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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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Blogs | Health

Expat guide to vaccinations in Thailand

Thailand is a world of opportunity for ambitious professionals. But it’s important to remember that you or your family could be exposed to health issues that you’ve never had to think about before.

Understanding which vaccinations you need in Thailand is essential when planning your move. Try to seek advice and start receiving any relevant vaccines up to six weeks before moving.

What vaccines do I need in Thailand?

This will depend on which part of Thailand you are going to, how you’re travelling, and how long you plan to stay.

 

 

All travellers need vaccines for: Tetanus, Hepatitis A & Typhoid

 

However you could need others, depending on your plans when you arrive in Thailand. The following extra vaccines should be received for anyone travelling to rural areas:

• Tuberculosis
• Japanese Encephalitis

If your work, lifestyle or underlying health means you are at increased risk of infections, you need to be up to date with any additional vaccines. Living in a crowded urban area, for example, could leave you more at risk of becoming infected with diphtheria, so you may consider whether you are protected against this condition and seek further vaccination if necessary.

 

rab-copy

7 deaths from Rabies in Thailand – Jan-Aug 2016

If you want to go trekking, you will need jabs for Hepatitis B given the increased chance of water-borne infection. You will also be more likely to encounter wild animals, so a Rabies vaccine is advised. But even with a Rabies vaccine, urgent medial attention should be sought after any animal bite.

thai-copy

Keep an eye on children’s vaccines – they need various jabs at different life stages

 

It is worth assessing which of the above diseases children could be more at risk to, for example Hepatitis B given the increased risks involved.

It’s worth closely monitoring the vaccination schedule for children up to the age of 12. They need the standard child vaccines at various stages in their development, in addition to any additional jabs for moving to Thailand. It can be easy to lose track and miss one.

Any family member over the age of nine months will need a certificate of Yellow Fever vaccination if you have either came from a country at risk, or transited through one for more than 12 hours.

You should also speak to a GP before leaving if you are pregnant or breastfeeding. Pregnant women are often advised to consider postponing travel to places that require vaccines.

If this is unavoidable, you need to weigh up the risks. Catching a disease could be much more harmful to you and your baby than the vaccine itself.

 

Malaria

Although there is no risk of malaria in Thailand’s major cities, there is a low risk in certain rural areas. Travellers visiting the following regions should take a course of malaria tablets:

• Rural and forested areas at the border to Burma, Cambodia and Laos
• Rural and forested areas in Phang Nga and Phuket

 

Other considerations

There are other circumstances in which you will be advised against having vaccines. For example, if you are receiving chemotherapy or have recently had a bone marrow or organ transplant. The impact on your immune system can make vaccines too risky.

It is worth remembering to be up to date on all vaccines required in your home country, too. Try not to assume that any vaccinations are still effective if you’ve had them before. Check that they are all still valid and arrange for boosters if necessary.

 

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Living with asthma and COPD

Any sort of change in weather, be it a spike in temperature, a dust storm or a thunderstorm, could trigger an asthma attack for some of the world’s 235 million sufferers. It’s essential to know the triggers and some of the ways to minimise symptoms.

How air quality impacts COPD

Weather and air pollution are two of the most common triggers for chronic obstructive pulmonary disease (COPD) and asthma symptoms, but unfortunately are also the most difficult to control.

Research by the Asthma and Allergy Foundation of America shows that four in 10 asthmatics are more likely to have an acute episode on high pollution summer days than on other normal days. Asthma UK reports that two-thirds of asthmatics say poor air quality makes their condition worse.

 

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Unfortunately, the climates in Thailand, Hong Kong and Dubai, UAE, are not ideal for people with respiratory conditions, and all three have other causes of asthma, such as high pollution levels. “The weather conditions in the UAE can trigger and aggravate asthma because of the high level of humidity and extensive use of uncleaned central air-conditioning systems in houses or offices that haven’t been cleaned,” says Dr Trilok Chand, of Burjeel Hospital, UAE.

Humidity is thought to carry more pollutants and moulds into the air and also make it more difficult to breath because the air itself is heavier. Industrial growth is another factor; the government of Hong Kong says street-level pollution and regional smog are its biggest pollution challenges, and urges people to check its live air quality index before going outside. In urban parts of Thailand, factory and vehicle pollution create a layer of smog that irritates the airways and lungs.

Sandstorms are another issue, especially in desert environments like Dubai. Dr Chand says the number of asthma patients visiting hospitals spikes during and after a sandstorm, when the quality of air is at its worst.

 

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How to minimise and manage your symptoms

Make sure air-conditioning units are professionally cleaned and invest in an air purifier for the home or office.

Unfortunately, there’s little to be done about the quality of outdoor air and some experts say protective face masks do more harm than good for asthmatics because they make it more difficult to breath.

There are many websites providing live readings of a city’s air quality so check these before spending time outside.

When you do go out, try to limit moving from hot and humid outdoor areas to cool, air-conditioned indoor areas or cars as this irritates the airways. Reducing soft furnishings in your home will reduce the number of dust mites, a common asthma trigger.

Always carry your inhaler and asthma medications, and if you’re travelling somewhere new, take enough supplies to last the trip.

 

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How to help someone in trouble

An asthma attack can take days to build so it’s important to know the symptoms.

These include chest tightness, wheezing, coughing and shortness of breath. If you’re with someone who’s having an attack it’s important to stay calm and keep the person sat upright with an open chest.

If there are any obvious triggers around such as pets or smokers, or you know of any other allergies they might have, remove the person from that situation. Asthma UK recommends taking one puff of a reliever inhaler every 30 to 60 seconds, up to a maximum of 10 puffs, and if things don’t improve, call an ambulance.

Where to find more information

Check local websites for up-to-date weather reports and air quality information. Thailand, Hong Kong and Dubai all have good public and private hospitals, so if you’re concerned about your asthma, see a doctor straight away.

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What is driving up the cost of global healthcare?

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

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

Consumer demand

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

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

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

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

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

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

Willis Towers Watson’s 2017 Global Medical Trends Survey Report

Convenience, mobility and choice

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

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

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

Deloitte 2018 Global Healthcare Outlook

Ageing and lifestyle factors 

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

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

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

Regulatory landscape and fraud

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

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

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

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

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

New healthcare approaches

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

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

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

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

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

Ivy Lai, country manager, Philips Singapore

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

How does this all impact my health insurance?

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

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

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Take care of your family’s tomorrow, today

Help protect your family financially if something happens to you.

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

Planning your legacy

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

Life insurance designed for expats

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

Our 2018 enhanced international life cover plan offers

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

Your job done

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

Start the conversation today

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

Find out more >parent_and_child_at_beach

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Blogs | Health Alert

Your guide to malaria protection

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

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

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

Who is at risk?

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

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

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

Malaria – the statistics

In 2015, 91 countries and areas had ongoing malaria transmission

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

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

World Health Organisation Factsheet

What is super malaria?

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

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

Your guide to malaria protection mosquito

 

What treatments are there?

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

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

Before you travel

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

What can I do?

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

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

 

Your guide to malaria protection spray

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

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

Deet –15-30% concentration

Picaridin – 20% concentration

Oil of Lemon Eucalyptus – 30% concentration

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

Your guide to malaria protection netting

 

 

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

How to spot malaria symptoms

high temperature

sweats and chills

headaches

vomiting

muscle pain

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

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Blogs | Health Tips

Keeping active in Southeast Asia

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

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

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

  • Group workout sessions

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

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

Southeast-Asia-martial-arts-1

  • Martial arts

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

Heat exhaustion

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

  • Yoga

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

Southeast-Asia-yoga

 

  • Bootcamps

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

  • Outdoor gyms

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

Air pollution

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

  • Hiking

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

Southeast-Asia-Hiking

Swiping for fitness

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

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

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

Getting social

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

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

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

Southeast-Asia-Outdoor-gyms

Should I join a gym?

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

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

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How expats in Thailand can reduce sugar intake

How much sugar do you consume? According to the World Health Organization (WHO), six teaspoons per day is the recommended daily allowance. Thailand’s daily sugar consumption is more than four times that level, and is contributing towards Thailand’s rising health problems.

Children are particularly at risk, with excessive sugar intake leading to tooth decay and diabetes, as well as hypertension and heart disease in later life, says the WHO.

Obesity among children is also a major concern. According to the Thai Health Promotion Foundation, one fifth of Thai school children drink fizzy drinks every day, and one in three will become overweight by the time they are teenagers.

Obesity and associated illnesses costs Southeast Asia up to US$10billion annually on healthcare, according to Food Industry Asia.

Taxing sugar in Thailand

In September 2017, the Thai government introduced a tax on soft drinks that contain high sugar levels in order to encourage the manufacture and sale of healthier drinking options.

Other initiatives to help tackle rising obesity levels have seen the government commit to working with schools to ban fizzy drinks on a voluntary basis.

“Iced drinks, such as Cha Yen and Nom Yen, are packed with sugar” – Marcela Soto Prats, Nutritionist

Easy access to sugary foods and drinks contribute to the problem.

Phuket-based nutritionist and dietician Marcela Soto Prats warns that popular iced drinks, such as Cha Yen and Nom Yen, are packed with sugar, and can contain added syrup and sweetened condensed milk.

While the availability of such processed food is having an effect on Thai diets, sugar is also a key ingredient of many traditional dishes.

Typical culprits include most curries and the iconic som tam or papaya salad. Pad Thai sauce, for example, can contain as much as two tablespoons of sugar.

Did you know?

Pad Thai sauce can contain as much as two tablespoons of sugar.

Ensuring food intake is balanced with whole grains, healthy fats and protein, as well as restricting the availability of snacks, will also help to avoid sugar spikes and crashes.

A sugar crash, when your body is low on energy, can cause mood swings and cravings for sugary foods.

Low-sugar alternatives

As alternatives, Soto Prats recommends snacks that contain nutrients high in energy, which build tissue and protect the immune system with minerals, vitamins and antioxidants.

Sugar intake Thailand healthy food

 

Soto Prats suggestions:

  • Baked sweet potato chips
  • Smoothies containing vegetables
  • Fresh fruit and seeds
  • Nut butter
  • Trail mix of dried fruit and nuts, using dates or dried fruit for natural sweeteners

If sweeteners are required for flavour in recipes, Soto Prats recommends coconut sugar, which is readily available in Thailand and will not result in a notable sugar spike.

Did you know?

Coconut sugar has a much lower glycemic index than common white sugar, according to the University of Sydney’s glycemic index database.

Reducing the appeal and impact of sugar

Social and lifestyle changes are another important consideration in monitoring your family’s sugar intake.

The increase in computer, mobile phone and social media use means families tend to spend more time indoors; this increases consumption of fast foods and sugary drinks as they are more convenient.

A more sedentary lifestyle and less exercise is certainly a trend that is contributing to rising obesity levels that saw Thailand ranked as the second highest obese nation in Asia in 2014.

Such a problem comes with a price. Obesity and associated illnesses costs Southeast Asia up to US$10billion annually on healthcare, according to a recent report by the Economic Intelligence Unit (EIU).

Boosting your family’s health

Making sure children are involved in regular exercise and sport, and educating them about good eating habits, can reduce the risks associated with sugar consumption and obesity.

Regular checks and tests to monitor high cholesterol, diabetes, poor kidney or liver function or cardiac risk can help understand your health, and promote a greater sense of wellbeing.

Some global health insurance plans will include wellbeing cover, helping gain access preventative health checks and tests.

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How to relocate as an expat with children

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

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

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

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

Preparing for change

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

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

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

Children with Ipad

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

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

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

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

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

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

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

Healthcare: know what to expect

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

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

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

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

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

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

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

Ipad Video Conf

Settling in and enjoying your new life

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

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

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

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

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

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

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

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

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

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Keeping insurance relevant to expats

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

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

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

Insurance for local needs

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

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

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

A changing industry

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

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

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

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

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

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

Flexibility for expats

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

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

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

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

Reliable service for nomadic professionals

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

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

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

What next?

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

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

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

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

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Is there a depression crisis in Asia’s cities?

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

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

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

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

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

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

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

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

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

Woman on phone

Contributing factors

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

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

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

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

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

Man and sunset

Taking steps

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

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

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

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

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

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

Piggyback

Expat pressures

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

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

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

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

 

Take care of you

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

1  Talk about your feelings

 

2  Keep active

 

3  Eat well

 

4  Drink sensibly

 

5  Stay in touch

 

6  Ask for help

 

7  Take a break

 

8  Do something you’re good at

 

9  Accept who you are

 

10  Take care of others

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How does physical activity affect your health?

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

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

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

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

What are the benefits of physical activity?

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

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

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

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

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

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

Pilates

How long should I exercise for?

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

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

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

What are moderate and intensive forms of exercise?

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

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

Do some activities bring particular benefits to over 50s?

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

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

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

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Expat guide to vaccinations in Thailand

Thailand is a world of opportunity for ambitious professionals. But it’s important to remember that you or your family could be exposed to health issues that you’ve never had to think about before.

Understanding which vaccinations you need in Thailand is essential when planning your move. Try to seek advice and start receiving any relevant vaccines up to six weeks before moving.

What vaccines do I need in Thailand?

This will depend on which part of Thailand you are going to, how you’re travelling, and how long you plan to stay.

 

 

All travellers need vaccines for: Tetanus, Hepatitis A & Typhoid

 

However you could need others, depending on your plans when you arrive in Thailand. The following extra vaccines should be received for anyone travelling to rural areas:

• Tuberculosis
• Japanese Encephalitis

If your work, lifestyle or underlying health means you are at increased risk of infections, you need to be up to date with any additional vaccines. Living in a crowded urban area, for example, could leave you more at risk of becoming infected with diphtheria, so you may consider whether you are protected against this condition and seek further vaccination if necessary.

 

rab-copy

7 deaths from Rabies in Thailand – Jan-Aug 2016

If you want to go trekking, you will need jabs for Hepatitis B given the increased chance of water-borne infection. You will also be more likely to encounter wild animals, so a Rabies vaccine is advised. But even with a Rabies vaccine, urgent medial attention should be sought after any animal bite.

thai-copy

Keep an eye on children’s vaccines – they need various jabs at different life stages

 

It is worth assessing which of the above diseases children could be more at risk to, for example Hepatitis B given the increased risks involved.

It’s worth closely monitoring the vaccination schedule for children up to the age of 12. They need the standard child vaccines at various stages in their development, in addition to any additional jabs for moving to Thailand. It can be easy to lose track and miss one.

Any family member over the age of nine months will need a certificate of Yellow Fever vaccination if you have either came from a country at risk, or transited through one for more than 12 hours.

You should also speak to a GP before leaving if you are pregnant or breastfeeding. Pregnant women are often advised to consider postponing travel to places that require vaccines.

If this is unavoidable, you need to weigh up the risks. Catching a disease could be much more harmful to you and your baby than the vaccine itself.

 

Malaria

Although there is no risk of malaria in Thailand’s major cities, there is a low risk in certain rural areas. Travellers visiting the following regions should take a course of malaria tablets:

• Rural and forested areas at the border to Burma, Cambodia and Laos
• Rural and forested areas in Phang Nga and Phuket

 

Other considerations

There are other circumstances in which you will be advised against having vaccines. For example, if you are receiving chemotherapy or have recently had a bone marrow or organ transplant. The impact on your immune system can make vaccines too risky.

It is worth remembering to be up to date on all vaccines required in your home country, too. Try not to assume that any vaccinations are still effective if you’ve had them before. Check that they are all still valid and arrange for boosters if necessary.

 

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Living with asthma and COPD

Any sort of change in weather, be it a spike in temperature, a dust storm or a thunderstorm, could trigger an asthma attack for some of the world’s 235 million sufferers. It’s essential to know the triggers and some of the ways to minimise symptoms.

How air quality impacts COPD

Weather and air pollution are two of the most common triggers for chronic obstructive pulmonary disease (COPD) and asthma symptoms, but unfortunately are also the most difficult to control.

Research by the Asthma and Allergy Foundation of America shows that four in 10 asthmatics are more likely to have an acute episode on high pollution summer days than on other normal days. Asthma UK reports that two-thirds of asthmatics say poor air quality makes their condition worse.

 

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Unfortunately, the climates in Thailand, Hong Kong and Dubai, UAE, are not ideal for people with respiratory conditions, and all three have other causes of asthma, such as high pollution levels. “The weather conditions in the UAE can trigger and aggravate asthma because of the high level of humidity and extensive use of uncleaned central air-conditioning systems in houses or offices that haven’t been cleaned,” says Dr Trilok Chand, of Burjeel Hospital, UAE.

Humidity is thought to carry more pollutants and moulds into the air and also make it more difficult to breath because the air itself is heavier. Industrial growth is another factor; the government of Hong Kong says street-level pollution and regional smog are its biggest pollution challenges, and urges people to check its live air quality index before going outside. In urban parts of Thailand, factory and vehicle pollution create a layer of smog that irritates the airways and lungs.

Sandstorms are another issue, especially in desert environments like Dubai. Dr Chand says the number of asthma patients visiting hospitals spikes during and after a sandstorm, when the quality of air is at its worst.

 

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How to minimise and manage your symptoms

Make sure air-conditioning units are professionally cleaned and invest in an air purifier for the home or office.

Unfortunately, there’s little to be done about the quality of outdoor air and some experts say protective face masks do more harm than good for asthmatics because they make it more difficult to breath.

There are many websites providing live readings of a city’s air quality so check these before spending time outside.

When you do go out, try to limit moving from hot and humid outdoor areas to cool, air-conditioned indoor areas or cars as this irritates the airways. Reducing soft furnishings in your home will reduce the number of dust mites, a common asthma trigger.

Always carry your inhaler and asthma medications, and if you’re travelling somewhere new, take enough supplies to last the trip.

 

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How to help someone in trouble

An asthma attack can take days to build so it’s important to know the symptoms.

These include chest tightness, wheezing, coughing and shortness of breath. If you’re with someone who’s having an attack it’s important to stay calm and keep the person sat upright with an open chest.

If there are any obvious triggers around such as pets or smokers, or you know of any other allergies they might have, remove the person from that situation. Asthma UK recommends taking one puff of a reliever inhaler every 30 to 60 seconds, up to a maximum of 10 puffs, and if things don’t improve, call an ambulance.

Where to find more information

Check local websites for up-to-date weather reports and air quality information. Thailand, Hong Kong and Dubai all have good public and private hospitals, so if you’re concerned about your asthma, see a doctor straight away.

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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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Your guide to malaria protection

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

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

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

Who is at risk?

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

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

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

Malaria – the statistics

In 2015, 91 countries and areas had ongoing malaria transmission

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

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

World Health Organisation Factsheet

What is super malaria?

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

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

Your guide to malaria protection mosquito

 

What treatments are there?

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

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

Before you travel

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

What can I do?

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

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

 

Your guide to malaria protection spray

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

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

Deet –15-30% concentration

Picaridin – 20% concentration

Oil of Lemon Eucalyptus – 30% concentration

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

Your guide to malaria protection netting

 

 

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

How to spot malaria symptoms

high temperature

sweats and chills

headaches

vomiting

muscle pain

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

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Keeping active in Southeast Asia

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

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

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

  • Group workout sessions

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

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

Southeast-Asia-martial-arts-1

  • Martial arts

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

Heat exhaustion

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

  • Yoga

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

Southeast-Asia-yoga

 

  • Bootcamps

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

  • Outdoor gyms

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

Air pollution

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

  • Hiking

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

Southeast-Asia-Hiking

Swiping for fitness

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

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

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

Getting social

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

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

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

Southeast-Asia-Outdoor-gyms

Should I join a gym?

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

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

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How expats in Thailand can reduce sugar intake

How much sugar do you consume? According to the World Health Organization (WHO), six teaspoons per day is the recommended daily allowance. Thailand’s daily sugar consumption is more than four times that level, and is contributing towards Thailand’s rising health problems.

Children are particularly at risk, with excessive sugar intake leading to tooth decay and diabetes, as well as hypertension and heart disease in later life, says the WHO.

Obesity among children is also a major concern. According to the Thai Health Promotion Foundation, one fifth of Thai school children drink fizzy drinks every day, and one in three will become overweight by the time they are teenagers.

Obesity and associated illnesses costs Southeast Asia up to US$10billion annually on healthcare, according to Food Industry Asia.

Taxing sugar in Thailand

In September 2017, the Thai government introduced a tax on soft drinks that contain high sugar levels in order to encourage the manufacture and sale of healthier drinking options.

Other initiatives to help tackle rising obesity levels have seen the government commit to working with schools to ban fizzy drinks on a voluntary basis.

“Iced drinks, such as Cha Yen and Nom Yen, are packed with sugar” – Marcela Soto Prats, Nutritionist

Easy access to sugary foods and drinks contribute to the problem.

Phuket-based nutritionist and dietician Marcela Soto Prats warns that popular iced drinks, such as Cha Yen and Nom Yen, are packed with sugar, and can contain added syrup and sweetened condensed milk.

While the availability of such processed food is having an effect on Thai diets, sugar is also a key ingredient of many traditional dishes.

Typical culprits include most curries and the iconic som tam or papaya salad. Pad Thai sauce, for example, can contain as much as two tablespoons of sugar.

Did you know?

Pad Thai sauce can contain as much as two tablespoons of sugar.

Ensuring food intake is balanced with whole grains, healthy fats and protein, as well as restricting the availability of snacks, will also help to avoid sugar spikes and crashes.

A sugar crash, when your body is low on energy, can cause mood swings and cravings for sugary foods.

Low-sugar alternatives

As alternatives, Soto Prats recommends snacks that contain nutrients high in energy, which build tissue and protect the immune system with minerals, vitamins and antioxidants.

Sugar intake Thailand healthy food

 

Soto Prats suggestions:

  • Baked sweet potato chips
  • Smoothies containing vegetables
  • Fresh fruit and seeds
  • Nut butter
  • Trail mix of dried fruit and nuts, using dates or dried fruit for natural sweeteners

If sweeteners are required for flavour in recipes, Soto Prats recommends coconut sugar, which is readily available in Thailand and will not result in a notable sugar spike.

Did you know?

Coconut sugar has a much lower glycemic index than common white sugar, according to the University of Sydney’s glycemic index database.

Reducing the appeal and impact of sugar

Social and lifestyle changes are another important consideration in monitoring your family’s sugar intake.

The increase in computer, mobile phone and social media use means families tend to spend more time indoors; this increases consumption of fast foods and sugary drinks as they are more convenient.

A more sedentary lifestyle and less exercise is certainly a trend that is contributing to rising obesity levels that saw Thailand ranked as the second highest obese nation in Asia in 2014.

Such a problem comes with a price. Obesity and associated illnesses costs Southeast Asia up to US$10billion annually on healthcare, according to a recent report by the Economic Intelligence Unit (EIU).

Boosting your family’s health

Making sure children are involved in regular exercise and sport, and educating them about good eating habits, can reduce the risks associated with sugar consumption and obesity.

Regular checks and tests to monitor high cholesterol, diabetes, poor kidney or liver function or cardiac risk can help understand your health, and promote a greater sense of wellbeing.

Some global health insurance plans will include wellbeing cover, helping gain access preventative health checks and tests.

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How to relocate as an expat with children

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

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

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

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

Preparing for change

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

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

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

Children with Ipad

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

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

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

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

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

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

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

Healthcare: know what to expect

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

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

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

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

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

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

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

Ipad Video Conf

Settling in and enjoying your new life

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

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

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

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

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

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

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

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

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

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Keeping insurance relevant to expats

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

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

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

Insurance for local needs

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

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

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

A changing industry

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

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

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

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

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

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

Flexibility for expats

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

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

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

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

Reliable service for nomadic professionals

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

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

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

What next?

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

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

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

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

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Is there a depression crisis in Asia’s cities?

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

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

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

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

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

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

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

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

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

Woman on phone

Contributing factors

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

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

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

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

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

Man and sunset

Taking steps

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

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

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

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

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

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

Piggyback

Expat pressures

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

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

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

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

 

Take care of you

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

1  Talk about your feelings

 

2  Keep active

 

3  Eat well

 

4  Drink sensibly

 

5  Stay in touch

 

6  Ask for help

 

7  Take a break

 

8  Do something you’re good at

 

9  Accept who you are

 

10  Take care of others

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How does physical activity affect your health?

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

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

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

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

What are the benefits of physical activity?

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

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

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

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

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

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

Pilates

How long should I exercise for?

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

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

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

What are moderate and intensive forms of exercise?

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

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

Do some activities bring particular benefits to over 50s?

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

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

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

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Expat guide to vaccinations in Thailand

Thailand is a world of opportunity for ambitious professionals. But it’s important to remember that you or your family could be exposed to health issues that you’ve never had to think about before.

Understanding which vaccinations you need in Thailand is essential when planning your move. Try to seek advice and start receiving any relevant vaccines up to six weeks before moving.

What vaccines do I need in Thailand?

This will depend on which part of Thailand you are going to, how you’re travelling, and how long you plan to stay.

 

 

All travellers need vaccines for: Tetanus, Hepatitis A & Typhoid

 

However you could need others, depending on your plans when you arrive in Thailand. The following extra vaccines should be received for anyone travelling to rural areas:

• Tuberculosis
• Japanese Encephalitis

If your work, lifestyle or underlying health means you are at increased risk of infections, you need to be up to date with any additional vaccines. Living in a crowded urban area, for example, could leave you more at risk of becoming infected with diphtheria, so you may consider whether you are protected against this condition and seek further vaccination if necessary.

 

rab-copy

7 deaths from Rabies in Thailand – Jan-Aug 2016

If you want to go trekking, you will need jabs for Hepatitis B given the increased chance of water-borne infection. You will also be more likely to encounter wild animals, so a Rabies vaccine is advised. But even with a Rabies vaccine, urgent medial attention should be sought after any animal bite.

thai-copy

Keep an eye on children’s vaccines – they need various jabs at different life stages

 

It is worth assessing which of the above diseases children could be more at risk to, for example Hepatitis B given the increased risks involved.

It’s worth closely monitoring the vaccination schedule for children up to the age of 12. They need the standard child vaccines at various stages in their development, in addition to any additional jabs for moving to Thailand. It can be easy to lose track and miss one.

Any family member over the age of nine months will need a certificate of Yellow Fever vaccination if you have either came from a country at risk, or transited through one for more than 12 hours.

You should also speak to a GP before leaving if you are pregnant or breastfeeding. Pregnant women are often advised to consider postponing travel to places that require vaccines.

If this is unavoidable, you need to weigh up the risks. Catching a disease could be much more harmful to you and your baby than the vaccine itself.

 

Malaria

Although there is no risk of malaria in Thailand’s major cities, there is a low risk in certain rural areas. Travellers visiting the following regions should take a course of malaria tablets:

• Rural and forested areas at the border to Burma, Cambodia and Laos
• Rural and forested areas in Phang Nga and Phuket

 

Other considerations

There are other circumstances in which you will be advised against having vaccines. For example, if you are receiving chemotherapy or have recently had a bone marrow or organ transplant. The impact on your immune system can make vaccines too risky.

It is worth remembering to be up to date on all vaccines required in your home country, too. Try not to assume that any vaccinations are still effective if you’ve had them before. Check that they are all still valid and arrange for boosters if necessary.

 

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Living with asthma and COPD

Any sort of change in weather, be it a spike in temperature, a dust storm or a thunderstorm, could trigger an asthma attack for some of the world’s 235 million sufferers. It’s essential to know the triggers and some of the ways to minimise symptoms.

How air quality impacts COPD

Weather and air pollution are two of the most common triggers for chronic obstructive pulmonary disease (COPD) and asthma symptoms, but unfortunately are also the most difficult to control.

Research by the Asthma and Allergy Foundation of America shows that four in 10 asthmatics are more likely to have an acute episode on high pollution summer days than on other normal days. Asthma UK reports that two-thirds of asthmatics say poor air quality makes their condition worse.

 

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Unfortunately, the climates in Thailand, Hong Kong and Dubai, UAE, are not ideal for people with respiratory conditions, and all three have other causes of asthma, such as high pollution levels. “The weather conditions in the UAE can trigger and aggravate asthma because of the high level of humidity and extensive use of uncleaned central air-conditioning systems in houses or offices that haven’t been cleaned,” says Dr Trilok Chand, of Burjeel Hospital, UAE.

Humidity is thought to carry more pollutants and moulds into the air and also make it more difficult to breath because the air itself is heavier. Industrial growth is another factor; the government of Hong Kong says street-level pollution and regional smog are its biggest pollution challenges, and urges people to check its live air quality index before going outside. In urban parts of Thailand, factory and vehicle pollution create a layer of smog that irritates the airways and lungs.

Sandstorms are another issue, especially in desert environments like Dubai. Dr Chand says the number of asthma patients visiting hospitals spikes during and after a sandstorm, when the quality of air is at its worst.

 

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How to minimise and manage your symptoms

Make sure air-conditioning units are professionally cleaned and invest in an air purifier for the home or office.

Unfortunately, there’s little to be done about the quality of outdoor air and some experts say protective face masks do more harm than good for asthmatics because they make it more difficult to breath.

There are many websites providing live readings of a city’s air quality so check these before spending time outside.

When you do go out, try to limit moving from hot and humid outdoor areas to cool, air-conditioned indoor areas or cars as this irritates the airways. Reducing soft furnishings in your home will reduce the number of dust mites, a common asthma trigger.

Always carry your inhaler and asthma medications, and if you’re travelling somewhere new, take enough supplies to last the trip.

 

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How to help someone in trouble

An asthma attack can take days to build so it’s important to know the symptoms.

These include chest tightness, wheezing, coughing and shortness of breath. If you’re with someone who’s having an attack it’s important to stay calm and keep the person sat upright with an open chest.

If there are any obvious triggers around such as pets or smokers, or you know of any other allergies they might have, remove the person from that situation. Asthma UK recommends taking one puff of a reliever inhaler every 30 to 60 seconds, up to a maximum of 10 puffs, and if things don’t improve, call an ambulance.

Where to find more information

Check local websites for up-to-date weather reports and air quality information. Thailand, Hong Kong and Dubai all have good public and private hospitals, so if you’re concerned about your asthma, see a doctor straight away.

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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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Your guide to malaria protection

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

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

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

Who is at risk?

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

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

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

Malaria – the statistics

In 2015, 91 countries and areas had ongoing malaria transmission

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

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

World Health Organisation Factsheet

What is super malaria?

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

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

Your guide to malaria protection mosquito

 

What treatments are there?

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

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

Before you travel

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

What can I do?

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

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

 

Your guide to malaria protection spray

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

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

Deet –15-30% concentration

Picaridin – 20% concentration

Oil of Lemon Eucalyptus – 30% concentration

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

Your guide to malaria protection netting

 

 

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

How to spot malaria symptoms

high temperature

sweats and chills

headaches

vomiting

muscle pain

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

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Keeping active in Southeast Asia

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

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

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

  • Group workout sessions

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

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

Southeast-Asia-martial-arts-1

  • Martial arts

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

Heat exhaustion

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

  • Yoga

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

Southeast-Asia-yoga

 

  • Bootcamps

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

  • Outdoor gyms

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

Air pollution

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

  • Hiking

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

Southeast-Asia-Hiking

Swiping for fitness

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

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

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

Getting social

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

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

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

Southeast-Asia-Outdoor-gyms

Should I join a gym?

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

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

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How expats in Thailand can reduce sugar intake

How much sugar do you consume? According to the World Health Organization (WHO), six teaspoons per day is the recommended daily allowance. Thailand’s daily sugar consumption is more than four times that level, and is contributing towards Thailand’s rising health problems.

Children are particularly at risk, with excessive sugar intake leading to tooth decay and diabetes, as well as hypertension and heart disease in later life, says the WHO.

Obesity among children is also a major concern. According to the Thai Health Promotion Foundation, one fifth of Thai school children drink fizzy drinks every day, and one in three will become overweight by the time they are teenagers.

Obesity and associated illnesses costs Southeast Asia up to US$10billion annually on healthcare, according to Food Industry Asia.

Taxing sugar in Thailand

In September 2017, the Thai government introduced a tax on soft drinks that contain high sugar levels in order to encourage the manufacture and sale of healthier drinking options.

Other initiatives to help tackle rising obesity levels have seen the government commit to working with schools to ban fizzy drinks on a voluntary basis.

“Iced drinks, such as Cha Yen and Nom Yen, are packed with sugar” – Marcela Soto Prats, Nutritionist

Easy access to sugary foods and drinks contribute to the problem.

Phuket-based nutritionist and dietician Marcela Soto Prats warns that popular iced drinks, such as Cha Yen and Nom Yen, are packed with sugar, and can contain added syrup and sweetened condensed milk.

While the availability of such processed food is having an effect on Thai diets, sugar is also a key ingredient of many traditional dishes.

Typical culprits include most curries and the iconic som tam or papaya salad. Pad Thai sauce, for example, can contain as much as two tablespoons of sugar.

Did you know?

Pad Thai sauce can contain as much as two tablespoons of sugar.

Ensuring food intake is balanced with whole grains, healthy fats and protein, as well as restricting the availability of snacks, will also help to avoid sugar spikes and crashes.

A sugar crash, when your body is low on energy, can cause mood swings and cravings for sugary foods.

Low-sugar alternatives

As alternatives, Soto Prats recommends snacks that contain nutrients high in energy, which build tissue and protect the immune system with minerals, vitamins and antioxidants.

Sugar intake Thailand healthy food

 

Soto Prats suggestions:

  • Baked sweet potato chips
  • Smoothies containing vegetables
  • Fresh fruit and seeds
  • Nut butter
  • Trail mix of dried fruit and nuts, using dates or dried fruit for natural sweeteners

If sweeteners are required for flavour in recipes, Soto Prats recommends coconut sugar, which is readily available in Thailand and will not result in a notable sugar spike.

Did you know?

Coconut sugar has a much lower glycemic index than common white sugar, according to the University of Sydney’s glycemic index database.

Reducing the appeal and impact of sugar

Social and lifestyle changes are another important consideration in monitoring your family’s sugar intake.

The increase in computer, mobile phone and social media use means families tend to spend more time indoors; this increases consumption of fast foods and sugary drinks as they are more convenient.

A more sedentary lifestyle and less exercise is certainly a trend that is contributing to rising obesity levels that saw Thailand ranked as the second highest obese nation in Asia in 2014.

Such a problem comes with a price. Obesity and associated illnesses costs Southeast Asia up to US$10billion annually on healthcare, according to a recent report by the Economic Intelligence Unit (EIU).

Boosting your family’s health

Making sure children are involved in regular exercise and sport, and educating them about good eating habits, can reduce the risks associated with sugar consumption and obesity.

Regular checks and tests to monitor high cholesterol, diabetes, poor kidney or liver function or cardiac risk can help understand your health, and promote a greater sense of wellbeing.

Some global health insurance plans will include wellbeing cover, helping gain access preventative health checks and tests.

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How to relocate as an expat with children

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

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

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

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

Preparing for change

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

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

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

Children with Ipad

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

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

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

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

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

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

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

Healthcare: know what to expect

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

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

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

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

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

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

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

Ipad Video Conf

Settling in and enjoying your new life

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

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

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

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

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

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

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

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

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

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Keeping insurance relevant to expats

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

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

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

Insurance for local needs

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

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

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

A changing industry

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

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

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

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

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

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

Flexibility for expats

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

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

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

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

Reliable service for nomadic professionals

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

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

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

What next?

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

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

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

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

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Is there a depression crisis in Asia’s cities?

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

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

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

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

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

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

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

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

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

Woman on phone

Contributing factors

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

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

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

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

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

Man and sunset

Taking steps

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

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

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

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

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

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

Piggyback

Expat pressures

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

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

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

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

 

Take care of you

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

1  Talk about your feelings

 

2  Keep active

 

3  Eat well

 

4  Drink sensibly

 

5  Stay in touch

 

6  Ask for help

 

7  Take a break

 

8  Do something you’re good at

 

9  Accept who you are

 

10  Take care of others

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How does physical activity affect your health?

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

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

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

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

What are the benefits of physical activity?

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

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

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

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

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

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

Pilates

How long should I exercise for?

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

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

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

What are moderate and intensive forms of exercise?

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

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

Do some activities bring particular benefits to over 50s?

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

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

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