One of the commonly used measures of social inequality is the Gini Coefficient. The Gini Coefficient ranges in value from zero to one. When it has a value of zero, a situation of perfect equality exists. When it has a value of one, it reflects a situation of perfect inequality. In other words, in a society with perfect equality (Gini Coefficient = zero) then all the wealth is divided equally among everyone. On the other hand, in a society with perfect inequality (Gini Coefficient = one) then only one person has all the wealth and everyone else has nothing.

Although many social scientists believe that social inequality is generally undesirable, one should use some care in using the measure. Some scientists believe that social equality may also be undesirable. Nevertheless, the Gini Coefficient is a useful tool to use to gauge the potential for problems that may arise from social inequality with international living. For potential retirees considering an overseas retirement, country comparisons of the Gini Coefficient can provide some insight into the political and social stability of those countries that you may be interested in.

To make the numbers easier to interpret, the Gini Coefficient has been multiplied by 100. Thus, zero represents a society with perfect equality and 100 represents a society with perfect inequality. The source of the data presented here is the United Nations 2009 Human Development Report. To help you in interpreting the data, some international comparison analysis is done for you. Just keep in mind that you should use these international comparisons only as a start in your investigation. Before taking the plunge into international living, it would be use to gather up as much information as you can about your potential retirement destination.

International Comparisons: Low Levels of Social Inequality (Gini Coefficient 10-29)

Countries with a Gini Coefficient that fall into this category of low social inequality (see table below) are developed European countries for the most part. This low Gini Coefficient value suggests a lower likelihood of domestic tension from social inequality. When making international comparisons with the Gini Coefficient, we are primarily looking at a measure of social inequality.

Of course, other factors may be relevant to your retirement decision such as the cost of living and this category has many high cost developed countries that may not be suitable for a modest retirement budget.

International Comparisons: Moderate Levels of Social Inequality (Gini Coefficient 30-39)

Countries with a Gini Coefficient that fall into this category of moderate social inequality (see table below) also include a mix of developed and developing countries. Theoretically, these countries with a moderate Gini Coefficient should be slightly more likely to experience internal problems caused by social inequality than those listed in the first table.

While this may be generally true for the developed countries, developing countries may face internal problems caused by other factors – such as ethnic separatism – so social inequality is not a perfect measure of social stability. Using these international comparisons (if social equality is a major factor to you), the countries listed below all possess a moderate level of social inequality and may be desirable countries for international retirement living.

International Comparisons: High Levels of Social Inequality (Gini Coefficient 40-49)

Countries with Gini Coefficients that fall into this category (see table below) consist of developing countries and a developed country with moderate to high levels of social inequality. These developing countries include countries from Latin America, Africa, and Asia. Interestingly enough, the one developed country that falls into this category is the United States. Although the United States has a moderately high Gini Coefficient, some social scientists would argue that the Gini Coefficient only measures cash income while some countries like the United States provides a considerable amount of social welfare that is non-monetary in nature. As a result, the Gini Coefficient for the United States is probably lower than what is shown.

Nevertheless, there still is probably more social inequality in this country than what the average person might assume. The United States is an interesting example. Although America may have high social inequality and crime rates, many Americans have found relatively peaceful places to live within the USA. This again, points out the fact that measures such as the Gini Coefficient is an ‘average’ used for international comparisons – and may not describe every location within a particular country with respect to the quality of life. In any country, there are likely to be significant internal variations due to differences between rural and urban areas, and between high and low income areas.

International Comparisons: Very High Levels of Social Inequality (Gini Coefficient above 50)

Countries with a relatively high Gini Coefficient in the table below are all developing countries with a sharp gap between the rich and the poor. Social inequality is at a very high level. For the most part, these countries are either in Latin America or Africa. Some social scientists believe that this is partly due to the colonial political systems that once dominated these countries that created very rigid social classes. For example, many of these countries have land ownership systems that evolved under a Spanish colonial influence which created and perpetuated a small wealthy landed class.

For international comparison purposes, there does appear to be higher levels of crime or instability in these countries with a high Gini Coefficient. One should keep in mind however, that the Gini Coefficient represents an average for an entire country. It is almost always the case that within a particular country there will be variations in Gini Coefficient values from one location to another. International comparisons of these countries against the rest world might suggest that these countries may not the most ideal for a peaceful and trouble free retirement due to the high degree of social inequality that exists. On the other hand, one might also conclude the opposite – that in these developing countries – pockets of development are beginning to emerge that may be suitable areas for a retirement abroad.

International Comparisons of Social Inequality: Summary

The Gini Coefficient is a useful measure of social inequality. It is not a perfect measurement and overstates the level of inequality for countries that provide non-monetary forms of social welfare to its citizens (e.g. the United States). As an indicator of social inequality, it does suggest the potential for social and political tensions that arise from differences in wealth between the rich and poor for any given country. The United States has a moderately high Gini Coefficient, which might be an indicator of the types of social problems that the United States has historically experienced as a result of social inequality.

There are developing countries that are viable international living destinations if you should choose to retire abroad that have levels of social inequality that are comparable to the USA or lower. For example, one could retire to a country with a good police force/army capable of managing social tensions. Alternately, one could decide to live in a large urban center where levels of security tend to be high.

(Photo by: Jon Rawlinson)

References and Bibliography

Countries With the Biggest Gaps Between Rich and Poor, Business Week

Gini Coefficient of Inequality, StatsDirect

Poverty Analysis, Measuring Inequality, World Bank

Social Inequality and Exclusion, Sociology Guide

For ease of interpretation, this article looks at and summarizes the WHO data on the percentage of deaths caused by environmental factors. The goal is to try to determine the healthiest countries for retirement based on the lowest levels of death caused by environmental factors.

Diseases associated with environmental factors that caused the greatest number of deaths worldwide were in the following order: diarrhea (water quality), lower respiratory infections (air quality), other unintentional injuries (workplace injuries, radiation, and industrial accidents), malaria (land management), road traffic accidents (urban transportation management) and chronic obstructive pulmonary disease (indoor air quality).

A high death rate from environmental factors is usually an indication of an inadequate infrastructure – such as a lack of an adequate improved and safe water supply or an inadequate sanitation system. In the list of deaths given above, it is likely that the very young and the elderly are the most vulnerable.

Most Healthy Countries to Retire: 14-20% of Deaths Caused by Environmental Factors

The countries in the table below can be considered to be the healthiest places to retire – where the percentage of deaths attributable to the environment is the lowest in the world (< 20%). For the most part, these are the ‘developed’ countries of the world like the United States. However, one will also find a number of countries that are considered ‘developing’ countries.

However, there is a significant difference in the causes of death between developed and developing countries – even though the percentage of deaths may be similar. In highly developed countries, there is a greater percentage of deaths caused from cardiovascular diseases and cancers – often associated with physical inactivity, a rich diet, and being overweight.

On the other hand, in developing countries, the major environmentally related causes of death will tend to be from communicable diseases (diarrhea and upper respiratory infections) and unintentional and road traffic injuries. These tend to be associated with a life of poverty in countries with inadequate infrastructure.

Healthy Countries to Retire: 21-25% of Deaths Caused by Environmental Factors

Countries listed in the table below are reasonably healthy places to retire on the basis of deaths attributable to environmental factors. In these countries, less than a fourth of the deaths are associated with an environmental factor manageable by humans. Infrastructure (water, sanitation, etc.) in these countries are reasonably good.

While not ideal, health risks associated with the environment are relatively low. Infrastructure will tend to be adequate in urban areas, and probably less so in rural areas. Countries in this category are all developing countries. With some precautions, these can be considered to be reasonably healthy countries for retirement purposes. It is recommended that the retiree do the necessary research and become familiar with infrastructure limitations and be prepared to manage them as needed.

Less Healthy Countries to Retire: 26-30% of Deaths Caused by Environmental Factors

Countries listed in the table below can be considered less healthy places to retire based on the percent of deaths caused by environmental factors. These are all developing countries – most of which are located in Africa or Asia.

These are probably not good retirement destinations for the average American. For the more adventurous type, it’s doable, but requires a lot more effort.

Least Healthy Countries to Retire: More than 30% of Deaths Caused by Environmental Factors

Countries in the table below can be considered the least healthy places to retire as a result of the relatively high percentage of deaths being attributable to environmental factors.

Retirement in these countries is not advisable. The lack of infrastructure is a significant problem. There is likely to be a high level of poverty with a greater chance of social unrest as well. In other words, there is a good chance that infrastructure problems will be linked to other social, economic and political problems as well.

Healthiest Places to Retire: Summary

One factor to consider when making the decision to retire abroad is how healthy a given country is. There are several ways to evaluate the healthiness of a country. In a previous article, we had examined the life expectancy of different countries. The assumption was that the average lifespan was greatest in the healthiest countries on the planet.

In this article, we’ve looked at the healthiness of a country based on the number of deaths which were attributable to environmental causes. In healthy countries, investments have been made to reduce the number of deaths caused by poor air or water quality, poor land management, or other cultural practices that have an adverse effect on the environment and ultimately human health.

(Photo: dawn)

References and Bibliography

Environment and Disease Risks, Science

Environmental Health Risk Assessment

Global Burden of Disease, World Health Organization

Global Health Risks, World Health Organization

World Health Statistics, World Health Organization

The United Nations publishes the data for international comparisons in an annual Human Development Index report each year. This report ranks the countries of the world into countries with very high human development index values to low human development index values. One is then able to compare and rank countries with a simple aggregate measure related to the quality of international living in those countries.

The values for the human development index can range from 0 to 1. For international comparison purposes, a score of 1.00 indicates a very high human development index ranking. On the other hand, a score of 0.00 indicates a very low quality of life level in the human development index rankings.

Human Development Index Ranking: Highest Levels of Human Development (0.90 to 1.00)

For purposes of international comparisons, countries falling in this category are the most economically developed countries in the world. Their human development index values are almost a perfect 1.00 which results in a high ranking. These high human development index rankings are associated with relatively high life expectancies, high levels of educational development, and very high standards of living (see table below).

Compared with all the other countries in the world these are probably the most ideal countries for work,  the raising of families abroad, and international living. They are also probably countries with highly developed health care systems and other infrastructure systems. If you retire abroad to these countries, you will be probably retiring to a country with all of the amenities that you are used to in America.

However, the major downside of countries with a high level of human development index ranking is that these will generally be countries with very high costs of living. This should be expected, since these countries will generally have high levels of taxation to maintain a very high social infrastructure.

Human Development Index Ranking: High Levels of Human Development (0.75 to 0.89)

Almost all of the countries that fall into this high human development index ranking (see table below) are developed countries. However, there are a handful of developing countries in this category that are oil producing nations that have been able to build modern educational, medical and economic infrastructures (e.g. Brunei Darussalam and Kuwait) with their oil revenues. Towards the bottom of this table, you will find some of the developing nations that are modernizing rapidly.

For international comparison purposes, if you retire abroad to countries near the top of this high human development index ranking list, you will enter a country with both a very high level of development and cost of living. However, there are a handful of countries located in the bottom half of this ranking with more moderate costs of living (e.g. Portugal, Czech Republic) that may be suitable for a retirement abroad and international living if you have a more modest retirement budget. Near the bottom of the table are developing with the lowest costs of living, but with a reasonable infrastructure in place.

For the most parts these countries have made substantial investments in their basic infrastructure. The retiree will generally find that the major urban centers of these countries are well developed and modern. However, it is likely that there are significant parts of the developing countries (near the bottom of the table below) that are not well developed with high levels of poverty.

Human Development Index Ranking: Average Levels of Human Development (0.60 to 0.74)

Countries with an average human development index ranking (see table below) are all developing nations that still have a way to go in the development of their educational, medical and economic infrastructure. Urban centers are likely to be well developed and modern, but there is wide variation in the level of infrastructure development. Rural areas are most likely not well developed and lacking in modern infrastructure.

If you retire abroad to these countries, there may be some missing pieces in terms of modern infrastructure, but the costs of living for these countries will be relatively low. Again, when making international comparisons, one should bear in mind that the human development index rankings represent an ‘average’ for a given country. Urban centers, particularly capital cities, may be significantly more developed than the human development index rankings might indicate.

Human Development Index Ranking: Low Levels of Human Development (less than 0.60)

Countries in this category are all developing and require a significant amount of development of their infrastructure. Major urban centers may have access to modern amenities, but there is a wide level of variation between countries and it is hard to generalize. Overall, costs of living will be quite low, but these will be challenging countries for international living because of gaps in their medical, educational and/or economic infrastructures.

The typical American retiree will most likely not select these countries as a retirement destination. The infrastructure in lacking in many areas and one will have to make major adaptations for international living in these countries. Of course, the cost of living will be very low, but access to quality medical, educational and economic amenities will be difficult. When making international comparisons with the human development index rankings, there are too many other affordable choices for a retirement to select these countries.

Human Development Index Rankings: Summary

Your ideal retirement destination depends on a number of different factors. The Human Development Index rankings can help you identify which countries are most suitable for your particular needs. For example, if access to modern healthcare is a major concern to you then countries that are high on the scale are likely to be best for you. If a low cost of living is the primary factor that you are concerned about, then the countries in the middle or lower range of the scale are more ideal.

As always, use statistics like this as a starting point, not for final decision-making. They can help you narrow down your options, but the final decision should be based on a more detailed analysis and assessment of where to retire abroad. The best international comparisons are made with your feet on the ground at the potential retirement destination if you are serious about retiring abroad.

(Photo by: Kamalayan)

References and Bibliography:

Economic Definition of the Human Development Index, Economic Glossary

Human Development Index Technical Notes, National Statistical Coordination Board

International Human Development Indicators, United Nations

Technical Definition of Gross National Income

The gross national income measures the total value of goods and services produced by a country plus the net of the payments received minus payments made to other countries.  In turn, gross national income per capita is the gross national income per person (GNI / population).

Gross National Income and Economic Development of a Country

Countries with a high gross national income are for the most part very developed countries. Generally, developed countries offer the retiree with the highest quality and most diverse range of amenities (e.g. health care, infrastructure, shopping) available. The downside is that the cost of living in such countries is usually very high.

Countries with a low gross national income are developing countries. They offer the retiree with lower costs of living, but with a much more limited range of amenities. One of the factors that should be considered by a typical retiree is finding a comfortable balance between access to needed amenities and the cost of living. By making some sacrifices with access to amenities it is possible for a retiree to still improve one’s standard of living by taking up expatriate living in a country with a lower cost of living than the United States.

Internal Variations in Gross National Income and Economic Development of a Country

One of the weaknesses in using a measurement like the gross national income is that it gives an overall snapshot of a country at one point in time. There are sometimes very significant variations in the contribution to gross national income from one part of the country to the next.

For example, urban centers are also major economic centers and make a significant contribution to the gross national income. Rural areas on the other hand usually make a smaller contribution to the gross national income.

A retiree can use this reality to his or her advantage by choosing to live in an urban area in a developing country. This usually provides the expatriate with a higher level of access to modern amenities while keeping the cost of living relatively low.

Adjusting the Gross National Income for Purchasing Power Parity

In the tables below, the gross national income for each country is adjusted for purchasing power. This purchasing power adjustment attempts to level out differences in the purchasing power of foreign currencies so that it is easier to make country to country comparisons. So for example, if in country A, a dollar buys one widget but can buy two widgets in country B – then the cost of living for each country is adjusted to take into account the difference in the buying power of the dollar.

Gross National Income by Country:  Highest Per Capita Incomes (greater than $30,000 per person)

The countries that have the highest gross national income per capita are the developed countries of the world. These are usually highly developed countries with 1) a diverse and well-developed economy (e.g. USA or Japan), or 2) a small state with a highly developed urban economy (e.g. Singapore or Hong Kong), 3) or a country that is a major oil producer (e.g. Kuwait). The cost of living in these countries will tend to be the highest when doing country to country comparisons.

Nineteen countries fall in this highest per capita income category.

Gross National Income by Country: Moderately High Per Capita Incomes ($15,000 – $29,999 per person)

This second group of countries (see table below) are a mixed of developed and developing countries with moderately high gross national income per capita. However, even the developing countries have a relatively modern infrastructure in place, and are on the leading edge of the developing countries.

These are primarily European countries, with a few exceptions like Argentina and Equatorial Guinea. They could be considered the less developed European nations, with a modern infrastructure in place, but a relatively low gross national income per capita. Some were former members of the old Soviet bloc of nations during the Cold War era. If one needs a high level of access to modern amenities but a low cost of living, these countries may be the most suitable for someone for retiring abroad.

Gross National Income by Country: Average Per Capita Incomes ($5,000 – $14,999 per person)

These are developing countries (see table below) that still have a lot of work in building their economic infrastructures. However, the capital cities of most of these countries are fairly modern by today’s standards and can provide an expatriate living abroad with a reasonably good standard of living.

Many of the countries in this category are Latin American, African, and Eastern European countries. The world’s average gross national income falls in this category with a value of about $11,000.

The more stable nations in this category have been popular retirement destinations among many expatriates, such as Mexico, Malaysia, Panama, Costa Rica and Brazil. Urban areas are usually capable of providing good access to modern amenities but with a reasonably lower cost of living than the United States.

Gross National Income by Country: Low Per Capita Incomes (less than $5,000)

These are all developing countries (see table below) that have a considerable amount of work remaining to develop their national economies. However, the capital cities in some of these countries will often be relatively modern with access to a reasonable amount of amenities for expatriate living. For example, in the Philippines, with a gross national income per capita of about $4,000, one has access to high quality hospitals, malls, housing, shopping and entertainment in the city of Manila.

Rural areas on the other hand will often be quite underdeveloped with a large percentage of the population living in poverty. Countries in this category are predominantly from Latin America, Asia, Africa, and the Caribbean.

As a general rule, if the gross national income per capita for the country is less than $3,000 these would probably not be a suitable retirement destination. Although the cost of living is very low, the high levels of poverty will often result in a considerable amount of social tension and instability – something that is not desired for international living. These countries probably would make decent retirement destinations for only the hardiest and most adventurous of retirees.

In general, the infrastructure in these countries are not well developed and access to modern amenities may be limited. Several factors may underlie why these are very poor countries. In many instances, these may be relatively isolated countries outside of the modern world economy or are countries that have undergone major political upheaval in recent years. The majority of these countries with a gross national income per capita below $3000 are located in Africa.

Gross National Income by Country: Summary

Countries of the world have been broken down into several categories based upon their gross national income per capita and level of economic development. These data provide a reasonable estimate of the cost of living overseas on a country by country basis.

However, it needs to be remembered that the gross national income by country data are gross aggregate data for individual countries. Within most countries, there is considerable variation in the economic wealth of regions – particularly between urban and rural regions. Use the gross national income data as a starting point in your analysis of potential retirement destination, but do follow up with a more in depth examination of each country by looking at internal variations in economic wealth and well-being.

Some would argue that the best opportunities lie in those countries with the lowest gross national incomes per capita, but with well developed urban areas capable of offering the most important amenities that one needs for international living.

(Photo by JonRawlinson)

References and Bibliography

Basic Indicators, UNICEF

Gross National Income, Nations Online

Measuring National Income, tutor2u

Rich and Poor Countries, The Equality Trust

Rich Nations, Poor Nations, Why the Difference

The consumer price index is a useful measure that looks at changes in the cost of a typical ‘basket of goods’ from one year to the next in a given country. It is a measure of inflation for that particular country over a year. If you are on a fixed income, keeping a close eye on inflation is an important activity that you will need to monitor – especially if you are retiring abroad on a very tight budget.

For purposes of this article, we will be looking at changes in the consumer price index for various countries for 2010. If you are planning on international living, but if your retirement income is fixed over time and if your overseas retirement budget is very tight, it will be worthwhile to evaluate the effects inflation rates by country.  This will enable you to determine how well your pension will hold up over time at different retirement destinations.

International Consumer Price Index: Lowest Inflation Rates by Country (less than 2% a year)

There is no clear pattern in terms of which countries fall into this consumer price index categories below (see table below). For example, the United States (inflation rate = 1.6%) is an example of a highly developed country, whereas El Salvador (inflation rate = 1.2%) is on the opposite end of the economic development scale. Nevertheless, both countries experienced relatively low inflation rates in 2010.
Although it is hard to make generalizations about the countries with low inflation rates, it is at least reasonable to say that the effect of the inflation rate on your retirement income in these countries is relatively low. In a country where the inflation rate is 2%, it will take 36 years for the price to a basket of goods to double. Where the inflation rate is 1%, the price of the same basket of goods will double in 72 years.

With an inflation rate of 1.6%, the price of a basket of goods will double in about 45 years. If your retirement income is fixed, the countries in the table below are ideal for international living due to a very low inflation rate.

International Consumer Price Index: Moderate Inflation Rates by Country (more than 2% – 4% per year)

Countries with moderately low inflation rates (see table below) are also a mixed bag of developed and developing countries. In these countries, the length of time that it takes for the cost of a basket of goods to double is much shorter than those in the table above. In a country like Estonia with a consumer price index of 3% a year, the doubling time of the cost of a basket of goods is 24 years. In Djibouti, the 4% consumer price index translates into a doubling time of 18 years for your basket of goods.

Inflation is moderately low in these countries. They are suitable for retirement on a fixed income, but one’s retirement should not be too tight and hopefully one’s pension has some kind of an annual cost of living adjustment to keep up with the moderate inflation rate.

International Consumer Price Index:  Average Inflations Rates by Country (more than 4% to 8% per year)

The countries in this category (see table below) are developing countries. Inflation rates are moderately high. Laos, with an inflation rate of 6% has a doubling time of 12 years and the Kyrgyz Republic’s inflation rate of 8% will experience a doubling time of 9 years.

For someone living on a fixed pension with a very tight living budget, the countries in this category are marginally suited for a retirement abroad. In time, the high consumer price index value will erode the purchasing power of your pension.

International Consumer Price Index: Very High Inflation Rates by Country (more than 8% a year)

Countries in this category are developing countries high inflation rates (see table below). Retiring abroad to countries with a consumer price index from above 8% will find inflation to be quite high, with the price of goods doubling every 7 years (10%) and 5 years (15%).

For pensioners with a fixed retirement income and a very tight international living household budget, these countries are not recommended for retirement. With a consumer price index this high, these countries are probably not suitable for international living unless you have very deep pockets.

International Consumer Price Index: Summary of Inflation Rates by Country

For retirees on small and fixed pensions, countries with a low inflation rate (low consumer price index) are more ideal as a long term retirement destinations. Of course, one needs to consider many other factors, but the inflation rate is a very useful statistic to evaluate to keep track of the purchasing power of your pension over time.

If the inflation rate is very high (high consumer price index), expatriates living abroad will find the purchasing power of their retirement incomes decreasing very rapidly from one year to the next. In general, from a financial perspective, countries with a high consumer price index may not be the best places to retire if your retirement income is fixed.

The inflation rate for any particular country does vary from one year to the next. The data in tables are for 2010. Depending on economic condition in any given country, inflation rates may go up or down from one year to the next.

(photo by: Peat Bakke)

References and Bibliography

Consequences of Inflation, tutor2u

Consumer Price Index, World Bank

Consumer Price Index, Bureau of Labor Statistics

CPI Inflation – Current International Consumer Price Index Inflation, Global-Rates (most current international consumer price index data)

International Price Levels and Global Inflation, OECD

An improved sanitation system usually begins with a flush or pour toilet connected to a piped sewage system. Human waste may then be disposed off by passing it to the piped sewage system with water. The piped system will usually transport the waste to some kind of treatment system such as a septic tank or large scale sewage treatment system before being returned to the environment.

In some instances, pour-flush latrines and regular latrines will be considered a safe sanitation system if they are private and possess mechanisms for treatment and transport of the waste away from human contact. Thus, public or shared latrines would not be considered an improved sanitation system.

Today, approximately 40% of the people in the world do not have access to what would be considered access to improved sanitation. In these parts of the world, the population is exposed to bacteria, viruses and parasites that are responsible for infectious diseases that claim millions of lives each year. This includes diseases such as cholera and typhoid, but less exotic problems such as diarrhea as well.

When making the decision to retire abroad, one should carefully evaluate one’s living conditions when looking for a home. This includes not only one’s immediate home but homes and sanitation systems in the neighborhood and even surrounding neighborhoods.

During a heavy rain for example, flowing surface water does not follow neighborhood boundaries. If one’s ‘middle-class’ neighborhood had adjacent squatter homes, one may be exposed to contaminated water no matter how high your rent or subdivision is. In many developing countries with a relatively high level of access to sanitation, over-crowded urban areas may create the risk of contamination – since slums may not have access to improved sanitation systems.

It is possible to live in countries without 100% access to improved sanitation, but one will have to insure that one’s home practices good hygiene and minimizes the risk from surrounding areas especially when there is surface runoff from heavy rains or floods. If the sanitation system does not adequately treat the waste water, there is a good chance that it may end up polluting rivers, lakes or the ocean. Thus, even recreational areas may be exposed to health risks from inadequate sanitation systems.

The tables below show the relative degree of access to improved sanitation systems among the countries of the world.

Extremely Safe Sanitation: 100% of the Population with Access to Improved Sanitation Systems

Countries whose populations have universal access to improved sanitation systems are shown in the table below. For the most part, these are the developed countries of the world and reflect substantial public investment into the nation’s sanitation infrastructure. The United States falls into this category.

Of course, even in these countries, sanitation systems are vulnerable to failure when extreme events such as a major hurricane or earthquake occur. For routine living conditions however, these countries can be considered to have very safe and improved sanitation systems in place and where the risk of contamination from human fecal matter is very low.

Safe Sanitation: 90-99% of the Population with Access to Improved Sanitation

Countries in the table below have relatively safe sanitations systems for their respective communities – where over 90% of the population have access to improved sanitation systems. Although most are ‘developing’ nations, a significant amount of public investment has been made in both rural and urban sanitation systems. These represent the ‘developing’ countries that have made the most progress in improving their national infrastructure.

In these countries, the greatest risk of exposure to health risks will tend to be in rural areas and in squatter settlements in congested urban areas. Risks are relatively well contained however, and under normal conditions probably do not pose an excessive risk to those retiring in these countries. In general, urban areas can be considered relatively safe for an overseas retirement.

Average Sanitation: 60-89% of the Population with Access to Improved Sanitation

In the large urban centers of the countries listed below, access to improved sanitation systems is usually higher than the numbers suggest. The numbers shown reflect the fact that the access to improved sanitation systems in rural areas is sometimes much lower than the numbers indicate.

In many of these countries, there has been inadequate public investment of sanitation systems in rural areas and one should probably take precautions if living in a rural area or in an urban area near to squatter type settlements. Precautions include drinking bottled water, obtaining necessary immunizations, and practicing a high level of personal and household hygiene.

Relatively Unsafe Sanitation: Less Than 60% of the Population with Access to Improved Sanitation

Populations in the countries shown below do not have a high degree of access to improved sanitation systems. This tends to be true for urban as well as rural areas. As a result, there is a greater risk in these countries of fecal contamination or transmission of disease in waste water.

In general, these are not countries that are recommended as a retirement destination for your typical American.

Access to Improved Sanitation: Summary

If one plans to retire abroad, it is extremely useful to look at a country’s investment in basic environmental systems that Americans take for granted. This includes the public’s access to safe water and improved sanitation systems. Countries with low levels of access to safe sanitation systems exposes these countries to a greater risk of being exposed to diseases carried by human waste such as cholera, typhoid and diarrhea.

(photo: mountain amoeba)

References and Bibliography

Millenium Development Goals Report, United Nations

Population Using Improved Sanitation, World Health Organization

Promoting Environmentally Safe Sanitation, One World South Asia

Water Facts, Water.org

Why Improved Sanitation is Important for Children, UNICEF

Access to clean water is essential for personal hygiene and human health and well-being. The World Health Organization looks at improved drinking water sources as providing safe drinking water for human consumption. An improved drinking water source is by the nature of its design able to protect the source from contamination – especially fecal contamination. Thus, piped in water, public taps, protected wells, and protected springs are considered improved drinking water sources capable of providing safe drinking water.

Why Are Improved Drinking Water Sources Important?

Improved drinking water sources are capable of providing water that is fit for human consumption. The human body is over 70% water and requires an adequate supply of water to replenish daily losses through sweating and elimination of body wastes. In developed countries, improved drinking water comes from a variety of sources such as groundwater, rainfall, and surface water. In developed countries, water is usually delivered via a complex supply network of pipes that is costly to install and maintain. In some developing countries, improved drinking water is not deliverable to all homes – particularly to rural homes and the population must purchase improved drinking water or consume untreated water.

Consumption of untreated water in turn, exposes the population to a variety of health risks. The most common of the risks from water borne diseases are diarrhea, typhoid and cholera. The primary source of pathogens causing these diseases is contamination from sewage and contributes to nearly two million deaths a year around the world.

In addition to water borne pathogens, water sources are vulnerable to contamination from a variety of toxic materials. These toxic materials include heavy metals (usually from industrial activity) and nitrates/nitrites (usually from agricultural sources).

Despite access to improved drinking water sources, some expatriates living abroad will consume only bottled water that has been treated in some way to reduce the risk of being exposed to some type of water borne pathogen.

Extremely Safe Drinking Water by Country: 100% of Population Using Improved Drinking Water Sources

The table below lists countries where almost all of the population has access to extremely safe drinking water. Countries where 100% of the population has access to improved drinking water sources are countries that are extremely well suited for international living and a retirement abroad from a health and safety standpoint.

Although most countries in the table are developed countries, there are a number of developing countries listed where the entire population has access to improved drinking water sources. These developing countries are also likely to have other improvements in their public infrastructure that make them suited for international living.

From an overseas retirement perspective then, it is possible to find developing countries (where the costs of living are lower, the climate more moderate, etc.) without sacrificing access to improved drinking water sources and exposing yourself to unnecessary health risks.

Very Safe Drinking Water by Country: 95-99% of Population Using Improved Drinking Water Sources

Countries in the second table (below) provide relatively good access to improved drinking water sources. It is not perfect though and one should use some degree of caution if deciding to retire abroad to these countries. It is likely that in urban areas, access to safe drinking water is very high – but is usually less so in rural areas.

To be on the safe side, it is not uncommon for many expatriates to drink bottled water that has been treated in some fashion rather than relying on some public source of drinking water. Many of the countries in the listing below are developing nations that have made the necessary investment to provide safe drinking water to their populations.

The world average of 95.8 is the figure for the level of access to improved drinking water sources in the world today.

Average Levels of Safe Drinking Water by Country: 85-94% of Population Using Improved Drinking Water Sources

Countries in the table below have populations with moderately safe drinking water with 85-94% of the people having access to improved drinking water sources. Although ‘moderately high’, it will probably be a good idea to drink bottled water or employ your own water treatment system if deciding to retire in any of these countries.

All countries in the table below with moderate levels of improved drinking water sources are developing countries. They have the potential to be a good location for a retirement abroad, but the retiree will have to take extra steps to provide his or herself with an adequate supply of safe drinking water. In these countries, the problems with access to safe drinking water tends is likely to be problematic in both urban and rural areas.

Relatively Unsafe Drinking Water by Country: Less Than 84% of Population Using Improved Drinking Water Sources

Countries whose population doesn’t have good access to safe drinking water are listed in the table below. For the most part, these are the least developed countries on the planet and not a recommended retirement destination for the average American. The low percent of the population using improved drinking water sources suggests that the risk of being exposed to water borne diseases are much higher than the countries listed in the previous tables.

It is very likely that other aspects of the country’s public infrastructure are also lacking and are likely to provide many challenges if retiring to these countries.

Safe Drinking Water by Country: Summary

Rather large variations exist between countries with respect to their populations’ access to improved drinking water sources. Access to safe drinking water is essential for good health and hygiene – things that a retiree should be conscious of when living abroad. On the other hand, it is not too difficult to insure a supply of safe drinking water by purchasing bottled water or treating the water before drinking.

For retirees with families, it is recommended that one selects a country with a high level of public access to improved drinking water sources as it is difficult to continuously monitor everyone’s water consumption daily. A country that does not have high levels of safe drinking water is one that probably does not have the financial resources to maintain other aspects of the public infrastructure as well (e.g. sanitation systems, roads, schools, etc.) and may not be a desirable place for international living for many reasons beyond access to improved drinking water sources.

(photo: Tomas Sobek)

References and Bibliography

Access to Safe Drinking Water Improving, Sanitation Needs Greater Efforts, World Health Organization

Drinking Water, Centers for Disease Control and Prevention

Global Health Observatory Data Repository, World Health Organization

Water.Org

What is Male Life Expectancy?

Male life expectancy is the average number of years that a newly born male child can be expected to live in a particular country. Variations in the male life expectancy between countries are caused by many factors. The statistics will vary from one country to the next, and will usually vary between locations within an individual country as well. In other words, if you are seeking out the healthiest place to retire, you should look at country male life expectancies (tables below), and look at in country variations as well (i.e. between urban and rural areas).

The male life expectancy of a country is a useful statistic that tells you something about a nation’s social and health conditions. If a country’s life expectancy is very high, then it is likely that you are looking at a developed country with a modern health care system – something of high importance for retiring abroad.

If the country’s male life expectancy is very low, it may be an indication of a poorly developed health care system, high poverty conditions, major health problems such as AIDS, a high infant death rate, internal wars and conflicts that increase the death rate, or a poor health and sanitation infrastructure. Countries with a low male life expectancy are not likely to be the healthiest places for international living.

Can Retirement Abroad Affect Your Personal Life Expectancy?

Unless you are an individual who enjoys a great deal of risks and living life on the edge, you will probably be interested in a retirement destination with a high male life expectancy. It not only is an indicator that the social situation and health conditions are very good if you retire abroad there, but it may be a guide for improving your own personal health as well.

For example, although the United States is one of the wealthiest and most developed countries in the world, Americans rank 44th on the list of countries for male life expectancy. Clearly, having a modern healthcare system and modern infrastructure are not the only factors affecting a country’s male life expectancy.

Factors such as diet, lifestyle, and environmental conditions also influence a country’s male life expectancy. Should you retire abroad, you may be presented with an opportunity to modify your diet and lifestyle to be more alike to those living in a foreign country. Assuming that your retirement destination has a high male life expectancy, it may be possible to increase your personal life expectancy as well. Healthiest places to retire are healthy not only because of external factors such as their health care system, but also because of the lifestyle choices their citizens make (more exercise, healthier diets, etc.)

However, there are some factors that are difficult to change which influence a country’s life expectancy. Good examples of these factors are gender and ethnic origin. From one country to the next, males typically have a lower life expectancy than women. And, on the opposite side of the scale, there are some ethnic/racial groups that seem to have a much higher life expectancy than others.

So, if you are considering international living for retirement, then an examination of a country’s male life expectancy may help you select a country with a decent infrastructure that supports good healthcare. And it may also help you to modify your lifestyle to actually increase your own life expectancy as well. A combination of good health infrastructure, positive social conditions, and healthy lifestyle choices will help you to find a healthy place for retirement.

The following is a list and analysis of countries by their life expectancies.

Healthiest Places to Live: Very High Male Life Expectancy (75 years or more)

To some degree, this category with a very high male life expectancies (see table below) contains many small and highly urbanized nations. The high country life expectancy may be simply an indication of countries with a fairly modern urban infrastructures in place and a very small rural population living in poverty. On the other hand, there are many studies about the longer life expectancies of the Japanese as a result of their diet and lifestyle. Whatever the case, a retired expatriate is likely to find the countries in the following table to possess the infrastructure and possibly lifestyles associated with a longer male life expectancy

It is interesting to note that the United States falls somewhere near the bottom high male life expectancy list. Most of the countries with a high country life expectancy are located in Europe, North America, North Asia or Oceania. However, toward the lower end of this high male life expectancy list, there are a handful of lesser developed countries – some from Central and South America and the Middle East that also rate among the healthiest places for retirement.

At first glance, a country life expectancy of 73.3 (Panama) may seem to be less healthy than a country with a score of 75.7 (USA). However, one needs to keep in mind that the poor make up a much larger percent of the population in a developing country like Panama and skews the national statistic for male life expectancy. However, it is likely that in the most urbanized parts of Panama and among the wealthier classes of Panama, the differences in male life expectancy may not be as great.

Thus, the decision to retire abroad does not necessarily create a risk to your life expectancy – as long as you are living in a part of the country with an adequate social and healthcare infrastructure and have the financial resources to afford a decent lifestyle to find a healthy place to retire. See table below:

Healthy Places to Live: Above Average Male Life Expectancy (70-74 years)

Most of the countries with an above average country life expectancy are developing countries that in recent years have made a lot of economic progress towards becoming a developed country. There a large number of Eastern European, Middle Eastern, Caribbean, Latin American and Southeast Asian countries in this category.

In part, the lower life expectancy in the Philippines (70.5) compared to the USA (75.7) is related to the large percent of their population living in poverty – a segment of the population with a higher rate of infant mortality and less access to healthcare that brings the average life expectancy down. Unless your retirement plan is to live in this kind of poverty, it is usually possible to avoid areas within the country that have a low life expectancy.

As such, many of these countries probably do not necessarily expose you to a risk of a lower life expectancy – if you are able to afford living in a decent neighborhood with access to quality healthcare. On the other hand, if you lack the resources to live in a decent neighborhood, then you are very likely exposing yourself to some risks that may lower your life expectancy. These countries can be relatively healthy places to retire with sufficient financial resources for the best healthcare and by living in the larger urban centers where the best healthcare is found.

Marginally Healthy Places to Live: Average Male Life Expectancy (60-69 years)

By and large, countries with an average male life expectancy (see table below) are the developing countries in the world. A variety of factors contribute to a lower male life expectancy. Many of these countries have not had the economic resources to really develop their economic infrastructure. In other cases, these countries have experienced a high level of military conflict (e.g. Iraq). For others, the infant mortality rates are very high and pulls the nation’s average life expectancy down.

If you are considering living abroad or planning to retire in one of these countries, it is recommended that you do some research on the country and its infrastructure to better understand the risks that you may or may not be exposing yourself to. These can be healthy places to retire to but it will take a lot more planning and adequate finances for international living in these countries. See Table below:

Unhealthy Places to Live: Below Average Male Life Expectancy (Less than 60 years)

Almost all of the countries in the below average male life expectancy list are African nations – a region of the world with relatively low levels of economic and infrastructure development. In addition, many are tropical nations with some risks associated with tropical diseases. Almost all are very poor countries and in some cases have been exposed to warfare, famines, or disease outbreaks (e.g. HIV).

In general, international living in these countries does carry some real risks and one should do as much research as possible on the country prior to making a decision to live there. For the typical American, these can be considered as relatively unhealthy places to retire and not recommended for international living.

Healthiest Places to Live by Male Life Expectancy:  Summary

It is very useful to look at the life expectancy of the country that you may be planning to retire to. In most developed countries, this is not much of a problem. You will probably end up in a situation with a good social and healthcare infrastructure in place. The same is true for large urban centers in many developing countries. If selecting international living in a developing country, an adequate amount of financial resources combined with a healthy lifestyle can make it one of the healthiest places to retire and live.

It is probably only in the most underdeveloped countries of Africa that it is extremely difficult to eliminate the risks to factors that might lower your life expectancy.

(photo by Wonderlane)

References and Bibliography

A Model for Geographic Variation in Health and Life Expectancy, Demographic Research

Life Expectancy, World Health Organization

Life Expectancy – Men and Women, UN Statistics

World’s Best Places to Live 2010 (Cities), CNBC

World’s Healthiest Countries, Forbes

The Joint Commission International (JCI) is an extension of America’s Joint Commission that sets quality healthcare standards for American hospitals. Foreign hospitals that receive JCI accreditation have demonstrated an ability to develop an organizational culture focused on continuous healthcare quality improvement with an emphasis on patient safety. JCI accreditation standards have been developed by healthcare experts from around the world to insure that healthcare and surgery abroad will be performed using the highest possible standards. A JCI accredited hospital may be your best option for the highest level of international quality healthcare.

At the same time, as the seemingly endless debate on healthcare continues in the USA, many Americans are choosing medical tourism as an alternative to what appears to be a broken and expensive American healthcare system. Many countries around the world have begun to add medical tourism as part of their economic development strategy by expanding the number of JCI accredited hospitals and healthcare facilities to meet this demand.

Today, many foreign hospitals and other healthcare facilities are seeking JCI accreditation. Obtaining JCI accreditation for a hospital is a complex process that foreign hospitals must go through to insure that they can provide quality care for their patients. This involves meeting JCI accreditation standards and the internal mechanisms to continuously upgrade, educate and train their staff.

The growth of medical tourism around the world works to the advantage of retirees who have moved abroad. Increasingly, it is becoming easier for expats to gain access to JCI accredited hospitals in many countries around the world.

International Quality Healthcare: Types of JCI Accreditation

In addition to JCI accredited hospitals, a several other types of healthcare services may also apply for accreditation. These other types of services are as follows:

JCI Accredited Ambulatory Care: ambulatory care is healthcare that is provided on an outpatient (visits the facility for care rather than staying for 24 hours or more) basis. The type of healthcare provided is typically free standing medical, dental and surgical facilities; dialysis and radiologic centers; and outpatient chronic and acute care centers.

JCI Accredited Care Continuum: a care continuum is a community based healthcare setting, where care is provided beyond the traditional institutional (i.e. hospital) setting. This would include providing home care (in home care provided by healthcare practitioners, assisted living (assistance with daily living activities), hospice (relief and prevention of suffering from a serious/terminal illness), and long term care (services for patients with a chronic medical condition that cannot care for themselves).

JCI Accredited Laboratories: specialized laboratories that perform a variety of medical tests for diagnosis and treatment of patient illnesses.

JCI Accredited Hospitals: includes both public and private medical facilities that provide inpatient (longer-term) patient treatments. It may also provide psychiatric care and outpatient services.

JCI Accredited Medical Transport: a health support organization that provide dispatch services, limited medical treatment and/or infection control during the transport of the patient, as well as vehicular management and safety practices.

JCI Accredited Primary Care Centers: a primary care center provides initial healthcare consultation and services within a community. Healthcare is usually provided by a doctor (general practitioner) but may also be provided by other healthcare providers such as nurses, pharmacists, and physician assistants.

JCI Accredited Clinical Care Program Certification: special certification for a healthcare organization’s ability to treat a specific disease condition (e.g. heart failure, stroke, cancer, HIV, asthma, etc.)

International Quality Healthcare: Other Accrediting Bodies

In addition to the JCI accreditation of hospitals, other countries may have their own healthcare accrediting system. A list is provided below of JCI accredited institutions in countries around the world. Although a particular country may not be listed, it may have in place a similar accreditation process used to insure quality control in national healthcare.

It will be useful for anyone retiring abroad to take a look at the medical accreditation process in their selected retirement destination. The presence of JCI Accreditation is an assurance that a healthcare facility meets certain quality standards. However, the absence of JCI accreditation of a foreign hospital does not necessarily indicate substandard healthcare.

International Quality Healthcare: JCI Accredited Hospitals and Facilities Around the World

A detailed table of the number and types of JCI accredited facilities in various countries are found at the end of this article. Regional summaries of the data in the table is provided below:

JCI Accreditation in Europe: As one of the more developed regions in the world, Europe offers the overseas traveler or expatriate a large number of JCI accredited healthcare institutions. Ireland, Italy and Spain seem to have the largest number of healthcare institutions with JCI accreditation that probably reflect their ambitious efforts to promote medical tourism.

Europe has well over 60 JCI accredited hospitals alone. This is no doubt an underestimation of the number of quality hospitals in the region since most countries have alternative mechanisms for insuring quality healthcare services. Generally speaking, the international quality of healthcare is very good in the Western European countries.

JCI Accreditation in the Caribbean, Mexico and Central America: Perhaps because the Caribbean and Central America are so close to the USA, there are not a large number of facilities with JCI accreditation in the region. At the present, Costa Rica and Mexico are the countries with the largest number of accredited healthcare facilities (11 JCI accredited hospitals) and may be the best option for healthcare and surgery abroad.

Combined with other amenities for the potential retiree, Costa Rica and Mexico are among the best countries for retirement abroad in the region. However, because of the close proximity to the United States, quality healthcare is never too far away. A JCI accredited hospital may be no more than a couple hours of flight time away for countries in this part of the world.

JCI Accreditation in Asia: In Asia, the countries that seem to provide the best options for healthcare and surgery abroad include: China, India, Singapore, South Korea, Taiwan and Thailand (each with 10 or more JCI accredited hospitals). It is clear that countries in this part of the world are making a significant investment in medical tourism and doing so in a quality fashion. Medical tourism is a multi-billion dollar industry in this part of the world.

The quality of some of these facilities is very high and some of the JCI accredited hospitals have developed a reputation as ‘luxury upscale’ types of facilities at a fraction of the cost of American hospitals.

JCI Accreditation in South America: Options for facilities that have JCI accreditation in South America are somewhat limited. Brazil is the one country that has a very large number of facilities (including 17 JCI accredited hospitals) that are now accredited. Chile and Colombia offer a small number of facilities with accreditation as well.

Brazil is aggressively going after the medical tourism market. Although at one time it was known primarily for cosmetic surgery, the industry is now broadening and expanding to include a broader range of medical procedures.

JCI Accreditation in the Middle East and North Africa: Interestingly enough, the Middle East and North Africa can provide an expatriate living in this part of the world with a wide range of facilities that have obtained JCI accreditation. Countries with the largest number of facilities with JCI accreditation for healthcare and surgery abroad are the Kingdom of Saudi Arabia, Turkey and United Arab Emirates (each with over 30 JCI accredited hospitals).

International Quality Healthcare: What kind of medical care will you need if you retire abroad?

You should consult with your doctor on this for the best advice. In general, if you have a family history where acute care  (short term hospital care and procedures) is likely to be needed, then a country offering several JCI accredited hospitals are a decent choice healthcare. Specialized JCI accredited certification and mobile transport may also be desirable depending on the nature of the medical condition.

On the other hand, if you have long term care needs – such as an American type nursing home – then a country that can provide facilities that have JCI accreditation for the Care Continuum may be your best choice for healthcare abroad.

(photo: US Navy Imagery)

References and Bibliography

Accreditation and Certification, Joint Commission International

Defining Patient Safety and Quality Healthcare, NCBI

International Benchmarking of Healthcare Quality, Rand Corporation

Medical Tourism, Healthbase

Quality of Care Program, American Medical Association