without really being aware of the risks involved.”

Here are some questions you can ask your surgeon.

Why am I having surgery?

This is pertinent for expats who may not be able to visit their regular doctor, who knows them well.

“The first thing is diagnosis,” says Dr Clarke. “Why am I having surgery? Do I need it? Then if I do need it, in the surgeon’s experience, where is the best medical facility to have it done?”

Is the surgery proposed definitely necessary?

“What are the risks of not having surgery? This is important, because maybe nothing significant will happen,” says Dr Clarke.

Although surgeons will only recommend a procedure that they feel will be of benefit to you, it may be the case that you feel a second opinion might be helpful in making your final decision.

You should also try to find out how long the benefits of surgery will last for, or if you will need any further treatment. If the benefits are only going to last a couple of years, talk to your surgeon to understand if the surgery is actually worth having.

Expats have many of their own considerations. Living in another location around the world could mean you are very close to another country with a great reputation for the surgery you need.

Getting to know the surgery team

When you have decided to have the surgery, knowing that the team contains the right people with the appropriate qualifications is vital to your peace of mind.

Find out the reputation of the hospital for this particular type of surgery. One can research the surgical team’s success and complication rates. These may all be good indicators to how your surgery will go.

“Ask the surgeon about their experience in carrying out the recommended procedure,” says Dr Clarke. “What technique are they going to use? Is that their preferred technique? At what point, if at all, will other, more junior doctors be involved?”

It’s vital to know the anaesthetist as well. They play a key role in the operation and ensuring the safety of patients. Will the procedure be carried out under local or general anaesthetic?

Expats have many of their own considerations. Living in another location around the world could mean you are very close to another country with a great reputation for the surgery you need.

“Obviously the quality of the hospital is vital,” says Dr Clarke. “If you need to go to a hospital in a neighbouring country, who pays for the travel and post-operative accommodation? Is it worth travelling long distances and perhaps being away from your family and social support systems?”

How can I help make the surgery go well?

Your surgeon will be able to advise on some steps you could take to make yourself more prepared for the effects of surgery. Stopping smoking, losing weight, doing more exercise – all of these things may help get you into the right shape physically.

“You also need to prepare yourself psychologically,” says Dr Clarke. “If you’re having major cardiac surgery, for example, then it can be very mentally demanding for both you and your family.”

Life after surgery

The effects on your life afterwards can vary, both physically and socially, so never feel apprehensive about asking too many questions.

For example, how long will you have to stay in hospital afterwards, how long will you be off work, or how long will your movement be impaired? Also, will you need assistance, such as a wheelchair or walking stick, or rehabilitation?

The surgeon should be able to advise on what activities you can or can’t do afterwards, and for how long. These questions could include driving, flying, eating, exercise, or sexual intercourse.

And for career-driven expats, there are questions to be asked about the impact on your ability to work. If you travel somewhere, when will you be able to fly afterwards? This could create complications in getting home. How will this affect your employment?

“You need to have the complete picture before deciding on surgery,” says Dr Clarke.

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Tackling type 2 diabetes in Dubai

Rising numbers of sufferers in the UAE are highlighting the risks for all.

For people living in Dubai, the growing trend towards wellness couldn’t have come at a better time, as figures show that areas within the United Arab Emirates are experiencing a marked increase in the numbers of type 2 diabetics.

According to the International Diabetes Federation Atlas, 19.3% of adults aged 20 to 79 in the UAE are diabetic, with the rate of diabetes in parts of the Arabian Peninsula over twice the global average. Cases of type 2 diabetes now outnumber type 1 by a ratio of 10:1 in the region.

While there’s little doubt that the two main triggers of type 2 – obesity and more sedentary lifestyles – are playing their part, recent research also suggests that the Arab population could actually be more susceptible on a genetic level.

Conducted by Manipal University in Dubai and Khalifa University in Abu Dhabi, the joint study reportedly made links between the disease and genes that cause obesity and high blood pressure in 500 Emiratis.

Glucose sticks are a quick and inexpensive method of monitoring your sugar levels via urine – and can be done at home. If type 2 diabetes is known to be in the family, Dr Clarke recommends having a urine test for sugar on an annual basis.

“We’ve known for some years that one’s genetic profile can be a factor causing type 2 Diabetes,” says Dr Jace Clarke, Chief Medical Officer at William Russell. “I would caution any expats in Dubai and across the UAE against viewing this merely as a problem for the local population. Instead, they should be treating this as an opportunity to discover what they can do to reduce their own risk of contracting a condition that is having a big impact on people the world over.”

Diabetes is a serious disease that in the worst cases can lead to cardiovascular problems, renal failure, blindness and even amputations. Learning how to monitor and manage your glucose levels is a critical part of staying healthy.

donughts

Understanding the condition

There are two types of diabetes:

Type 1 (insulin dependent) – Stemming from childhood in most cases, but typically before the age of 40, it occurs when the body is unable to produce a hormone known as insulin. Sufferers are required to take a daily dose of insulin to avoid a build up of glucose in the blood.

Type 2 (non-insulin dependent) – The most common form of diabetes, type 2 now accounts for between 85 and 95% of all diagnoses. It is typically associated with the over-40s, but is affecting growing numbers of younger people – including children. Type 2 occurs when the body becomes unable to produce enough insulin or is unable to use it properly (insulin resistance). It is treated with a healthy diet and increased physical activity, as well as any required medication.
In recent years, type 2 diabetes has attracted some fairly bad press – with its known links to obesity and more sedentary lifestyles prompting many to label it as a preventable or man-made disease, with some experts suggesting it should even be renamed ‘Walking Deficiency Syndrome’.

“This is vastly over-simplifying the disease,” insists Dr Clarke. “While being obese and inactive is certainly known to exacerbate the risk and severity of type 2, the fact is that anyone with a genetic predisposition to diabetes can develop the condition – even those with an ideal BMI and fitness levels.”

Recognising the symptoms

While the symptoms can be hard to spot, things to look out for include:

  • Tiredness
  • Thirst
  • Weight loss
  • Frequent urination

 

Prevention and treatment

The good news about type 2 diabetes is that, for the most part, it responds well to diet and lifestyle changes, so if you’re beginning to display some of the signs of the disease – or have been given an official diagnosis, there’s still a lot you can do.

“If it is caught in its early stages, type 2 can be managed far more effectively,” Dr Clarke continues, “with the need for medication much reduced. In some cases, it may even be reversible. Unfortunately, we are seeing an increasing trend towards insulin dependence – when taking action in the early stages could have helped avoid this.”

Some of these key measures include:

  • Reducing your carbohydrate intake to control blood glucose levels
  • Examining your diet as a whole
  • Getting more exercise
  • If applicable, aiming for a normal bodyweight

In the UAE, metabolic surgery is also being considered as an option, with specialists from King’s College Hospital, London, reportedly interested in extending their research to Emirati patients.

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Cancer care for expats living abroad

A cancer diagnosis can come at any stage in life and if you’re living abroad you’ll want to know what help is available

Getting a cancer diagnosis is a scary experience, and can be more so when you’re not living in your home country. No two health systems are the same and working out what you need and where you can get it can be complicated.

As well as seeking out the standard medical cancer treatments, there are other services you may want to find, and having a good expat health insurance plan can make your journey a lot easier. Here are some of the main points to consider:

Genome testing

A major medical advance in cancer care has come from the study of genomics in recent years, which is the gathering and examination of genetic information from cancerous cells. This helps medical professionals diagnose the type of cancer affecting a patient and potentially opens up different treatment approaches.

Doctors now know there’s no one-size-fits-all formula for cancer treatment, and each case requires a tailored approach. Genome testing of the cancer cells after diagnosis can help medics create a more tailored treatment plan for each patient, with the aim of being able to provide the most effective treatment and best prognosis. So, make sure you talk to your doctor or consultant to find out more.

Emotional support

Facebook can be a useful tool when you’re living abroad. Whether you’re in Thailand, the UAE, Hong Kong or anywhere else in the world, there’ll be dozens of expatriate groups active on Facebook, including ones created specifically to connect people living with cancer to share tips, advice and local support.

Searching on Facebook for groups that are relevant to your circumstances can include Cancer Connect in Hong Kong, a Facebook Bangkok Breast Cancer group, and the general Expat Focus UAE group.

Most hospitals with oncology departments have internal cancer support groups, so make sure you ask your doctor for recommendations. In Thailand, for example, there’s the Bangkok Breast Cancer Support Group, run by expatriate volunteers, at the Queen Sirikit Center for Breast Cancer, Chulalongkorn Hospital.

Professional counselling with a registered psychologist or counsellor following the cancer treatment can also help provide you with essential practical and emotional tools to cope with the experience.

Senior couple holding hands in nature

Getting a tailored diet plan

Unsurprisingly, what you consume during your cancer treatment is very important. The American Cancer Society advises: “you might need to change your diet to help build up your strength and withstand the effects of the cancer and its treatment.”

Consultations with a dietician mean you can have a diet plan tailored specifically for you and your type of cancer and treatment, boosting your wellbeing.

Hair loss and wigs

Some chemotherapy causes hair loss and it’s comforting for some cancer patients to purchase wigs during treatment or after it ends. Cancer Research UK recommends researching your ideal wig before you start treatment so it can be matched to your natural hair colour and texture.

Reconstructive and restorative surgery

Depending on the type of cancer, you maybe eligible for reconstructive surgery. For example, reconstructive surgery may be required after a mastectomy during breast cancer treatment, or to replace tissue removed in treatment for skin cancer.

Support and cover

While a cancer diagnosis can be a scary experience, survival rates are higher and more improved cancer treatments are being brought out each year. For peace of mind, make sure your global health insurance plan will cover your treatment for a cancer diagnosis while living overseas, and provides the reassurance of a strong support network at home and work so you have the support you need at a challenging time.

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Diabetes: Healthy eating tips for expats living abroad

As the number of people affected by diabetes globally is set to rise by 227 million over the next 20 years, find out how you can stay healthy by reading these tips.

According to the International Diabetes Federation (IDF) Atlas, the number of people with diabetes is on the rise. In the Middle East and North Africa, 35.4 million adults aged 20-79 are diabetic and this number is expected to double by 2040.

In Southeast Asia 78.3 million adults are affected by diabetes, which is over twice as many as in the Middle East and North Africa, and is set to rise by 79% by 2040.

It is important to remember that there are two types of diabetes, type 1 and type 2. Type 1 diabetes is autoimmune condition – where the body destroys cells creating insulin – and is not caused by lifestyle, but lifestyle choices can affect it. Type 2 diabetes usually develops later in life, with lifestyle factors – particularly diet – playing a large part in its development and how it is managed.

While genetics does have an impact, expats often face additional health challenges of living and working in a country where cultural differences make it harder to source a diet that can help control both types of diabetes and avoid the onset of type 2 diabetes.

Access to a better standard of living where you may find it easier to eat out, and being at times too busy to exercise, can exacerbate these challenges.

Solve the diet puzzle

In terms of diet, consuming less alcohol, eating more balanced meals at home, and avoiding late-night eating can all control the possibility of putting on weight, which is one of the main risk factors for developing type 2 diabetes.

Zeina Soueidan, a clinical dietician at The Right Bite Nutrition Centre based in Dubai, says it’s important for expats to look for ways to reduce their intake of processed foods that have a high sugar and fat content, particularly desserts and sugary drinks, if they want to minimise their risk of type 2 diabetes.

Couple shopping in outdoor market, Bangkok, Bangkok, Thailand
“Couple shopping in outdoor market, Bangkok, Bangkok, Thailand”

Zeina’s advice is to reduce the temptation for snacking on high fat and sugary foods by learning to control portion sizes and eat to satisfaction, not fullness.

“Eat smaller meals at intervals of no more than 3-4 hours and aim for more fruits and vegetables, plus high-fibre products such as beans and grains,” she says.

Did you know?

In a 330-350ml portion:

Coca Cola contains approximately 40 grams of sugar (10 teaspoons)

Apple juice contains approximately 39 grams of sugar (9.8 teaspoons)

Coconut water contains approximately 15 grams of sugar (3 teaspoons)

Heathline.com & BBC Good Food

A more consistent approach to eating teaches your body to avoid sugar cravings which, when supplemented with regular exercise, can help shed any excess weight.

Zeina suggests even a minimum of 2.5 hours a week exercise can make a difference, along with getting enough sleep and rest to balance hormones.

One way of staying informed about what you are eating is using the glycaemic index (GI). This is a scale that ranks food from 1 to 100 to tell you how slowly or quickly they will increase your blood glucose levels. You should try to avoid food with high GI numbers and replace them with food with low GI numbers, which are better for you.

A separate measure, glycaemic load, tells you both how quickly glucose will be absorbed and how much glucose is in a certain food, per serving.

Cultural differences can make it tougher for expats to structure their diet to tackle diabetes. For example, if you are moving to China then it may be tough to avoid white rice, given it is a staple of many dishes. But it is widely regarded as key to the country’s diabetes epidemic. Replacing white rice with brown rice reduces the risk of diabetes by 16%, according to a Harvard study, as brown rice has a lower glycaemic index and glycaemic load.

Did you know?

White rice glycaemic index = 72

Brown rice glycaemic index = 50

Harvard Health Publishing, Harvard Medical School

Health complications from diabetes

It’s important to realise that long-term complications associated with diabetes can include heart problems, strokes, kidney failure, eyesight issues and loss of limbs. So make sure you take care of your eating habits, exercise regularly and it should go a long way to help avoid the onset of type 2 diabetes and other health complications in the future, wherever you are in the world.

Thailand, Ratchaburi province, Damnoen Saduak, floating market
Thailand, Ratchaburi province, Damnoen Saduak, flotting market

Are you covered?

Knowing you have global health insurance that suits your circumstances and gives you access to the best possible care overseas can give you peace of mind. But it’s essential to check cover limits carefully, as not all global health insurance plans offer the same benefits, particularly for pre-existing conditions.

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Blogs | Insurance Insights

What affects the cost of health insurance?

For those without inside knowledge of the actuary industry, health insurance premiums can seem something of a minefield.

But the calculations behind them can just depend on a few key factors, the rate of claims being one of the most important.

The insurance premiums need to be high enough to cover the cost of claims. This doesn’t mean your own insurance premium needs to cover the exact cost of your own claims, it means the total cost of those premiums need to cover the total cost of claims by people with those premiums.

If the cost of healthcare increases year on year, and the number of people making claims increases, this will push up the cost of health insurance.

Net effect of hospital visits cost and frequency:

2016 1 hospital visit at US$50 = US$50

2017 2 hospital visits at US$55 = US$110

So even though the healthcare cost hasn’t increased significantly, the increased number of visits pushed the total cost up by 120%. Insurance companies need to take these increases into account, however small they might appear to the individual.

Claim trends

In recent years, countries such as Hong Kong and Dubai have seen increases in their populations, alongside significant investment in their health infrastructure. There’s a wider range of treatments available, as well as a more expensive range of treatments.

Statistics have shown that medical trend – the term used to describe the change in claims cost per insured person – is rising, pushing up the insurance premiums that need to cover these costs.

According to risk management consultancy Aon Hewitt’s 2016 Global Medical Trend Report, the gross global medical trend rate was 8.7% in 2015, and 9.1% in 2016. This demonstrates the increase in claim costs around the world.

 

Factors that affect the cost of health insurance

 

Cost of healthcare

Number of insurance claims

Fraudulent claims

Regulations and taxes

Chronic diseases

Ageing population

Cost factors

As well as the increasing cost of healthcare and greater number of claims, there are a number of other factors that influence insurance premiums: fraud, regulation and taxes, ageing populations and chronic diseases.

Fraudulent claims give a false impression to insurance companies of the rate of claims, contributing to a misleading – and ultimately more costly – medical trend prediction.

Changing regulations and taxes also affects medical insurance companies. New rules (such as mandatory coverage of chronic conditions in Dubai) can make it much more costly to insure people in a particular country or region because the claim costs are likely to be much, much higher.

 

Countries with the highest health insurance costs in 2016

(shows average cost)

 

Impact of chronic conditions

The International Diabetes Federation estimates that the cost of treating someone with diabetes is up to four times the cost of treating a healthy person. If an insurance company must shoulder this cost and a significant portion of the population has diabetes, it increases premium costs for everyone.

There has been a significant increase in these type of illnesses, and this has a corresponding impact on the cost of healthcare.

You will also pay more for your insurance premium as you get older and your healthcare needs increase. The older an individual is, the more likely they are to suffer from certain conditions – such as cancer, cardiovascular disease and respiratory problems – that are expensive to treat.

The premium is calculated in age brackets for example: 25 to 30 years, 30 to 35 years etcetera. So the premium will therefore increase each year to reflect health cost inflation and, when the member’s age reaches the next age band, it will go up to reflect the additional risk of age.

Sources:

Pacific Prime – Cost of International Health Insurance Report – 2016 – https://www.pacificprime.com/cohi-2016/

Aon Hewitt – 2016 Global Medical Trend Report – www.aon.com

International Diabetes Federation – www.idf.org

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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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