The appeal of living in the countryside is obvious. You’ll enjoy living in plenty of space, perhaps in a larger house with your own garden or plot of land, with ample opportunities for adventure on your doorstep.

However, pastoral living also has its downsides, and one of these is that you may find it harder to access high-quality healthcare. With less access to medical facilities, including emergency support, it’s important to understand your options when moving to a new country, and to have a plan for accessing healthcare if and when you need it.

What challenges do rural hospitals face?

Hospitals in rural and remote areas face a number of challenges that their urban counterparts do not. It’s important to be aware of these challenges, as they may affect your ability to access healthcare when you move abroad. Some of the challenges faced by rural hospitals include:

Smaller hospitals

Research from around the world shows that, while the numbers of hospitals are relatively similar in both urban and rural areas around the world, rural hospitals tend to be just one-third the size of those in cities.

Poorer resources

Urban hospitals tend to be much better equipped than rural hospitals. In India, for instance, 69% of the country’s hospital beds are found in urban hospitals, while in Brazil essential medical technology such as MRI machines are much more highly concentrated in cities, leaving some rural areas without any machines of their own.

Fewer staff

Another challenge faced by rural hospitals is attracting highly-qualified staff. Top healthcare professionals tend to flock to cities, where higher patient volumes and closer proximity to medical schools can help to enhance their careers. This can leave hospitals in rural areas under-stocked or even devoid of certain specialists. In the UK, for instance, rural hospitals have a hard time attracting GPs.

Longer travel times

Patients in rural areas also find it much harder to get to their nearest hospitals. In the USA, rural dwellers live an average of 10.5 miles from their nearest hospitals, while city dwellers usually live within just 4.4 miles. This means urban citizens also have a greater range of options when it comes to choosing a hospital. It also adds additional costs to those living in rural areas, who must pay more for transport to their nearest facilities.

Generally older populations

Another challenge faced by rural hospitals is that they tend to serve a much older population. For instance, in Spain, 11% of people in rural areas are aged 80 and above, compared to just 5% in urban areas. Since older people are more likely to present at hospital, rural hospitals may actually end up experiencing a higher workload.

Poor digital infrastructure

Finally, rural hospitals may face challenges when it comes to aligning themselves with technological standards. They may lack telecommunications infrastructure, or find it hard to employ technology experts, which make it difficult for them to offer the latest digital services. You may therefore find that modern conveniences such as video consultations are less common in rural areas.

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The furthest places on Earth from medical facilities

According to research published in Nature, a few regions on Earth are known for being the furthest away from any suitable medical facilities. These particular areas may involve patients travelling over 24 hours to reach their nearest high-quality medical facilities.

Australian Outback

While Australia’s coastal regions are well-stocked with hospitals, those living inland – and particularly the Gibson desert region in the west of the country – may find it incredibly difficult to access hospitals. Southwestern Tasmania is another region that is not well-stocked with hospitals.

Saudi Arabia

While the Saudi Arabian capital of Riyadh has over 100 hospitals, the rest of the country – particularly the region to the south of the Arabian Peninsula – has limited availability of healthcare services. Those living in the desert regions of Jordan, southern Iraq and northern Yemen may encounter similar difficulties. 

Northern Canada and Alaska

The sparsely populated northern regions of Canada contain very few hospitals. Indeed, of the 1,017 hospitals in Canada, only 28 are in Nunavut and 21 are in Northwest Territories. Yukon has just 8 hospitals for the whole region. It’s a similar story in Alaska, where hospitals tend to be found only in the major towns and cities.

Saharan Region

Those who fall sick in the Sahara Desert are in for a long journey to their nearest hospital. The entire region travelling through Western Sahara and Mauritania, via Mali, Algeria, Niger, Libya, Chad, Sudan and Egypt is a black spot for medical facilities.

Amazon Region

The sparsely populated interior of South America is once again a black spot for hospitals. Those living or visiting the Amazon rainforest region, encompassing northwestern Brazil along with parts of Peru, Colombia and Venezuela, may find themselves in need of a plane ride to their nearest hospital.

Himalayan Region

While India and China have over 100,000 hospitals between them, the Himalayan region that separates them is notoriously poorly stocked. This is particularly true in the Chinese region of Tibet, which has just 7 hospitals in 474,000 square miles.

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New Guinea

The island of New Guinea, which includes the Indonesian province of Papua and the country of Papua New Guinea, has some of the lowest numbers of hospitals in the world. Papua New Guinea faces a particular health crisis, whereby despite 80% of its 10 million population living in isolated areas, rural hospitals are closing rapidly, leaving large regions without good access to healthcare.

Sunda Islands

The Greater and Lesser Sunda Islands, which includes regions such as Java, Borneo and Bali, are spread between the countries of Indonesia and Malaysia and also includes the country of Brunei. Many of the Sunda Islands are well stocked with hospitals (with 14 hospitals to itself, Bali is a popular destination for medical tourism) while others may have no hospital at all. The central provinces of Borneo also do not have a hospital.

Patagonia

The wild region of Patagonia, which straddles Argentina and Chile, is notoriously sparsely populated. As such, hospitals can be very hard to come by, particularly in the southernmost regions.

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We rank the best countries for living a long and healthy life

What to expect from living in a rural area

If you intend to move to an isolated region in a foreign country, you will need to be prepared to face certain complications when it comes to accessing healthcare. These include:

Long journeys to hospitals

Living in a rural region, there’s a strong probability that your nearest hospital will be a considerable journey away from your home. As such, you may not be able to depend on ambulatory care in an emergency, as ambulances may need to travel a considerable distance to reach you. This can have a significant impact in emergency situations, or if you intend to give birth.

If you intend to live alone, you will need to prepare an emergency response protocol for times when you will not be able to transport yourself to hospital. This may include purchasing a panic alarm, which will allow you to summon the emergency services with just the press of a button. You may also wish to consult with your closest neighbours, in case you need to call on them for emergency support or transport to a hospital.

Being prepared to treat yourself

If you will face a long wait for the emergency services, you or your partner should be prepared to administer first aid while you wait. You may wish to attend a first aid course to ensure you know the necessary skills, such as CPR, getting someone into the recovery position, preventing choking, and bandaging a wound.

You should also keep your home well-stocked with medication and first aid equipment. You may want to ask your GP for additional stock of medication, to ensure you’ll never run out. If you have allergies, you should always keep a supply of EPIPENs around the house. If you have diabetes, make sure you keep a good supply of insulin. And if you suffer from asthma, you should always have a spare inhaler close at hand.

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Less access to specialist services

Rural hospitals tend to be less well equipped, both with highly-trained staff and top-of-the-line medical equipment. You may find that your nearest rural hospital lacks certain types of medical specialists, or equipment like CT and MRI scanners.

In these cases, you will need to be prepared to travel further afield for specialist treatment. Depending how far it is to your next-nearest hospital, this may incur significant expenses.

Higher medical expenses

While the cost of treatment tends to be cheaper in rural hospitals, you may find the cost of secondary expenses to be far higher. If you need to take an ambulance over a long distance, or be transported by air, this can add a significant extra cost to your hospital bill. And, if your nearest hospital is too far to travel there and back from in a single day, you may need to pay extra to book a hotel room for the night.

These costs will become apparent if you need to attend a hospital for routine treatments, such as chemotherapy.

More emergency planning

Living in a remote area, you will need to have a strategy in place for if and when you encounter an emergency. This may involve getting in touch with services such as your local air ambulance (if you will need to be airlifted to hospital), mountain rescue and sea transport services (for instance, if you live on an island, or may require emergency sea or river transport).

Before setting off on your new life in a remote region, it’s important to know who you can contact in your region. This is especially true if you will need to register with these services, and you may also be required to make supplementary insurance payments to these services providers.

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The importance of medical evacuation (medevac) insurance

If you intend to live in a rural or remote area, you may wish to consider taking out international health insurance that includes medical evacuation insurance.

Medical evacuation insurance may be helpful if:

• You will be living on an island, in a jungle or in a desert area without high-tech medical facilities
• You will be living a long way away from your nearest major city
• You will be living in an area that does not have its own advanced medical facilities

Medical evacuation insurance gives you the peace of mind to know that you will always be able to reach a high-quality hospital, wherever you are. This includes transport by land, sea and air, and even transport into other countries, or to your home country.

Medical evacuation insurance with William Russell

At William Russell, all of our international health insurance policies include medical evacuation insurance as standard.

As a William Russell member, we’ll ensure you’re always able to reach your nearest high-quality medical facility or hospital. Depending on your coverage zone, this policy can extend from your own front door to any remote region anywhere in the world – so you can travel freely with total peace of mind.

With William Russell, your medical evacuation insurance covers the cost of your return transport to a hospital via land, sea or air, plus the cost of a friend or family member you wish to travel with you, and accommodation for your travel companion. We will even transport you across national borders, or back to your home country when necessary.

You also have the option to upgrade to our Medevac Plus policy, which offers extended accommodation for your companion, a lower threshold for evacuation, advanced repatriation costs, plus a medical escort to travel with you if you do not travel with a companion.

Some locations are more desirable than others for expats

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Go anywhere with total peace of mind

At William Russell, we have over 30 years’ experience helping expats just like you settle into their new lives overseas.

We offer flexible policies to suit your needs, offering you access to a network of over 40,000 private medical facilities, hospitals and clinics across the globe, and all of our policies include medical evacuation insurance as standard.

Find out more about our international health insurance policies and get a quote online in under two minutes today.

The post Healthcare In Remote Areas: What You Need To Know appeared first on William Russell.

Climate change is amplifying these risks. Rising temperatures, extreme weather events, and environmental shifts are affecting air quality and increasing health concerns worldwide. In this article, we explore how changes in our atmosphere – from air quality, to UV light and global temperatures – are affecting our long-term health, and what this might mean for you.

How air pollution and climate change are impacting our health

The way we breathe is changing. As towns and cities around the world become ever-more congested, we are increasingly breathing in airborne pollutants such as methane and black carbon.

The combination of these short-lived climate pollutants (SLCPs) contribute both to our own declining health, and to climate change (and it’s double jeopardy, since climate change further affects our health).

Where are the most polluted cities and countries?

In 2023, the 10 most polluted cities on earth according to the real-time Air Quality Index (AQI) were:

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Meanwhile, the 10 most polluted countries overall in 2023 were:

* The AQI (Air Quality Index) measures the total density of pollutants in the air, including carbon monoxide, sulphur dioxide and particulates. A higher score indicates more pollutants in the air.

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How and why is air quality changing?

Global air quality is worse than ever. According to the World Health Organization (WHO), almost everyone – 99% of the world – lives in an area that falls below air quality limits. In 2020, air pollution was directly responsible for 3.2 million deaths worldwide.

What is air pollution?

Air pollution is an accumulation of particulates in the atmosphere that are harmful to human beings. Air pollution is measured by determining the density of these particulates within a set volume. The higher the concentration of pollutants, the more polluted the air.

There is no single type of air pollutant. Any particulate that can be carried by air and breathed in by a human can be considered air pollution, and some pollutants are deadlier than others. They may include:

• Carbon monoxide (CO): a colourless, odourless gas produced by the incomplete combustion of carbon-based matter. CO quickly diffuses into our systems, preventing our body’s cells from binding to oxygen. It can be deadly in large concentrations or produce a range of symptoms and illnesses over long exposures.
• Nitrogen oxides (NOX): in particular, nitrogen dioxide (NO2), which is released from the burning of fossil fuels, causes serious breathing problems and irritation, and can exacerbate the symptoms of asthma.
• Lead: lead particulates can be released from everyday products including paints, ceramics, gasoline, batteries and cosmetics. Lead is seriously toxic to young children and unborn foetuses, while in adults long-term exposure can experience cardiovascular problems, lower fertility and decreased kidney function.
• Ozone (O3): smog-like ozone is formed by the reaction of other air-based pollutants, especially carbon monoxide and nitrogen oxides. It is photochemical in nature, trapping ultraviolet radiation from the sun, which causes ambient temperatures to rise. It also contributes to breathing difficulties and lung disease.
• Methane: a colourless, odourless gas produced by the burning of fossil fuels, and from livestock and agricultural processes. It can displace atmospheric oxygen, and over long exposures contributes to health problems including cancer, central nervous system damage and birth defects.
• Sulphur dioxide (SO2): a colourless gas largely produced by the burning of fossil fuels. It is widely linked to hospital admissions for breathing difficulties, especially in asthmatics.
• Mould: appearing in areas of high moisture, mould spores enter the atmosphere and cause irritation to the eyes, nose, throat and lungs. Long-term exposure to mould can cause health complications in asthmatic people and those with allergies.

Thinking about moving abroad?

Check out our list of the most-environmentally-friendly countries

What is causing air pollution?

To put it simply, it’s because the world is releasing more pollutants into the air than at any point in human history. This has to do with record levels of fossil fuel burning, as well as an ever-increasing range of pollutants entering circulation. 

Alongside fossil fuels (gas, oil and coal) burned during home and industrial processes or from vehicles, sources of air pollution include:

• Wildfires: a historic 12 million hectares of land burned during 2023. Agricultural, heath and forest fires release large amounts of carbon into the atmosphere, and are only becoming more common as a result of climate change.
• Crop residues: pesticide spraying, ammonia and nitrogen-based fertiliser spreading, and other crop residues are key contributors to air pollution. Our use of pesticides and other agricultural sprays has been gradually increasing since 2000.
• Poor waste management: the world generates 2 billion tons of solid waste per year. Inadequate disposal of this waste is common in developing countries. Waste discarded in landfill releases greenhouse gases, while burning releases particulates into the air.
• Desert dust: sand, whipped up by high winds in desert areas, irritates and exacerbates conditions like asthma. Around 2 billion tons of sand enters the atmosphere every year, with high winds carrying these sands further than ever before.
• Others: increasing use of private vehicles, increasing urbanisation and increasing industrialisation are all touted as secondary factors (since they tend to be linked to fossil fuel consumption) in the declining quality of our air.

How does air pollution contribute to climate change?

Many airborne pollutants are known as ‘greenhouse gases’. They are called this because they trap radiation from the sun inside the earth’s atmosphere. This causes the air to warm up, thus increasing the ambient temperature.

Not all greenhouse gases are bad. It’s thanks to greenhouse gases that Earth is a suitable temperature to support life. However, human activities have increased the density of greenhouse gases in our atmosphere to such a degree that they are directly responsible for the rapid warming of the earth.

Global temperatures have increased 1.3°C on average since the 1800s, and are expected to rise a further 2–4°C by 2100.

This process is known as climate change, or global warming. Climate change is an existential threat to life on earth, as it threatens to make the planet inhospitable. Air pollution in the form of greenhouses is just one of the many causes of climate change, but arguably the most significant – especially when coupled with other causes, such as deforestation (the fewer trees we have, the less carbon dioxide can be replenished as oxygen).

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How does air pollution affect me?

Air pollution is a silent killer. Increased levels of air pollution have been linked to a variety of illnesses, including:

There may be many more diseases that can be either directly or indirectly attributed to air pollution. Research into the impacts of air pollution on human health is still ongoing.

How do I know if I live in an area of high air pollution?

It’s important to know whether you will be moving to, or already live in an area of high air pollution. The real-time Air Quality Index can help you to see air pollution levels across various cities around the world. You can also purchase your own air quality monitors to test the air quality levels inside your home or place of work.

Which diseases are on the rise?

We look at diseases surging around the world

What can we do about air pollution?

There is no easy answer to solving the global air pollution crisis. Reducing levels of air pollution back to a safe level would require the world to stop most industrial and agricultural processes, transportation, and deforestation. All of this would amount to just one step in the race to reverse climate change.

Global political initiatives are heavily invested in trying to undo the impacts of climate change. The Conference of the Parties of the UNFCCC, better known as COP, is an annual meeting of leaders from around the world to discuss climate change priorities. Air pollution is a regular feature on the agenda. 

As a result, many cities and countries are already taking steps to implement changes that are intended to lower air pollution levels and stop the escalation of climate change. Some of these include:

Ultra Low Emission and Clean Air Zones in the UK

The Mayor of London has established an Ultra-Low Emission Zone (ULEZ) throughout all boroughs of the British capital. Vehicles may only drive in the ULEZ a certain number of times in a year, and drivers from outside the capital must pay a charge to drive their vehicles into London. The ULEZ has made London the world’s largest clean air zone, and helped to reduce air pollution across the city by up to 50%.

In response, many other cities in Britain have implemented similar schemes. These include: Aberdeen, Bath, Birmingham, Bradford, Bristol, Dundee, Edinburgh, Glasgow, Newcastle, Oxford, Portsmouth, Sheffield and Southampton.

Breathe Warsaw

As the home to 36 of the European Union’s 50 most air polluted cities, Poland has started to take steps to combat poor air quality. One of their ambitious schemes is Breathe Warsaw, launched by the City of Warsaw, Bloomberg Philanthropies and the Clean Air Fund. 

The scheme has manifested in the launch of a new low-emission zone, supporting the phasing-out of coal heating in homes, and a huge data-gathering initiative that has involved placing 165 new air sensors across the city. Warsaw’s aim is to reduce the number of premature deaths in the capital by 55% by 2030.

Green Bangkok 2030

After hundreds of schools were forced to close in 2020 when Bangkok’s air pollution reached dangerous levels, the city has decided not just to meet, but smash the goals set by the Paris Agreement.

The Royal Thai Government has set an ambitious target of reducing greenhouse gas emissions by up to 30% by 2030, as well as reorganising the entire city to ensure 10sqm of green space per person, that any person can reach a green space within five minutes from their front door, and that the city has 30% tree coverage.

The first phase of the project will see the opening of 11 new parks and a 15km greenway. These will include outdoor gymnasiums and provide new transport links, encouraging people to walk rather than to take public transit.

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Does air pollution affect my health insurance?

While living in an area with high air pollution may affect your health and life expectancy, it is not typically a factor health insurance companies consider when deciding your eligibility or the cost of your premiums. It is unlikely you will be denied health insurance simply because you live in an area known to have higher levels of air pollution.

However, if you live in an area of high air pollution, your health insurance may be affected in other ways. 

For one thing, you will be more likely to require a health insurance policy, as it is more likely you will develop diseases related to air pollution such as chronic obstructive pulmonary disease (COPD), asthma and lung cancer. This means you will also be more likely to make a claim over the course of your life. While your health insurance should cover you, remember that you will need to pay an excess for each new claim.

If you do develop chronic health problems related to air pollution, your health insurer may determine these to be pre-existing conditions. This could make it harder for you to change, upgrade, or take out a new health insurance policy.

Conclusion

Air pollution is a global crisis. Not only does it contribute to global warming, presenting an existential threat to all life on earth, it also contributes to a wide range of health complications.

Living in an area of high air pollution can impact your health in both the short-term and the long-term. There is no treatment for air pollution exposure. It can both lower our quality of life, and contribute to the development of fatal illnesses.

Many places around the world are taking steps to reduce air pollution, but in the meantime it is up to us as individuals to be vigilant and protect our own wellbeing. If you can, choose to live and work in an area with lower air pollution – the less you are exposed to air pollution, the less chance you have of developing an air pollution-related illness.

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Protect your health today

At William Russell, we have over 30 years’ experience providing international health insurance. Our policies offer you access to the best quality medical care all over the world, with flexible options to suit your needs.

Don’t take your health and well-being for granted. Find out more about our international health insurance policies and get a quote online in under two minutes today.

The post Is Air Pollution And Climate Change Affecting Your Health? appeared first on William Russell.

However, only 10% of the global demand for organ donation is currently being met, leaving millions of people waiting for life-saving transplants. Donation rates vary widely across the world, influenced by cultural attitudes, healthcare infrastructure, and national policies. In this article, we explore which countries have the highest organ donation rates, as well as those with the lowest.

Organ donation around the world

Our research explores where organ donors are in the highest demand and which countries are stepping up to meet that need. By studying key data, we’ve uncovered the gaps in donations and the countries leading the way with the most registered donors.

We compare donation rates, the number of registered donors by country, and the organs most commonly donated worldwide. Additionally, we examine different donation systems—opt-in vs. opt-out—and how they impact donor registration.

Beyond organ donation, this research also emphasises the importance of international health insurance, which can play a key role in supporting people who need transplants and ensuring healthcare access globally.

Different countries have different types of healthcare systems

Take a look at the major types of healthcare systems around the world

The countries with the highest organ donation rates

1/ Spain

494 deceased donors per one million people

Spain has the highest organ donation rate, with 2,346 deceased registered donors in 2023, equaling 494 donors per one million people.

Spain’s effective government policies, public awareness campaigns, and robust healthcare system have achieved this impressive rate. Spain’s success in organ donation is due to its registration system, which automatically registers people as donors unless they explicitly opt out.

Spain has also focused on training medical professionals to identify potential donors early, ensuring that families are informed and supported. The country’s strong emphasis on transplant networks and national collaboration has also helped simplify the organ donation process and reduce wait times for patients needing transplants.

2/ United States

480 deceased donors per one million people

In 2023, the United States identified 480 deceased organ donors per one million people. The US operates under an opt-in donation, where people must register as donors at the United Network for Organ Sharing. Individuals can also register with the Department of Motor Vehicles by indicating their wishes on their driver’s license or state donor registry should they get into an accident.

Despite the challenges, the US has made significant progress in recent years, thanks to the efforts of the Organ Procurement and Transplantation Network, which works to improve the efficiency of organ donor identification and education. The US has also implemented public awareness campaigns to educate nationals about the importance of organ donation and the growing need for transplantable organs, especially with increasingly long waiting lists.

3/ Portugal

368 deceased donors per one million people

Portugal is another European country experiencing an influx of organ donors, registering 368 deceased donors per one million people in 2023. This is a significant increase over the past decade, largely due to Portugal’s adoption of an opt-out donation system in 2018, automatically registering nationals as organ donors unless they choose to opt-out. 

Since its introduction, the country has seen a notable rise in donor registration and overall rates. Between 2018 and 2023, the number of deceased organ donors per million people rose by approximately 20% in Portugal.

Despite these gains, challenges have remained, particularly in rural areas with limited medical care access. However, Portugal continues to make progress in bridging these gaps, improving the efficiency of its transplant system, and reducing waiting times.

Top 10 countries with the highest organ donation rates

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The countries with the lowest organ donation rates

1/ Kazakhstan

4 deceased donors per one million people

Kazakhstan has one of the lowest organ donation rates globally, with just 4 deceased donors per one million people in 2023. This places it at the top of the list of nations lacking in organ donations.

Despite efforts to raise awareness about the importance of donations, Kazakhstan still faces challenges in increasing these numbers, including cultural factors, a lack of public awareness, and limited infrastructure for transplantation.

Organ donation is voluntary in Kazakhstan, and the country’s healthcare system is still developing in this area. The government has recognised the ongoing need for training medical professionals to identify potential organ donors and support families in making decisions.

Kazakhstan’s lack of organ donations is a stark reminder of the global disparities and the ongoing work needed to increase donor registration and medical structure in certain countries.

2/ Oman

4 deceased donors per one million people

Oman is ranked alongside Kazakhstan, with only 4 deceased organ donors per one million people. Despite a relatively well-developed healthcare system, Oman faces several challenges when it comes to increasing organ donation.

One of the primary reasons Oman has a low organ donation rate is the influence of cultural and religious views. In Oman, as in other parts of the Middle East, there may be concerns about the sanctity of the body, and afterlife considerations play a huge role in public opinion.

Public awareness about the importance of organ donation remains limited, and many people are unaware of its benefits. This lack of understanding can create uncertainty and fear around the process and discourage people from registering as donors.

Despite these challenges, Oman is slowly making progress in addressing the organ donation gap, including launching a collaboration with neighbouring countries and international organisations to improve transplant and donation infrastructure.

3/ Japan

12 deceased donors per one million people

Japan, with 12 deceased donors per one million people, faces unique challenges in improving organ donation rates despite being one of the world’s most advanced healthcare nations. While this figure is higher than that of countries like Kazakhstan and Oman, Japan falls behind countries such as Spain and Portugal.

One of the key barriers to organ donation in Japan is deeply rooted cultural attitudes. In Japan, there is a fear and reluctance surrounding the idea of death and the preservation of the body after death. Organ donation was also historically restricted by strict laws and a deep reluctance to recognise brain death as the official cause of death.

Although Japan passed the Organ Transplant Law in 1997, which legalised organ transplants from brain-dead individuals, the law included provisions that required consent from families for donation. This family-based consent law has significantly slowed the rate of donations.

The Japanese government has slowly increased its efforts to raise awareness and improve the donation process. For example, in 2020, the country introduced a law that lowered the age for registering as a donor from 15 to 13, hoping to encourage more young people to consider organ donation.

Top 10 countries with the lowest organ donation rates

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Discover the countries with the best healthcare in the world

The country with the highest percentage of unutilised deceased organ donors

Türkiye has the highest percentage of unutilised deceased organ donors

Percentage of unutilised deceased donors: 37.7%

Türkiye has the highest percentage of unutilised deceased organ donors, with a staggering 37.7% of potential organ donations not being utilised despite donors being registered.

While Türkiye’s organ donation rates are relatively high (36 per one million people), it still faces challenges in maximising its organ donors.

There is a substantial gap between the demand for organ transplants and the available donors. Türkiye has seen a significant rise in registered donors over the years, but the demand for organs, especially kidneys and livers, far exceeds the supply.

This imbalance means that when organs are available, they may not be suitable for transplantation due to tissue incompatibility, organ condition, or the timing of the donor’s death.

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The organ most commonly donated globally

Kidneys are the most commonly donated organ

Kidney transplants in 2023: 69,468

Kidneys are the most commonly donated organ worldwide, with 69,468 transplants across 53 countries in 2023. This is mainly because kidney disease is prevalent, and transplants are often the most effective treatment for people with end-stage renal failure.

There are also more patients waiting for kidney transplants than any other organ, which has contributed to higher donation rates and the longest waiting list of any other organ.

The liver is also in high demand, mainly due to diseases like cirrhosis (often caused by alcohol abuse or hepatitis), liver cancer, and non-alcoholic fatty liver disease. According to a study by Clinical Medicine, liver transplantation is now a routine procedure with a five-year survival of more than 70%. However, there is a shortage of grafts, and 15% of listed patients die while awaiting a graft.

Heart transplants are also in high demand for patients with end-stage heart failure, which can result from coronary artery disease, congenital heart defects, or heart valve disease. The demand for heart transplants is large but not as significant as for kidneys. Heart transplants still face considerable shortages, especially in younger patients.

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Read our full guide on how to use pharmacies overseas

How to become an organ donor in the UK

In May 2020, the law around organ donation in England was changed to allow more people to save more lives.

Now that the law has changed, it will be considered that you agree to donate your organs when you die if you are:

• an adult over 18
• you have not opted out
• you are not in an excluded group

However, the public still has a choice whether or not to become an organ donor and can register or amend their decisions on the NHS website.

In Wales, the legalisation is ‘deemed consent’, which means that if you haven’t organised an organ and tissue donation decision, you are considered to have no objection to becoming a donor. Scotland follows the same procedure called ‘deemed authorisation’.

Wherever you go, go with total peace of mind

At William Russell, we have over 30 years’ experience of helping expatriates finding best places in the world to move abroad and settle into their new lives overseas by providing world-class international health insurance. Plus, we produce lots of expert material to help you and your family adapt to life abroad.

Making the move to another country can be challenging. But no matter where you go, you can take one thing off your mind. William Russell offers international health insurance that covers you for everything from minor injuries to long hospital stays, and we also provide medical evacuations for patients who require emergency life or limb-threatening treatment where it’s not available locally.

The post Organ Donation: Which Countries Have The Most And Least Organ Donors? appeared first on William Russell.

In this article, we compare over-the-counter medicine costs across global destinations, highlighting where common medications come with the highest price tag. We also explore the key factors—such as government regulations, supply chains, and market competition—that influence how much you’ll pay for everyday remedies abroad.

The cost of over-the-counter medicines

The escalating cost of healthcare is a global issue, and over-the-counter (OTC) medications are no exception. 

From pain relief to digestive aids, we’ve compared prices in popular expat destinations and investigated the factors that drive them up or down. Discover how government policies, distribution, and competition may affect what you pay at the pharmacy counter, and learn how to make savvy decisions about your health expenses abroad.

Where are the best countries to live in the world?

We look at best countries for expats to live in and work abroad

Where are common OTC medications the most expensive?

Based on Google search data, we looked at 10 of the most popular expat locations. We then investigated the most prominent online chemists and pharmacies and found the lowest price of 10 common OTC medications—including paracetamol, aspirin, laxatives, nasal spray, and more. We then used this to calculate the average cost per OTC item. 

Over-the-counter medications are most expensive in Norway – on average

1/ Norway

Average cost: £7.98 per item

Norway is one of the most expensive countries for OTC medications, with an average cost of £7.98/US$10.07 across ten commonly used products. The high price of antiseptic cream, at £17.23/US$21.74 (NOK 241.29) for 50g, drives the average cost up. 

One explanation for this could be strict government regulations—you can only buy OTC medicines that are approved by the Norwegian Medicines Agency (NMA). The NMA controls pricing to ensure safety and quality, but can also lead to higher costs. 

The country’s high wages and cost of living also contribute to the expense, as businesses adjust pricing to cover operational costs.

2/ Switzerland

Average cost: £7.59 per item

Switzerland follows closely behind, with an average cost of £7.59/US$9.57 for common OTC medicines. Like Norway, Switzerland has a highly regulated pharmaceutical market, where strict pricing controls and quality standards contribute to higher costs. 

While private health insurance often helps cover prescription medications, OTC medicines are generally an out-of-pocket expense, making affordability a concern for some residents and expats.

3/ Portugal

Average cost: £6.37 per item

Portugal ranks third on the list, with an average OTC medication cost of £6.37/US$8.04. While significantly cheaper than Norway and Switzerland, this is still higher than in many other European nations. 

A potential reason for this is Portugal’s reliance on imported medications, which can be affected by exchange rate fluctuations and international supply chain issues. Additionally, the country has a smaller pharmaceutical manufacturing base than larger economies, meaning fewer locally produced, cost-effective alternatives.

Top 10 countries where over-the-counter medicines are most expensive

It’s important to think about the quality of healthcare

Discover the countries with the best healthcare in the world

Everyday over-the-counter medication prices

How much could expats pay for common OTC medications around the world? Let’s dive into the highest prices for paracetamol, cough syrup, and throat lozenges.

Countries with the most expensive paracetamol

The USA, Canada, and Norway rank as the most expensive countries for paracetamol, with prices of £3.68/US$4.64, £3.34/US$4.21, and £2.98/US$3.76 for a pack of 20 tablets, respectively.

In the USA, prices are primarily market-driven, as there are no government-imposed price controls on OTC medications. This allows manufacturers and retailers to set prices freely, leading to significant variations depending on where the medication is purchased.

Average cost of paracetamol (20 tablets)

1. USA: £3.68
2. Canada: £3.34
3. Norway: £2.98

Countries where cough syrup costs more than £13 – on average

Norway, the Netherlands, and Switzerland have the highest average prices for 200ml of cough syrup, costing between £11 and £13 (US$13.88-16.40). 

The Netherlands’ high cough syrup prices could be due to regulatory policies and restricted competition within the pharmacy sector. Although the country has an advanced healthcare system, over-the-counter medicines often come at a premium, particularly for branded options.

Average cost of cough syrup (200ml)

1. Norway: £13.36
2. Netherlands: £12.99
3. Switzerland: £11.64

Countries where you could pay nearly £6 for throat lozenges

If you need throat lozenges to accompany your cough syrup, you’ll likely pay the most in Ireland. The average cost of a pack of 16 lozenges is £5.99/US$7.56 (€7.15)—just under 5% more than it costs in Portugal.

Over half of Irish adults say the cost of their OTC medication has risen recently, with two reasons being widespread medicines shortages and business expenses getting more and more costly.

Average cost of throat lozenges (16 pieces)

1. Ireland: £5.99
2. Portugal: £5.70
3. Netherlands: £3.18

The cost of living in the UK has surged over the last few years

We compare the UK to countries with a cheaper cost of living

Why are over-the-counter medications so expensive in some countries?

The cost of OTC medications varies widely between countries, with some nations charging significantly more due to a combination of regulatory policies, distribution limitations, and economic factors. 

In countries with strict government regulations, such as Norway and Switzerland, price controls intended to maintain high safety and quality standards can also result in limited competition and higher consumer costs. Additionally, in many high-cost countries, over-the-counter medications are primarily sold in pharmacies rather than supermarkets or online, reducing opportunities for price competition and discounts. 

For expats, these price differences can significantly impact healthcare accessibility and daily expenses. Those moving from a country with lower medication costs may experience sticker shock when purchasing basic medicines abroad, especially if they are used to easy access and lower prices. 

This could lead expats to explore alternative options, such as purchasing in bulk when travelling, opting for generic brands where available, or considering international health insurance plans that cover over-the-counter medications.

Are you on prescribed medication and thinking about moving abroad?

Read our full guide on how to use pharmacies overseas

How expats can make informed decisions about health-related expenses

In some cases, restricted availability of over-the-counter drugs outside pharmacies can also mean additional inconvenience, requiring expats to adjust their habits and plan for everyday healthcare needs. Here are some tips and tricks to make your lives easier: 

1. Know before you go – Make informed decisions as an expat by researching your host country’s healthcare system and costs — what are the regulations and restrictions? This includes understanding how prescription and over-the-counter medications are priced and dispensed.
2. Go for local and generic brands – In some countries, local brands may be more affordable than international ones you recognise. Opt for generic brands whenever possible, as they typically offer the same efficacy at a fraction of the cost. Make sure you ask a pharmacist or healthcare provider for recommendations so you can get an OTC medication that will help you.
3. Organise your international insurance before you go – International health insurance is particularly crucial for expats as it offers financial protection and peace of mind in case of unexpected medical needs. The best international healthcare providers can also provide access to a network of healthcare providers and support services, ensuring that expats receive appropriate care and assistance while living abroad. 
4. Shop around – Prices can vary between pharmacies and online retailers. Don’t hesitate to compare prices and look for discounts or promotions. Depending on the country you’re in, some over-the-counter medicines may also be available within supermarkets, which is often cheaper than in chemists.

Wherever you go, go with total peace of mind

At William Russell, we have over 30 years’ experience of helping expatriates finding best places in the world to move abroad and settle into their new lives overseas by providing world-class international health insurance. Plus, we produce lots of expert material to help you and your family adapt to life abroad.

Making the move to another country can be challenging. But no matter where you go, you can take one thing off your mind. William Russell offers international health insurance that covers you for everything from minor injuries to long hospital stays, and we also provide medical evacuations for patients who require emergency life or limb-threatening treatment where it’s not available locally.

The post Over-The-Counter Medications: Which OTC Medicine Is Most Expensive? appeared first on William Russell.

In this article, we explore what it’s like living with a rare disease, including how it affects daily life, access to healthcare, and the challenges of living, working, or studying abroad. Through a personal case study of someone living with nephrotic syndrome, we’ll provide insight into the reality of navigating life with a rare condition.

Living with a rare disease

It’s estimated that around 3.5 million people in the UK and between 25 and 30 million people in the U.S. live with a rare disease. This shows that while the diseases themselves are rare, living with one is more common than you might think.

Over 7,000 rare diseases are thought to exist, and new conditions are continually being identified, leaving many patients to face challenges such as delayed diagnoses, limited treatment options, and a lack of understanding or support.

Due to this, there is a lack of data surrounding the topic, particularly regarding diagnosis levels.

Which diseases post the biggest risks in the future?

We look at which diseases are most at risk of resurgence

Cade’s story – living with nephrotic syndrome

We spoke to Cade Morant, who lives with nephrotic syndrome, about what life is like with a rare disease.

What are the symptoms of nephrotic syndrome?

The most common symptom of the disease is swelling, particularly around the eyes and face, but this can also occur in the fingers, legs, and abdomen. Protein leakage may also result in some people passing frothy urine.

Speaking about his symptoms, Cade said he started to experience swelling in his lower legs, which was very minor at first and would only be present in the evenings. However, the swelling worsened, and he made an appointment with his GP. The doctor carried out some blood tests, but these only ever came back clear.

After another few weeks, Cade struggled to complete simple everyday tasks, such as putting on his socks and shoes or walking. After booking an appointment with a different GP, who carried out blood pressure and urine dip tests, it was found that Cade’s body was leaking protein.

Following further examination through blood tests and a biopsy, Cade was officially diagnosed with nephrotic syndrome.

How is nephrotic syndrome managed?

Since his diagnosis, Cade has tried many treatments to manage his condition. He currently takes four medications: one for phosphate management, a neural blocker, an antidepressant and a form of vitamin D supplement. 

Other medications used to manage nephrotic syndrome include (but are not limited to) water tablets to reduce water retention, anticoagulant treatments to reduce the risk of thrombosis, and cholesterol-lowering drugs.

Everyone living with nephrotic syndrome will respond to treatments differently. While some may only require one round of steroid treatment, others may not respond to treatment at all. This can lead to the kidneys eventually failing due to prolonged protein leakage. 

In order to treat this, an individual may require kidney dialysis or a kidney transplant. Cade has been having haemodialysis for almost nine years. Dialysis is essential as it helps keep Cade alive by filtering waste and excess fluid from his blood.

Cade performs haemodialysis at home, doing three-hour sessions four times a week. He previously had four-hour-long sessions three times a week, but although his blood levels were good, Cade felt generally unwell the following day. His new schedule has helped him to feel better.

How can nephrotic syndrome physically affect someone’s day-to-day life?

After being diagnosed with nephrotic syndrome, Cade was advised to make adjustments to his diet and the amount of fluid he was drinking. This involved avoiding phosphate, potassium and salt and drinking one litre of water per day. 

Cade has been eating a whole-food, plant-based diet for a few years. This diet involves eating various fruits, vegetables, seeds, nuts, and legumes and avoiding highly processed and sugary foods. 

This particular diet has helped Cade restore his potassium levels and allowed him to stop taking his blood pressure medication and EPO injections. Cade’s phosphate medication and iron injections have also been reduced. 

However, despite these vast improvements, Cade still gets fatigued quickly and is often tired, affecting his productivity at work and home. It also means he struggles to go to the gym or work out due to lacking motivation and energy.

How can nephrotic syndrome affect people financially?

The level of financial strain on someone living with nephrotic syndrome can be different for every individual. Some people may be able to claim personal independence payment (PIP) if their condition affects their ability to carry out everyday tasks or they experience extra living costs to manage their disease. 

Cade previously qualified for the higher weekly rate of PIP, which currently stands at £108.55 for the daily living section and £75.75 for the mobility section. The amount you receive depends on how difficult you find everyday tasks and getting around, and is not affected by your income or savings.

Although Cade no longer qualifies for the higher PIP rate, he still receives monthly payments to cover the cost of electricity and water for his home dialysis.

However, one thing that Cade struggles with financially, in terms of his condition, is going on holiday abroad. Living with a rare disease can make taking out a travel insurance policy that covers all of your medical needs expensive. Most insurance providers don’t tend to cover pre-existing medical conditions in their standard policies*.

*William Russell won’t cover you for investigations, treatment, or medication relating to pre-existing medical conditions or related conditions—unless you tell us about them in your application, and we agree to cover them. We also provide only limited coverage for private medical treatment in the USA on certain policies.

What is a pre-existing medical condition?

Learn more about pre-existing medical conditions here

Can I still become an expat if I have a rare disease?

Moving abroad is a significant decision for anyone, and for those living with a rare disease, the process can feel even more daunting. Relocating to a new country requires thorough research and careful planning to ensure the destination aligns with your personal and medical needs.

For individuals with rare conditions, this research becomes even more critical, as some countries may not provide the necessary healthcare infrastructure, treatments, or support. It’s essential to consider various factors to determine whether a destination is viable and to plan for the unique challenges that may arise.

Things to consider when moving abroad with a rare disease

Here are a few key considerations for those living with a rare disease and thinking about moving abroad.

1/ Cost of living

Finances can play a major role in someone’s life if they live with a rare condition. For example, they may need to use a lot of electricity for at-home treatments, or they may be required to eat a certain kind of diet. These things can be expensive for someone with a rare disease, so it’s important only to consider moving to countries with a relatively affordable cost of living.

2/ Healthcare costs

Those with a rare condition may need to access healthcare frequently for regular treatments or unexpected hospital visits. It’s important to remember that healthcare isn’t free in every country. For example, countries like the U.S. and South Africa don’t have free healthcare, so these locations may not be a viable option for everyone. However, many countries do have established healthcare systems such as Australia, France, Belgium and Denmark.

3/ Public transport

For those living with a rare disease, public transport can be a very important factor when relocating to another country. Ideally, public transport would be frequent and have affordable fares, making it easy for people to attend any medical appointments, particularly those unable to drive. They should also have plenty of disability-friendly features, like ramps or lifts for those living with rare diseases such as muscular dystrophy, and raised markings on doors and buttons for those with rare eye conditions such as Stargardt disease.

4/ Climate

Although it may seem obvious to some, it is important to consider the climate of the location you’re thinking about moving to. Some rare conditions, such as hypohidrotic ectodermal dysplasia (HED), can be affected by heat, so anyone with this disease should avoid relocating to countries with very hot climates. This includes locations such as the United Arab Emirates, Singapore and Thailand. On the other hand, those with rare conditions affected by the cold, like cold agglutinin disease, should avoid moving to countries such as Canada, Sweden and Norway, as they have very cool climates.

5/ Availability and quality of medical treatments

One of the most important things to consider when relocating to another country is the availability and quality of medical treatments. For some people living with a rare disease, these treatments may be what keeps them alive, so it’s vital that they are available and can be given to a high standard. If not, this may lead to complications and cause an individual to become seriously ill. Before deciding on which country you’ll be relocating to, carry out thorough medical research to ensure that you can access the treatments you need and that these are delivered at a high quality.

It’s important to think about the quality of healthcare

Which countries have the best healthcare in the world?

Why do people travel abroad for medical treatment?

According to ONS data, around 348,000 UK residents travelled abroad to receive some form of medical treatment in 2021. This is a 129.5% increase since 2018 when the figure stood at 151,609.

Every year, millions of U.S. residents also travel to other countries for medical care, with the most popular locations being Mexico, Canada, Central America, South America and the Caribbean.

The purpose of these visits may be for elective procedures, such as dental or cosmetic work, or for life-enhancing or saving treatments, such as organ and tissue transplantations or stem cell therapy.

Reasons people travel abroad for medical treatment

There are many reasons why people may choose to receive medical treatment abroad, including:

1. When a particular procedure or treatment is cheaper
2. When there are shorter waiting periods in another country
3. If a treatment is only available in certain countries

Those travelling to another country for medical treatment should conduct thorough research beforehand. This ensures they know potential risks and the steps to take if any issues arise. For this reason, it’s also important to purchase full medical insurance before travelling.

Medical tourism is a booming industry

What is medical tourism and where is it popular?

Wherever you go, go with total peace of mind

At William Russell, we have over 30 years’ experience of helping expatriates finding best places in the world to move abroad and settle into their new lives overseas by providing world-class international health insurance. Plus, we produce lots of expert material to help you and your family adapt to life abroad.

Making the move to another country can be challenging. But no matter where you go, you can take one thing off your mind. William Russell offers international health insurance that covers you for everything from minor injuries to long hospital stays, and we also provide medical evacuations for patients who require emergency life or limb-threatening treatment where it’s not available locally.

The post The Rare Reality – What Is Life Like Living With A Rare Disease? appeared first on William Russell.

From understanding healthcare systems to securing appropriate international health insurance and knowing what to do if unexpected situations arise, in this guide we’ll help you navigate the journey of giving birth abroad, ensuring you have everything you need for a successful delivery overseas.

Preparing for pregnancy and giving birth abroad

The first and most important step when it comes to preparing for childbirth abroad is to understand the healthcare system in your host country. Healthcare systems vary widely across the globe, which is why it’s important to familiarise yourself with how the system operates in your new home, and to be aware of any pitfalls you may encounter far in advance – this includes access to care at the time of delivery, after-care and of course paying for the process.

Are you planning to give birth abroad?

Learn more about our maternity health insurance

If you’re planning to start a family in a new country, there are three important things to consider when looking at an unfamiliar healthcare system:

1/ Public vs private healthcare

In many countries, public healthcare is funded by the government and is generally accessible to all residents. It is often more affordable than private services, but may involve longer waiting times and less personalised care due to higher patient loads. Public healthcare systems usually offer comprehensive maternity services, but the quality and availability of these services can vary greatly. 

As an expat looking to give birth abroad, you will need to be sure that you qualify for maternity care as early as possible in your pregnancy. If you do not meet the criteria for public healthcare in your new country, you could find yourself with a big medical bill at the end of your delivery.

Private healthcare, on the other hand, usually involves higher out-of-pocket costs but offers quicker access to services, more personalised care and higher-quality facilities. Private hospitals and clinics often have more modern maternity wards, and you will often have the option to choose a private room for any inpatient requirements. 

You will also benefit from shorter waiting times, and a higher staff-to-patient ratio, which can result in a more comfortable experience during pregnancy and childbirth. You’re also more likely to have access to doctors and midwives who speak your native language. 

For this reason, many expats looking to give birth abroad choose to invest in international health insurance to ensure they get the best possible care – and total peace of mind.

2/ Maternity services

The quality and availability of maternity services also differs greatly from country to country. If you’re planning to have your baby overseas, make sure you thoroughly research maternity services in your area.

This includes looking into local hospitals, birthing centres and the reputations of obstetricians and midwives. High-quality maternity care can make a huge difference to your childbirth experience, so it’s worth taking the time to find the best options.

Online resources such as expat forums, social media groups and local community websites can be a great way to gather first-hand information about different maternity providers in your areas. And be sure to consider factors such as the availability of private rooms, pain relief options and any additional facilities such as birthing pools that might be important to your birth plan.

Some cities make things easier for new parents than others

Discover the best cities around the world for expecting parents

3/ Prenatal and postnatal care

Your journey to giving birth isn’t just about the birthing experience – it’s also the care and support you receive before and after welcoming your child into the world. Some countries might have different guidelines for pre- and post-natal care, so it’s important to be informed about what to expect. 

Here are some pre- and post-natal services you might want to look into before deciding to have your baby abroad: 

• Prenatal check-ups: Regular prenatal check-ups are essential for monitoring the health of both mother and baby throughout the pregnancy. Find out the frequency of these check-ups and what they entail in your host country. Ensure that the healthcare provider offers comprehensive prenatal care, including blood tests, urine tests, and monitoring for any potential complications.

• Scans and tests: Ultrasound scans and other diagnostic tests are a standard part of prenatal care. Verify the availability and quality of these services, and understand what tests are recommended at different stages of your pregnancy. 

• Prenatal classes: Many healthcare providers offer prenatal classes that cover topics such as childbirth preparation, breastfeeding, and newborn care. These classes can be particularly beneficial for first-time parents or those unfamiliar with the local healthcare system. Check if these classes are available in a language you are comfortable with, or if there are interpreters available.

• Support services: Investigate the availability of additional support services, such as nutritionists, physiotherapists, and mental health professionals who specialise in prenatal and postpartum care. Having access to a comprehensive support network can help you maintain your overall well-being during pregnancy.

• Hospital stay: Understand the standard length of hospital stay for new mothers and babies in your host country. In some countries, it is common to stay for several days, while in others, you may be discharged within 24 hours if there are no complications.

• Postnatal check-ups: Regular postpartum check-ups are essential to monitor your recovery and address any concerns. These appointments typically occur a few weeks after delivery and may include physical examinations, discussions about mental health, and guidance on breastfeeding and newborn care.
• Lactation consultants: If you have trouble breastfeeding, access to lactation consultants can be incredibly beneficial. Find out if your healthcare provider offers lactation support services and if they are included in your health insurance cover.

Pregnancy is a significant journey, both emotionally and financially

Find out how much giving birth abroad could cost you

Giving birth abroad: Handling unexpected situations

No matter how thoroughly you plan, unexpected situations can arise during pregnancy and childbirth, and this can be especially stressful when you are living abroad.

Here’s how to prepare for unexpected scenarios when having a baby overseas:

Medical emergencies

One of the first things to do when you move to a new country is familiarise yourself with the local emergency services. Ensure you have the contact numbers for emergency medical services, nearby hospitals, and your healthcare provider readily available. It’s also wise to identify the nearest hospital or clinic with an emergency department that is equipped to handle pregnancy-related emergencies.

Take time to understand the emergency protocols in your new country, particularly those related to pregnancy and childbirth. Some countries may have different procedures for handling medical emergencies, including how ambulances are dispatched and paid for. Knowing what to expect can help reduce stress in an urgent situation.

If you’re a William Russell member and you’re experiencing a medical emergency, call our 24-hour emergency medical assistance service on +44 1243 621 155.

Why do you need international health insurance abroad?

Here’s everything you need to know about health insurance

Complications during pregnancy

Educate yourself about the signs of common pregnancy complications, such as preeclampsia, gestational diabetes, and preterm labour.

Early recognition of these symptoms can be crucial for getting timely medical attention. Regular prenatal check-ups will help you monitor your health and your baby’s development but being aware of warning signs in between visits is equally important.

If you have a high-risk pregnancy or develop complications, you may need access to a specialist, such a perinatologist. Specialist services like this can be expensive or difficult to access on some public healthcare systems, so it’s a good idea to check your private health insurance covers maternity complications as early as possible in your pregnancy.

Lastly, it can help to agree an emergency plan with your birthing partner that includes what to do if complications arise. This plan should cover transportation to the hospital, childcare arrangements, and how to communicate with your healthcare provider in an emergency. Having this plan in place can help reduce anxiety and ensure that you can act quickly if necessary.

Language barriers

In many countries, translation services and bilingual physicians are not available on public healthcare services. If you are living in a country where you are not fluent in the local language, consider taking language classes to improve your ability to communicate, particularly in medical situations.

Even basic knowledge of medical terms related to pregnancy and childbirth can be incredibly useful. You can also carry a phrasebook or a translation app on your phone for quick reference in emergencies.

If you have specific birth preferences or medical needs, it’s a good idea to have these written down in both your language and the local language. This document can be shared with your healthcare provider and hospital staff to ensure that your wishes are understood and respected.

Legal registration, nationality and parental leave

Having your baby in another country will have legal implications when it comes to registering the birth, applying for nationality and obtaining a passport. If you’re working abroad, you may also need to think about how much parental leave you are entitled to. 

Let’s take a closer look at some of the formalities you may need to think about after birth:

Birth registration

The process of registering your baby’s birth can vary significantly depending on the country you’re living in. It’s essential to understand the specific requirements and procedures in your host country well before your due date. 

Typically, births must be registered within a certain time frame, often within a few days or weeks after the birth. Delays in registration can lead to complications in obtaining other essential documents like a passport.

If you are a citizen of a different country than your host country, you may need to register your baby’s birth with both the local authorities and your home country’s embassy or consulate. This dual registration ensures that your baby’s birth is legally recognised in both countries.

In order to register your baby’s birth, you will likely need the following documents to hand: 

• Valid passports for both parents
• Residency permits
• Marriage certificate (in certain countries)
• Birth notification form 

The concept of family forms the bedrock of society

We look at cultural attitudes to family around the world

Citizenship and nationality

As an expat giving birth abroad, the question of citizenship and nationality is particularly important. Different countries have different rules around whether birth in the country makes your baby a citizen, and this will affect what kind of passport you’re able to obtain for your newborn. 

Let’s take a look at how different countries allocate citizenship. 

Birthright citizenship (Jus Soli)

Some countries, like the United States and Canada, grant citizenship to any child born on their soil, regardless of the parents’ nationality. This is called jus soli or “right of the soil”. If you give birth in a country that follows this principle, your child will automatically acquire that country’s citizenship. However, this may have implications for dual or multiple citizenships, depending on the laws of your home country.

Citizenship by descent (Jus Sanguinis)

On the other hand, many countries, particularly in Europe and Asia, follow the principle of jus sanguinis, or “right of blood,” where a child’s citizenship is determined by the nationality of the parents, regardless of the place of birth. If you are a citizen of such a country, you may need to follow specific procedures to pass on your citizenship to your child, which may involve registering the birth with your home country’s embassy or consulate and providing proof of your own citizenship.

Dual or Multiple Citizenship

Nearly half of all countries worldwide (49% to be exact), allow dual or multiple citizenships.

It’s important to research and understand the implications of your child potentially holding more than one citizenship. This might affect things like compulsory military service, taxation, and legal obligations in each country of citizenship. However, it also comes with many advantages, such as access to multiple healthcare systems and the ability to live and work in multiple countries without obtaining a visa.

Some countries that allow dual citizenship include: Albania, Argentina, Australia, Belgium, Brazil, Bulgaria, Cambodia, Canada, Chile, Colombia, Costa Rica, Croatia, Denmark, Germany, Hong Kong, Italy, Latvia, Mexico, New Zealand, Peru, Portugal, Spain, Sri Lanka, Sweden, Switzerland, Thailand, the United Kingdom, the United States and Vietnam.

Already planning ahead for your child’s education?

Discover countries with the best education systems

Parental leave

If you are working abroad as an expat, you will need to understand the local laws regarding parental leave and employment rights after having a baby. These laws can vary greatly depending on the country, with differences in the length of leave, whether it is paid or unpaid, and whether both parents are entitled to take leave. 

As an expecting parent abroad, take the time to familiarise yourself with these parental rights:

Maternity leave

How long is maternity leave, and how is it structured? Some countries offer generous paid maternity leave, while others may provide only a short period of unpaid leave. Understanding your rights allows you to plan your finances and childcare accordingly.

Paternity Leave

Increasingly, countries are recognising the importance of paternity leave. Check whether your host country offers paternity leave, how long it lasts, and whether it is paid. In some cases, parental leave can be shared between both parents, allowing for greater flexibility.

Parental Leave

Beyond maternity and paternity leave, some countries offer parental leave, which can be taken by either parent or shared between them. This leave is sometimes flexible, allowing parents to take it in blocks or spread it out over a certain period.

Employment Protection

Ensure that you are aware of your rights regarding job protection during and after your leave. In many countries, laws protect your right to return to the same or an equivalent position after your leave period. It’s important to understand these rights and discuss them with your employer.

Understanding the financial implications of parental leave is crucial. If your leave is unpaid or only partially paid, you’ll need to plan how to manage your household finances during this time. You should also look into whether there are any government benefits – such as maternity or parental allowances – that you may be eligible for in your new country, and how to apply for them.

Find the best home for your family abroad

These are the best and worst countries to raise a family

How to find the best maternity cover as an expat

The quality of your health insurance can significantly impact your childbirth experience, from prenatal care to delivery and postpartum support. Here’s how to find the best maternity health insurance as an expat. 

1/ Understand what you need included in maternity cover

Maternity cover should encompass the full range of services you might need throughout pregnancy and childbirth, as well as postpartum care. As an expat, it’s important to ensure that the cover you choose is as comprehensive as possible, helping you plan for every eventuality. 

These are some of the most important things to look for in your maternity cover: 

• Prenatal care: This should include the cost of regular check-ups, ultrasounds, and any necessary blood tests during your pregnancy. Check if your insurance covers routine prenatal visits as well as more specialised care if complications arise.
• Delivery costs: Ensure that your policy covers the full cost of delivery, whether it’s a vaginal birth or a C-section. This should include hospital fees, doctor and midwife fees, anaesthesia, and any additional costs associated with your hospital stay.
• Postpartum care: After the birth, you’ll need follow-up visits to monitor your recovery and the baby’s health. Check that your insurance covers postpartum consultations, health checks, vaccinations, and any treatments your newborn might need in the first months of life.

2/ Compare global health insurance providers

As an expat you may benefit most from an international health insurance policy that provides maternity cover across borders. When comparing providers, here are some factors to consider:

• Coverage zone: Ensure the policy you choose provides cover in your host country and any other countries you might visit during your pregnancy or postpartum period. Some policies offer global cover, while others are limited to specific regions. 
  
  At William Russell, we have six zones, giving you flexibility to choose your geographical coverage zone, while keeping your premiums manageable. Find out more about where we cover here.
• Network of healthcare providers: Check whether the insurance company has a good network of approved hospitals, clinics, and doctors in your host country. If your cover is restricted to certain hospitals, be sure that these are within a reasonable distance from where you’re living. 
  
  At William Russell, we do things a little differently. Instead of having a network of hospitals that you must use, we give you the freedom to choose any hospital in your coverage zone. Use our hospital finder tool to see the hospitals and clinics where our members have received treatment in your area. 
• Access to English-speaking doctors: Language barriers can cause added stress during medical appointments, particularly when discussing complex issues related to pregnancy and childbirth. Make sure your maternity policy provides access to English-speaking doctors and specialists, making it easier to communicate your needs and understand your care. 
  
  Members of William Russell have access to top hospitals and English-speaking doctors locally, as well as a dedicated contact they can speak to about any concerns with their care as they come up.

Limitations and exclusions apply – you can find these in the plan agreements.

Want to know more about our international health insurance?

Discover the benefits of health insurance with William Russell

3/ Consider waiting periods

Most international health insurance policies have a waiting period before maternity benefits take effect. This period is typically a year, meaning you need to plan ahead. 

If you’re already pregnant when purchasing insurance, or if you become pregnant shortly after, maternity benefits may not apply at the time of birth. Therefore, you may wish to secure maternity cover as early as possible – ideally before you conceive – to ensure you’re fully protected.

With William Russell, we have a 12-month waiting period before you can use our pregnancy benefits. This means you wouldn’t be immediately covered for routine maternity care or pregnancy complications. However, for newborn cover, there is no waiting period.

Practical tips for giving birth abroad

Whether you are already living abroad or planning an international move during your pregnancy, careful preparation can help ensure a smooth and positive childbirth experience. Here are a few tips to help you plan for a comfortable birth overseas. 

1/ Decide on your maternity care in advance

Choosing the right maternity care is crucial when giving birth abroad. Research the healthcare system in your host country to determine whether you’ll use public or private healthcare, and select a hospital, birthing centre, or home birth option that best fits your needs.

Consider factors like the quality of care, the language spoken by the healthcare providers, and proximity to your home. Additionally, ensure that your chosen facility and healthcare provider are covered by your health insurance.

2/ Create a birth plan

A good birth plan outlines your preferences for labour, delivery, and postpartum care, helping to communicate your wishes to your healthcare team. Include details about pain management, the presence of a birth partner, and any specific cultural or personal preferences that you want to be respected.

It’s also important to plan for emergency situations. For example, think about what you’d prefer if a C-section becomes necessary or if complications arise. Make sure your birth plan is clear and translated into the local language if needed.

3/ Pack your hospital bag

A well-packed hospital bag ensures you have everything you need for a comfortable stay. Here’s a checklist to get you started:

• Essential documents: Include your ID, insurance details, birth plan, and any necessary medical records.
• Comfort items: Pack comfortable clothing, toiletries, and personal items to make your stay feel more enjoyable.
• For the baby: Bring baby clothes, a blanket, nappies, a car seat to help you transport your newborn back home.

4/ Build a support network

Having a strong support network can make a significant difference during pregnancy and after birth, especially when you’re living in a foreign country. Start by connecting with other expat parents, either through local community groups, social media, or online forums. These connections can provide valuable advice, emotional support, and recommendations for local services. 

It’s also important to make sure you’re happy with the medical team supporting your pregnancy and seek out alternative care options if you feel uncomfortable.

By taking these practical steps, you’ll be able to approach your childbirth abroad with confidence, knowing that you are well-prepared for the magical journey ahead.

Kate Robertson gave birth overseas in Hong Kong

Read about Kate’s childbirth experience here

Looking for international health insurance with maternity cover?

With a Gold international health insurance plan from William Russell, we’ll make sure that you and your bump get the care you need from the start of your pregnancy right through to labour and beyond, including cover for maternity complications.

From your first contact with our team, you’ll speak to a named adviser, each one an expert in pregnancy and expat maternity care. You’ll also have access to top hospitals and English-speaking doctors locally, easing the stress and helping you enjoy your childbirth journey.

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However, a new global crisis is on the way: antibiotic resistance. To put it simply, our use of antibiotics over the last century has not killed off diseases, rather it has forced them to adapt, mutate, and become strong enough to endure antibiotics. We are now entering an age where antibiotics are becoming less effective, while diseases are becoming more powerful.

As such, doctors worldwide are now limiting the prescription of antibiotics, especially for less deadly diseases, in a bid to stave off the rise of antibiotic-resistant diseases. In this article, we’ll explain what antibiotic resistance may mean for you as a patient.

What is antibiotic resistance?

Antibiotics are antimicrobial substances that are prescribed to treat bacterial diseases. They work by either killing the bacteria that cause diseases or by inhibiting their growth. Antibiotic resistance occurs when those diseases become strong enough to counteract the effects of the antibiotic.

Some bacteria have already developed resistance to antibiotics. These include:

Methicillin-resistant Staphylococcus aureus (MRSA)

‘Staph’ is a skin condition that can cause painful sores, swellings and blisters on the body, face and eyelids. When the strain became resistant to beta-lactam antibiotics, it became the more deadly MRSA, which is known to spread rapidly throughout hospitals and contributes to hundreds of thousands of deaths every year.

Vancomycin-resistant Enterococcus (VRE)

Enterococcus faecalis is a species of Enterococci, an intestinal bacteria known to cause urinary tract infections (UTIs), wound infections, bacteremia, endocarditis and meningitis. Enterococci are highly resistant to antibiotics, and when they develop resistance to Vancomycin they become known as VREs. VRE can cause nasty and highly infectious illnesses.

Multi-drug resistant Mycobacterium tuberculosis (MDR-TB)

Mycobacterium tuberculosis causes the tuberculosis (TB) disease, an infection that affects the lungs and can cause a highly infectious and potentially fatal range of symptoms. When the disease becomes resistant to isoniazid and rifampin, it is known as MDR-TB, a more complicated strain that accounts for nearly 250,000 deaths per year.

Carbapenemase-producing Enterobacterales (CPE)

Enterobacter is a species of bacteria found in the gut and faecal matter, which causes a variety of infections including UTIs, respiratory infections, endocarditis and soft tissue infections. They can become resistant to antibiotics, at which point they become known as ‘superbugs’. Patients can carry CPE without knowing it, and the disease spreads quickly by close contact with a carrier.

Which diseases will dominate future health concerns?

We look at which diseases pose the biggest risks in the future

Antibiotic-resistant infections already account for at least 700,000 deaths per year, and it is believed that figure could climb to around 10 million deaths per year by 2050 unless immediate action is taken.

The World Health Organization (WHO) is particularly concerned about gram-negative bacteria becoming resistant to antibiotics. Gram-negative bacteria pass along genetic material that allows them to become drug-resistant as they spread and multiply. Diseases such as e-coli, salmonella and shigella may eventually develop resistance to antibiotics in this way.

Other bacteria the WHO is monitoring as of 2024 include Neisseria gonorrhoeae (which causes gonorrhoea), Streptococcus pneumoniae (which causes pneumococcal infection) and Haemophilus influenzae (which cases meningitis, sepsis, pneumonia and epiglottitis).

What is causing antibiotic resistance?

To put it simply, over the course of the last century doctors have tended to prescribe antibiotics unnecessarily.

In other words, some believe that doctors have tended to prescribe antibiotics in cases where they were not strictly necessary, such as for minor bacterial infections where the patient would have otherwise made a full recovery without intervention.

Another factor is patient demand for antibiotics. Either by insisting that their doctors prescribe antibiotics, or by purchasing them without a prescription, individuals may have inadvertently contributed to the overuse of antibiotics. In some cases, patients may have taken antibiotics unnecessarily, for instance by attempting to use them to treat viral diseases.

Through general over-prescription and overuse of antibiotics, humankind has accelerated the adaptation and mutation of disease-causing bacteria to the point where some are now resistant to certain antibiotics.

In 2015, 30% of all antibiotics prescribed worldwide were deemed unnecessary. In the case of acute respiratory infections, as many as 50% of antibiotic prescriptions may have been unnecessary.

Countries where antibiotics can be purchased without a prescription

In most countries, antibiotics need to be prescribed by a medical professional, such as a doctor, dentist, or a nurse or pharmacist with a special licence to prescribe.

In these countries, changing policies mean that antibiotics will now only be prescribed in cases where those antibiotics are both effective and necessary. You will need to visit your GP or other doctor in order to obtain a prescription, which will then be filled by a pharmacist.

Need to fill your prescription in a foreign country?

Make sure to read our guide on how to use pharmacies overseas

However, there are still many countries around the world where it is possible to buy antibiotics without a prescription. Sales of consumer antibiotics, which are often used to cure minor infections (and often taken incorrectly, i.e. in an attempt to cure viral illnesses such as influenza or COVID-19), are often linked to the rising crisis of antibiotic resistance. 

In 2023, the WHO estimated that around one in three people worldwide use antibiotics without a prescription. In the EU, it’s estimated that around 7% of all antibiotics are sold without a prescription.

Countries where you may be able to purchase antibiotics off the shelf include:

The practice is also widely reported throughout developing countries in Africa, Asia and South America.

Will another pandemic happen in our lifetime?

What could the next pandemic be and what we can do about it?

How does antibiotic resistance affect me?

As bacteria become more resistant to antibiotics, doctors around the world are taking steps to limit the prescription of antibiotics to patients. New policies are being written to ensure that antibiotics are only administered in cases where it is absolutely necessary.

As a patient, it’s difficult to say all the ways antibiotic resistance may affect you in the future. For now, there are a number of ways in which you may start to see global healthcare changing as a result of antibiotic resistance:

The impacts of antibiotic resistance

• Patient morbidity – With certain diseases now resistant antibiotics, and antibiotics no longer prescribed for various other diseases, patients may experience longer hospital stays, an increased need for intensive care, excess surgery, periods of quarantine and higher risks to life.
• Increased costs – Antibiotics are an affordable means to treat diseases. Without them, patients may experience rising healthcare costs, especially in cases where they require alternative methods of treatment such as screening, nursing, imaging and intensive care.
• New guidelines – As doctors worldwide adapt to antibiotic resistance, the way we access healthcare will change. Expect to see alternative forms of medication and treatment prescribed more often.
• Complications – The decreasing use of antibiotics may impact other areas of healthcare. For instance, surgeries may become more complex without the ability to prescribe antibiotics.

In summary, the impacts of antibiotic resistance could include fewer antibiotics being prescribed, higher healthcare costs, and the emergence of of new, possibly more deadlier variants of diseases.

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What can you do about antibiotic resistance?

Most countries around the world have already implemented policies to combat the development of antibiotic resistance. These policies include regulating the prescription of antibiotics even among medical professionals, investing in research into antibiotic resistance, implementing surveillance to monitor the use of antibiotics in the population and improving infection control to stop the spread of diseases known to be resistant to antibiotics.

If you would like to learn more about policies affecting antibiotic resistance, a good place to start is with the UK government’s 2024–2029 five year action plan.

As individuals, we can also take steps to ensure we are doing our part to slow down antibiotic resistance. Here are some things you could do if you want to ensure the stop of antibiotic resistant infections:

1/ Remember that prevention is the best cure

The best way to stop the spread of infections developing resistance to antibiotics is for people not to get those diseases in the first place. As we’ve learned from the COVID-19 pandemic, it is possible to stop diseases spreading from person to person by taking a few simple steps when you start to display symptoms.

If you have an illness, avoid coming into contact with other people as much as possible. Practise good hygiene, such as washing your hands regularly with soap for at least 20 seconds, and wearing a facemask when out in public. If you are able, you should stay home and away from others until you are no longer symptomatic.

2/ Get vaccinated

Another way to limit or prevent the spread of diseases is to inoculate yourself against them. All medically approved vaccines have an efficacy rate of at least 50%, meaning they can reduce the risk of serious illness by half, and therefore reduce the use of antibiotics. Vaccines are widely available against many diseases that might otherwise require antibiotics to treat, such as typhoid fever.

It’s important to look out for your health, safety and well-being abroad

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3/ Consult your doctor

Your doctor will be briefed on antibiotic resistance, and will be informed by their medical council and the latest research about best practice in handling antibiotics. 

By speaking to a doctor before seeking medication, you open the door to the opportunity to try alternative means of treatment. Your doctor will also be able to record the data from your treatment in the hopes of developing new forms of treatment to combat antibiotic resistance.

You may therefore be prescribed:

• Alternative forms of treatment, such as bacteriophages, probiotics or plant-based medications
• Antibody treatment, if this is available
• Non-medication based treatments such as rest and exercise

4/ Only take antibiotics that have been prescribed for you

Even if you live in a country where antibiotics are available over the counter, you should only take antibiotics as they are prescribed by a doctor, dentist or licensed medical professional. This means:

• Only taking antibiotics that are prescribed to you
• Taking those antibiotics only as prescribed
• Only taking antibiotics at the time they were prescribed

Avoid using antibiotics that were prescribed to someone else, antibiotics that you have leftover, and antibiotics that you have purchased with a prescription.

5/ Do not demand antibiotics

If your doctor decides not to prescribe antibiotics, it’s because they are following the latest medical guidance and best practices to ensure you receive the most appropriate treatment. If you’re still unsure, you can seek a second opinion—but it’s important to follow medical advice and only take antibiotics when they are truly needed.

Protect your health worldwide

William Russell, we have over 30 years’ experience providing international health insurance to expats living all over the world.

We offer flexible policies to suit your needs, giving you access to a network of over 40,000 private medical facilities, hospitals and clinics across the globe.

Find out more about our international health insurance policies and get a quote online in under two minutes today.

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The only question is whether it will be a disease already known to us – such as one of these diseases on the rise globally – or like COVID-19, an as-yet unknown disease.

Let’s take a look at what we know already and see what might be different if and when the next pandemic rolls around.

What could the next pandemic be?

Unfortunately, it is almost impossible to predict the next pandemic: both what it will be, and when it will occur. 

As with COVID-19, the next pandemic is more than likely to blindside the world, perhaps once more arriving in the form of a previously-unknown disease.

What we do know is that there are various candidates for the next pandemic, including:

Avian influenza

The H1N1 subtype of the influenza A virus, better known as ‘bird flu’, has already accounted for several pandemics, including the 1918 Spanish Flu outbreak and the 2009 Swine Flu pandemic. 

While birds are the prime targets of the disease, humans and other mammals are susceptible after prolonged exposure. The disease presents itself with fever, coughing and diarrhoea, and can have a high mortality rate.

Cases of a new strain of bird flu, H5N1, are currently on the rise globally (the disease has already ravaged livestock in California) and governments have started to take precautions. Australia recently invested US$64 million on ‘biosecurity’ measures designed to protect the country specifically from bird flu, while France has launched a nationwide vaccination campaign.

H5N1 does not spread easily among humans, but can combine with seasonal influenza to produce a deadly combination. It remains to be seen how far the new variant will spread.

Zika

Zika is a virus that is spread by mosquitos. It originated in subsaharan Africa and has since spread throughout the Americas, Asia and the Pacific. While not particularly deadly, it can cause complications during pregnancy. Most people who contract Zika are asymptomatic, but it can cause symptoms such as rash, fever, conjunctivitis, muscle and joint pain, malaise and headaches in some patients.

Because Zika spreads via mosquitos, it is unlikely to spread through Europe and other parts of the world where mosquitos are less common, meaning there is a low chance of it becoming a pandemic in its current form. But since the virus has a high mutation rate, there is a chance it may adapt to become more transmissible in the future.

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Ebola

The Ebolavirus is a harrowing illness that spreads rapidly, causing hemorrhagic fever, nausea, vomiting, diarrhoea and abdominal pain. The mortality rate is around 50%, although some outbreaks have seen mortality as high as 90%.

From 2013–2016, ebola ripped through West Africa, causing over 11,000 deaths. Thankfully, intervention with support of the World Health Organization (WHO) helped to stop the transmission of the disease, giving scientists enough time to develop a vaccine, which can now be used to stop outbreaks before they become epidemics.

Ebola is not a prime candidate to become the next pandemic. However, should the virus mutate suddenly to become resistant to existing vaccines, there is a chance it could spread more easily around the world. And given its high rate of mortality, an ebola pandemic could be extremely deadly.

COVID-19

While the WHO officially ended the public health emergency of international concern (PHEIC) on 5th May 2023, effectively declaring the COVID-19 pandemic over, the disease remains a subject of high concern for epidemiologists worldwide. 

Resurgences have been, and will remain common for the foreseeable future (in August 2024, over 20% of people in Europe contracted the disease) perhaps leading to another situation in which COVID-19 is once again declared a pandemic.

While 72% of the population of Earth is vaccinated against COVID-19, the virus has been known to rapidly mutate in order to make itself more infectious to bypass vaccinations. And while the disease is decreasing in lethality, one mutation may cause a full resurgence of the COVID-19 pandemic.

Disease X

Disease X is the moniker given to a currently unknown disease that could be a candidate for the next pandemic. Prior to the discovery of COVID-19 in 2019, this coronavirus was itself a Disease X. And, like COVID-19, scientists predict that the next Disease X may be a zoonotic virus (one that originates in animals) that spreads to humans.

As well as being the most likely scenario, Disease X is also the most fearsome prospect for the next pandemic. As we saw with COVID-19, the early stages of a novel pandemic are marked by confusion. Without an existing vaccine or cure available, reactive measures including strict lockdowns are required to prevent the spread of the disease while scientists scramble to find treatments.

While the world learned some valuable lessons from the COVID-19 pandemic, a new Disease X pandemic could throw all those learnings out the window – if the disease is more contagious and more deadly, the next pandemic may be considerably more formidable than the last.

Will antibiotic resistance contribute to the next pandemic?

Find out more about antibiotic resistance here

Are we already experiencing the next pandemic?

Another school of thought is that the next pandemic is already upon us. However, instead of a virus or bacterial infection, the list of ongoing pandemics is largely composed of chronic conditions – ones that may worsen over time to become full-blown global health crises.

Some of the conditions already mooted to be defined as ongoing pandemics include:

Obesity

While the WHO officially classes obesity as an epidemic, some scientists have gone a step further to declare it a pandemic. Globally, more than one billion people are now classed as obese, with the World Obesity Federation warning that half the population of the world may be obese by 2035, as our diets become less and less healthy.

Obesity is not only a cause of death in and of itself, but exacerbates a number of other diseases – from heart disease, to stroke, diabetes and even COVID-19. Reversing the worrying rise of obesity around the world is a huge priority for the WHO, which has implemented an Acceleration Plan to stem the upcoming global health crisis.

HIV/AIDS

The HIV/AIDS pandemic officially started in 1981, and has been ongoing ever since. While cases have been declining since 1996, still more than 39 million people worldwide were living with HIV at the end of 2023, with 630,000 HIV-related deaths in that year alone.

Thankfully, various treatments are now available for HIV, including post-exposure prophylaxis (PEP) and antiretrovirals (ARVs). These are designed to repress HIV levels until they are practically undetectable, thus preventing both the transmission of the disease, and stopping HIV from developing into lethal AIDS.

However, as of yet no cure or vaccine exists for HIV/AIDS, and the spread of the disease is still prevalent in Africa. It is therefore likely HIV/AIDS will remain a pandemic for the foreseeable future.

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Cholera

The first cholera pandemic started as far back as 1817, while the current pandemic has been ongoing since the 1960s. While the disease is rare in developed countries, cholera continues to be a mainstay illness in less-developed parts of Asia and Africa. Researchers estimate there to be around 1.3 million to 4 million cases of cholera and anywhere between 21,000 to 143,000 deaths each year.

The WHO has set out to put an end to the cholera pandemic, with a roadmap to reduce cases by up to 90% by 2030. Until then, cholera remains a highly contagious illness that is a key cause of public health concern in many countries.

Hypertension

Hypertension (high blood pressure) is the number one risk factor for deaths globally, and directly responsible for around 10 million deaths every year.

It’s also a growing concern: in the last 30 years, the number of adults aged 30–79 years exhibiting high blood pressure has increased from 650 million to 1.28 billion globally. The US Office of Disease Prevention and Health Promotion has therefore declared: “The data unequivocally paint the picture of a global pandemic.”

High blood pressure is known as the silent killer because it can go undetected or underestimated until it reveals itself in the form of a major event, such as heart attack, stroke or vascular dementia. The WHO has committed itself to strengthening responses to the global spread of hypertension with its Global Hearts initiative.

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Can we predict the next pandemic?

While pandemics are currently impossible to predict, scientists around the world are attempting to create tools that will help them to figure out patterns in public health data and identify pandemics sooner rather than later. If successful, they may even help point the way towards an understanding of how, why, where and when pandemics begin.

One such tool, developed by Harvard Medical School and the University of Oxford, is EVEscape. Using artificial intelligence, EVEscape predicts the future mutation of diseases such as coronavirus, HIV and influenza, which could allow pharmacists to proactively develop vaccines and stop the spread of diseases faster.

Elsewhere, scientists at the University of California, Irvine (UCI) and the University of California, Los Angeles (UCLA) are using AI models to chart the spread of diseases through social media content. By monitoring patterns of self-reported symptoms through people’s social media posts, they hope to be able to map the early stages of an outbreak, identifying the markers that could lead to it becoming a pandemic.

“People overshare on social media all the time, but that can be exploited to our advantage,” says Andrew Noymer, associate professor of population health and disease prevention at UCI. “If we noticed patterns of hundreds of people all of a sudden tweeting about fever or pneumonia in such and such a city, that might be useful information.”

It is worth remembering that research is still in its early phases and we are still many years away from being able to accurately forecast pandemics. Until then, we must remain vigilant and ready to respond to pandemics, if and when they rear their ugly heads.

What can we do to prepare?

If there’s one thing the world learned from the COVID-19 pandemic, it’s that we are radically underprepared for a pandemic. 

In the words of The Lancet, “widespread failures during the COVID-19 pandemic at multiple levels worldwide led to millions of preventable deaths and a reversal in progress towards sustainable development for many countries.” That’s saying nothing of the trust many people lost in their governments’ pandemic preparedness programmes.

Thankfully, valuable lessons were learned, and the world is already taking steps to ensure the next pandemic can be dealt with far more swiftly and effectively. The responsibility to prepare for the next pandemic rests on the shoulders of both policymakers at intranational and governmental levels, and individuals like you.

Let’s look at how the world can start to prepare for the next pandemic.

How are governments preparing for the next pandemic?

After seeing the human and economic costs of the COVID-19 pandemic, many governments are committing to plans to ensure they will be adequately prepared for the next pandemic.

One such plan, which is currently being debated and drafted, is the WHO’s Pandemic Preparedness Treaty – the exact terms of this treaty are yet to be seen, but will likely establish a global standard for how individual countries prepare for and react to the emergence of a new global pandemic.

One of the WHO’s key priorities is that individual governments will mobilise their populations to start preparing for the next pandemic well ahead of time. The WHO’s Health Emergencies Programme (HEP) is supporting states in order to do this.

Elsewhere, the World Bank is committing funds to under-developed countries to support them in vaccine preparedness.

And the Coalition for Epidemic Preparedness Innovations (CEPI), supported by the G7, has set itself a landmark target for the next pandemic: to organise a vaccine response within 100 days of the next outbreak. Using advanced pathogen modelling techniques, and by encouraging governments to work together to share data, they aim to create a system through which future pandemics can be mitigated in time to save millions of lives.

In short, various agencies and governments are taking broad steps to prepare for the next pandemic. While there is, as yet, no single methodology that all countries are aligned to, a number of programmes are already being drafted. It remains to be seen whether the world will align to a single pandemic preparedness strategy, but early signs are positive.

How can individuals prepare for the next pandemic?

There is no right way to prepare for the next pandemic, other than to remind ourselves of the lessons we have learned from COVID-19.

Contact tracing

Knowing if and when you were in the vicinity of an infected person was important during the COVID-19 pandemic to ensure that anyone who had been exposed to the disease could self-isolate in order to limit the spread of the disease. 

During the next pandemic, contact tracing will be just as important. As the technology of contact tracing evolves, we may be able to more easily, accurately and quickly identify exposures, and reduce the spread of the disease with even greater efficiency.

Self-isolating

Quarantining was another essential mechanism by which individuals helped to stem the spread of COVID-19. But, coming as a bit of a shock, it’s fair to say that many of us were unprepared to spend weeks and months at a time locked in our homes. Mental health took a nosedive around the world as a result – the WHO estimates depression and anxiety skyrocketed by around 25% worldwide.

When the next pandemic rears its head, it will be up to each of us to ensure we are ready for self-isolation once more. This means preparing ourselves mentally for the step change in our lifestyles, and using mechanisms learned from the last pandemic to ensure that we remain positive and focused in spite of the lack of social contact.

Vaccinations

Vaccines are not only the fastest and surest way to end a pandemic, they are also the best means we have to preventing them. It was vaccines that ultimately brought the COVID-19 pandemic under control – and if we are fortunate, the next pandemic may be stopped in its tracks by a vaccine before it becomes a global crisis.

Unfortunately, when it comes to vaccines, misinformation is rife. And while it is important to be well-informed about your medical options, it is also important to remember that it is our own responsibility to self-present for vaccinations as and when we are called. Only by ensuring a spread of immunity within the population can we bring a pandemic under control for everyone’s benefit. Therefore, listen to the advice of reputable medical professionals and follow instructions as best you can.

Look out for number one

The last and perhaps most important lesson we learned from COVID-19 was that it is up to each and every one of us to protect ourselves and those around us. We have all learned the proper techniques to prevent the spread of disease – maintaining social distancing, wearing a facemask, washing our hands, and so on. When the next pandemic comes, we must be ready to repeat this behaviour, and to do it sooner rather than later.

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Could international health insurance help?

During the COVID-19 pandemic, William Russell paid out over US$150,000 to support our members in 26 countries. With 30 years’ experience providing international health insurance to expats all over the world, we promise to be there for you no matter what.

Protect your health and well-being with William Russell. Find out more about our international health insurance policies and get a quote online in under two minutes today.

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As climate change expands the habitats of disease-carrying organisms, and global travel accelerates the spread of pathogens, the emergence of new diseases and the resurgence of old ones seem inevitable. Some of these threats may come from viruses we’ve only recently encountered, while others are familiar foes reemerging with greater resilience, like antibiotic-resistant bacteria or strains of influenza with pandemic potential.

In this article we’ll consider which diseases are most at risk of resurgence, and highlight where we’re starting to see new cases emerge.

Rabies

Deaths per year: 59,000

Rabies is a deadly viral infection that affects the central nervous system of mammals, including humans. Caused by the lyssavirus rabies, it is typically transmitted through the saliva of infected animals, mainly via bites. Dogs are responsible for 99% of human rabies cases, but other carriers include bats, raccoons, skunks, and foxes.

Initial symptoms of rabies include fever, headache, and general weakness. As the virus progresses, more severe symptoms such as anxiety, hallucinations, excessive salivation, and difficulty swallowing can develop, leading to hydrophobia (fear of water). Infected animals may exhibit behaviour changes like aggression, lethargy, or excessive drooling.

Prevention relies on mass dog vaccination, bite prevention, and prompt administration of post-exposure prophylaxis (PEP), which involves wound washing, rabies vaccination, and, if needed, rabies immunoglobulin.

Rabies remains a serious public health issue in over 150 countries, particularly in Asia and Africa, where tens of thousands of deaths occur annually. 40% of rabies victims are children under 15 years old. In the Americas, dog-mediated rabies is largely controlled, but bat-transmitted rabies has emerged as a new threat which has a higher likelihood of spreading to other regions in the coming years.

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Malaria

Deaths per year: 608,000

Malaria is a mosquito-borne infectious disease caused by Plasmodium parasites, primarily spread through the bites of infected Anopheles mosquitoes. Symptoms include fever, chills, headache, muscle aches, and fatigue, which can progress to severe complications like organ failure if not treated. Preventive measures include the use of insecticide-treated bed nets, indoor spraying, and antimalarial medications.

The WHO African Region suffers a disproportionately high share of the global malaria burden, accounting for 94% of all cases (233 million) and 95% of all malaria deaths (580,000). Tragically, children under 5 years old are the most vulnerable, making up about 78% of malaria deaths in this region.

Despite best efforts, the fight against Malaria is far from over and the disease is currently making a significant comeback in Sub-Saharan Africa, driven by growing mosquito resistance to insecticides and parasites developing resistance to drugs.

Regions in South Asia and Southeast Asia also continue to see high transmission rates with factors such as climate change, migration, and gaps in healthcare allowing malaria to re-emerge in areas where it was previously controlled.

Depression

Deaths per year: 700,000*

Depression, or depressive disorder, is a common mental health condition characterised by persistent feelings of sadness, emptiness, or irritability, and a loss of interest in activities.

Around 280 million people globally are affected by depression, including 5.7% of adults over 60. Depression can impact all aspects of life, leading to problems in relationships, work, and daily activities, and is a major contributor to suicide, which claims over 700,000 lives each year.

The causes of depression are complex, involving a mix of social, psychological, and biological factors. Stressful life events, such as job loss, trauma, or bereavement, can increase the risk. Physical health issues, like chronic diseases, may also contribute to or exacerbate depression. 

Treatment options for depression range from cognitive behavioural therapy (CBT) to community and talking therapies. While antidepressants like SSRIs can be effective, they are not recommended for children and should be used cautiously in adolescents.

Regular physical activity, maintaining social connections, and avoiding substance abuse are recommended for both prevention and management of depression. Despite available treatments however, access remains a challenge, particularly in low- and middle-income countries, where over 75% of those affected receive no treatment due to stigma and lack of resources.

*by suicide, though not all may be caused by depression.

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SARS

Deaths per year: Unknown

Severe Acute Respiratory Syndrome (SARS) is a viral respiratory disease caused by a SARS-associated coronavirus. First identified in February 2003, it emerged in China and rapidly spread to several other countries. In late 2019, a mutation of the virus caused by SARS-CoV-2 led to the COVID-19 pandemic.

SARS is primarily transmitted through airborne droplets, similar to influenza, but can also spread via contaminated surfaces. It has an incubation period of 2–10 days, with symptoms starting as a high fever (over 38°C), often accompanied by chills, headache, muscle pain, and occasionally mild respiratory symptoms.

After 3–7 days, it may progress to a severe respiratory phase with a dry cough and difficulty breathing, requiring mechanical ventilation in 10–20% of cases. The disease primarily affects healthy adults aged 25–70, with a case fatality rate of around 3%.

Containment relies on measures such as isolating cases, contact tracing, quarantine, and disinfection of public transport such as trains, buses and aeroplanes.

It’s also key to note that coronaviruses, like SARS-CoV, are RNA viruses which have a high rate of mutation. Future mutations may still lead to new variants that are more transmissible, show different symptoms, and evade existing immunity.

Ebola

Deaths per year: 61*

Ebola is a severe and often fatal viral haemorrhagic fever caused by the Ebola virus. It spreads through direct contact with the blood, body fluids, or tissues of infected individuals or animals.

Symptoms can appear suddenly and include fever, muscle pain, vomiting, diarrhoea, and both internal and external bleeding. The virus has an average case fatality rate of 50%, though this can vary from 25% to 90% depending on the outbreak and response.

One of the factors making Ebola an ever-present risk, is its high transmission rates. Transmission of Ebola occurs through direct contact with infected animals (such as fruit bats, chimpanzees, and gorillas) or through human-to-human contact, especially via bodily fluids.

Recent Ebola outbreaks have resurged in Central and West Africa, with countries like the Democratic Republic of the Congo (DRC) and Guinea seeing recurrent cases. The resurgence is partly due to challenges in containment, such as unstable healthcare systems, limited access to vaccines, and sociopolitical issues that hinder public health efforts.

*Based on 2022 data

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Gonorrhoea

Deaths per year: Unknown

Gonorrhoea is a common sexually transmitted infection caused by Neisseria gonorrhoeae, mainly spread through vaginal, oral, or anal sex. In 2020, there were an estimated 82.4 million new infections globally. 

While the infection is curable with antibiotics, rising antimicrobial resistance is making treatment more challenging. Symptoms vary by gender; many infected people show no symptoms but some may experience discharge and pain when urinating.

The prevalence of gonorrhoea is highest among vulnerable populations, including men who have sex with men, sex workers, and adolescents. Complications can affect various body parts: pelvic inflammatory disease and ectopic pregnancies in women, scrotal swelling in men, and eye infections in newborns. Rarely, the infection can spread throughout the body, causing fever and affecting organs such as the skin, heart, and joints.

Preventing gonorrhoea primarily relies on consistent condom use. Early diagnosis and treatment are also crucial, and cephalosporin antibiotics, especially ceftriaxone, are the preferred treatment. However, growing antibiotic resistance requires careful monitoring worldwide.

Lyme disease

Deaths per year: Unknown

Lyme disease is a bacterial infection caused by Borrelia burgdorferi, transmitted to humans through bites from infected black-legged ticks, also known as deer ticks. Early symptoms typically include fever, fatigue, headache, and a distinctive bull’s eye-shaped rash.

Lyme disease has seen a notable resurgence across parts of North America and Europe. In the United States, Lyme disease is most prevalent in the Northeastern and Upper Midwest regions, including states like Connecticut, New York, and Wisconsin. According to the Centers for Disease Control and Prevention (CDC), around 476,000 Americans are diagnosed and treated for Lyme disease every year.

In Canada, reported cases have also increased, particularly in Ontario, Quebec, and Nova Scotia, with a more than tenfold increase in cases over the last decade. In Europe, countries like Germany, Austria, and Switzerland are experiencing similar trends, attributed to expanding tick habitats driven by climate change, urban sprawl, and shifts in land use.

Preventative measures are critical to controlling Lyme disease. This includes using insect repellents, wearing protective clothing, performing regular tick checks, and managing environments to reduce tick populations. Early detection and prompt treatment with antibiotics can prevent severe health complications.

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E. coli

Deaths per year: 950,000

Escherichia coli (E. coli) is a bacterium that can cause illness when certain pathogenic strains contaminate food or water. While most strains are harmless, some, such as Shiga toxin-producing E. coli (STEC), can cause severe illness.

Symptoms range from mild abdominal cramps and diarrhoea, to vomiting and fever. The illness typically lasts about 10 days, but in about 10% of cases, particularly in young children and the elderly, it can lead to haemolytic uremic syndrome (HUS) – a life-threatening condition characterised by acute kidney failure, anaemia, and low platelet counts. HUS is the leading cause of acute renal failure in children, with a case-fatality rate ranging from 3% to 5%.

Cattle are the main carriers, but other animals like sheep, goats, and deer can also carry the bacteria. In recent years, there have been a number of E. coli resurgences in North America, Europe, and Asia with an increasing number of cases tied to fresh produce, suggesting that contamination during farming, harvesting, and handling is a growing concern.

Prevention of E. coli involves proper cooking, food hygiene, and strict monitoring of water and food sources.

Hantavirus

Deaths per year: Unknown

Hantavirus is a group of viruses transmitted primarily by rodents. In humans, it can lead to two syndromes: Hantavirus Cardiopulmonary Syndrome (HCPS) in North and America which has a case fatality rate of 40-50%, and Haemorrhagic Fever with Renal Syndrome (HFRS) in Europe and Asia which has a fatality rate of up to 12%.

More than 200,000 cases of hantavirus occur globally each year. China reports the most HFRS related deaths in the world, with almost 210,000 cases of HFRS and 1,855 deaths reported between 2004 and 2019. 

Meanwhile, in 2020 Finland and Germany claimed 85% of HFRS cases in the EU/EEA, with Finland alone accounting for 71%. The overall rate of infection in Europe fluctuated between 0.4 and 1.0 cases per 100,000 from 2016 to 2020, with no significant long-term trend.

The resurgence of hantavirus infections is linked to environmental changes that increase human-rodent contact, such as deforestation and urban expansion. There is currently no licensed vaccine for hantavirus, so prevention relies on rodent control and minimising exposure to rodent droppings. Public health strategies emphasise education and preventive actions to reduce infection risk.

Dengue fever

Deaths per year: 6,892

Dengue is a viral infection spread by Aedes mosquitoes. About half of the global population is at risk, with 100–400 million infections estimated each year, primarily in tropical and subtropical regions.

The disease ranges from mild fever, headache, body aches, and rash to severe forms causing internal bleeding and organ failure. Severe dengue can be fatal without hospital care, and those infected for a second time are at greater risk of more grievous symptoms.

Dengue cases have surged globally, with a historic peak of over 6.5 million cases in 2023, and nearly 7,000 reported deaths. Dengue fever is endemic in over 100 nations, particularly in Asia, which bears about 70% of the global burden.

Preventing dengue relies on controlling mosquito populations and protecting against bites. Strategies include wearing protective clothing, using insect repellents, and managing water storage to reduce mosquito breeding. No specific treatment exists, and care focuses on pain relief and hydration. A vaccine, QDenga, is available for children in some high-risk areas, with other vaccines in development.

The resurgence of hantavirus infections is linked to environmental changes that increase human-rodent contact, such as deforestation and urban expansion. There is currently no licensed vaccine for hantavirus, so prevention relies on rodent control and minimising exposure to rodent droppings. Public health strategies emphasise education and preventive actions to reduce infection risk.

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West Nile virus

Deaths per year: approx. 128 confirmed

West Nile virus, first identified in Uganda in 1937, is a mosquito-borne disease primarily transmitted to humans through bites from infected mosquitoes.

While approximately 80% of infected individuals remain asymptomatic, the virus can lead to severe neurological complications, including encephalitis and meningitis, particularly in individuals over 50 and those with compromised immune systems.

West Nile virus is most prevalent in North America, particularly in the United States and Canada, as well as parts of Europe, Africa, and the Middle East. 

The risk factors contributing to the spread of West Nile virus are closely tied to environmental changes, such as rising temperatures, urbanisation, and the presence of stagnant water, which create ideal breeding conditions for mosquitoes.

Ongoing surveillance of animal populations, especially birds and horses, is essential for early detection of West Nile virus activity, as outbreaks in these groups often precede human cases.

Tuberculosis

Deaths per year: 1.3 million

Tuberculosis (TB) is a serious bacterial infection caused by Mycobacterium tuberculosis, primarily affecting the lungs but capable of spreading to other parts of the body, such as the brain and spine.

TB poses a significant public health challenge, particularly in regions such as South and Southeast Asia, Africa and Eastern Europe. The resurgence of TB in these areas can be attributed to various factors, including the emergence of drug-resistant strains, co-infection with HIV, and overcrowding.

Symptoms of TB include a persistent cough, chest pain, fever, night sweats, and weight loss. While about 80% of individuals infected with TB bacteria remain asymptomatic, a small proportion will develop active TB disease, which is contagious and requires immediate medical intervention.

Diagnosis typically involves rapid molecular tests, while treatment consists of a strict regimen of antibiotics for four to six months. However, the rise of multidrug-resistant TB (MDR-TB) has become a critical public health crisis, necessitating more complex and costly treatment options.

Preventative measures against TB include early diagnosis and treatment with antibiotics, as well as vaccination with the Bacillus Calmette-Guérin (BCG) vaccine, which is effective in preventing severe forms of TB in children.

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Cholera

Deaths per year: 21,000-143,000

Cholera is an acute diarrheal disease caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Although most people infected experience mild or no symptoms, the disease can cause severe diarrhoea that can lead to dehydration and death within hours if untreated.

Each year, an estimated 1.3 to 4.0 million cases of cholera occur globally, resulting in as many as 143,000 deaths.

Cholera remains a significant global health threat, often serving as an indicator of inequity and poor social development.

Cholera outbreaks are particularly common in areas with compromised water and sanitation systems, such as peri-urban slums and camps for displaced persons or refugees. Risk factors include humanitarian crises, unplanned urbanisation, and climate change, which disrupt water supply systems and increase exposure to contaminated environments. 

Cholera can be effectively treated with oral rehydration solutions (ORS) for mild cases, while severe cases require rapid administration of intravenous fluids and antibiotics. Preventing and controlling cholera involves improving water, sanitation, and hygiene (WASH), surveillance, treatment, and vaccination. Oral cholera vaccines (OCVs) are used in areas with high risk or ongoing outbreaks.

Pertussis (whooping cough)

Deaths per year: 160,700

Pertussis, commonly known as whooping cough, is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. It spreads easily through coughing and sneezing, producing toxins that cause severe coughing fits, often followed by a “whooping” sound during inhalation.

Before vaccines became widespread in the 1940s, whooping cough caused around 200,000 infections and 9,000 deaths annually in the U.S. Despite significant progress, whooping cough has resurged in North America, Europe, and Australia, mainly due to declining vaccination rates and waning immunity.

Booster shots are needed throughout life since the protection from childhood vaccination wears off, leaving adolescents and adults susceptible. Infants under three months are most at risk, often catching the infection from unknowing older siblings, parents, or caregivers.

Preventing whooping cough relies on vaccines like the DTaP for children and Tdap boosters for teens and adults. Worldwide, there are about 24.1 million cases annually, resulting in 160,700 deaths, primarily in children under five.

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Influenza (Flu)

Deaths per year: 700,000

Influenza, commonly known as the flu, is a contagious viral infection that affects the respiratory system. Symptoms include fever, chills, body aches, sore throat, and cough. The flu virus mutates frequently, leading to seasonal outbreaks each year.

Seasonal influenza causes around 700,000 deaths globally each year, primarily from respiratory and cardiovascular complications.

Although the risk of dying from the flu has declined significantly over the past century due to better sanitation, healthcare, and vaccination, the disease remains a major burden, particularly in regions with limited healthcare access and among ageing populations.

Historically, flu mortality has decreased because of improved hygiene practices and the development of vaccines, which are updated annually to match circulating strains. However, severe flu seasons can still occur when new strains emerge through “antigenic drift” or “antigenic shift,” making the virus more infectious and sometimes deadlier. Past influenza pandemics, such as the Spanish flu, resulted from such shifts, causing millions of deaths worldwide.

To reduce the impact of seasonal influenza, increased vaccination coverage and better healthcare access are essential, especially in lower-income countries. Continued improvements in global health infrastructure can further decrease the flu’s burden, building on the significant progress already made over the past decades.

Pneumonia

Deaths per year: 2.5 million

Pneumonia is a severe lung infection caused by bacteria, viruses, or fungi, leading to inflammation of the alveoli, which fill with pus and fluid. This condition makes breathing painful and reduces oxygen intake.

The infection spreads primarily through respiratory droplets when an infected person coughs or sneezes.

The global burden of pneumonia has shifted over recent decades. Child mortality from pneumonia has significantly decreased, with annual deaths dropping by almost two-thirds since 1990 due to better access to vaccines, antibiotics, and improvements in sanitation and nutrition.

However, the number of deaths among older adults has increased, primarily because of ageing populations. In 2019, over one million deaths were reported among those aged 70 and older, with the highest mortality rates seen in sub-Saharan Africa and South Asia.

Prevention and treatment strategies include vaccination, reducing air pollution, and early medical intervention with antibiotics and oxygen therapy. Despite advances, pneumonia remains most prevalent in low-income regions, earning its label as “the ultimate disease of poverty” due to limited healthcare access and resources.

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Protect your health worldwide

William Russell, we have over 30 years’ experience providing international health insurance to expats living all over the world.

We offer flexible policies to suit your needs, giving you access to a network of over 40,000 private medical facilities, hospitals and clinics across the globe.

Find out more about our international health insurance policies and get a quote online in under two minutes today.

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In this guide, we’ll walk you through the process of obtaining medication while you’re living overseas, including some of the challenges you may face.

Getting medication abroad: how to fill a prescription when moving overseas

When moving abroad, navigating the local pharmacy system may vary depending on the country’s healthcare regulations. Some nations might require a new prescription from a local doctor, while others accept international prescriptions.

It’s essential to understand the process early on, including which medications are available, how to get refills, and whether you need to find alternative brands due to availability or regulations.

International insurance tailor-made for expats

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Preparing to move abroad if you’re on prescribed medication

If you are currently taking prescribed medication, there are some steps you’ll need to take in order to prepare for your move abroad.

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1/ Take out international health insurance

Wherever you plan to move in the world, international health insurance can be very helpful – especially if you are taking regular medication.

International health insurance ensures that if you need help obtaining medication in a foreign country, or run out of essential medication while living abroad, you will have access to emergency healthcare services.

With international health insurance, you may be able to:

• Fund the cost of emergency prescriptions
• Help you find doctors and pharmacies in a foreign country
• Ensure you are protected when you travel to a different country to the one you’re living in

With international health insurance, you will also be covered for the cost of new prescriptions, i.e. prescriptions written for medical conditions you develop while living abroad and already insured.

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2/ Make sure you have a copy of your prescription

Before you leave, visit your GP to obtain a notarised copy of your prescription along with a cover letter. 

These should record the name of the medication prescribed, and the condition(s) it is intended to treat. They should also identify you as the person to whom they are prescribed – for this reason, it’s important to make sure the name on your prescription and cover letter matches the name on your passport.

While travelling through the border of a foreign country, you should keep any medication containing a controlled drug in your hand luggage along with a copy of your prescription and cover letter. You must be ready to declare these medications, to show your doctor’s note, and to prove that you are the person identified in your cover letter. 

If you are travelling by air, remember that the amount of liquid you can take in a single container via hand luggage must be no more than 100ml, meaning you may need to decant liquid medication into separate vials.

3/ Do you need to get your prescriptions translated?

Whether you’re crossing the border or visiting a foreign pharmacy, some countries may accept a copy of your prescription and cover letter in English, while many others will only accept these documents in the local languages.

Before setting off, you should check which language your prescription and cover letter should be in. If in any doubt, speak to a medical translation specialist.

Remember, you will need to provide your original prescription and cover letter in a notarised format, i.e. signed by your doctor and/or written on letter headed paper. Therefore, you may wish to return to your doctor to have your translated copy notarised, or alternatively bring both the original and translated copies with you.

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4/ Ask for additional stock of your medication

If you take medicine regularly in the form of a repeat prescription, you may be entitled to receive a stock of up to three months’ worth of your prescription. This is to help tide you over while you complete the move to a foreign country.

It should be noted that, after you arrive in a foreign country, your healthcare supplier may relinquish responsibility for you, at which point you will be required to register with a healthcare provider in your new country of residence in order to receive your prescription moving forward.

It should also be noted that some nations may restrict the supply of medicine you are allowed to bring into the country. For instance, if you are travelling between Schengen states, you will only be allowed to carry up to one months’ worth of medicine.

5/ Check if your prescribed medication is banned or not available overseas

Before you set off, you should research the availability of your prescribed medication in the country you are moving to. In some cases, you may find that your prescribed medication is:

• Prohibited for sale in your new home country
• Not widely available, or not available at all
• Extremely expensive, i.e. out of your price range

This may be especially true for opioid-based painkillers, psychotropic substances and medical marijuana.

You may also find that your prescribed medication is not available from reputable suppliers. This means that, while the medication may be listed as available, it may be distributed by a different manufacturer.

The efficacy of the drug may therefore not be as great as the one you are currently taking, and you may also run the risk of receiving counterfeit medication. If you fear this may be a possibility, you should research thoroughly whether it will be possible to receive your preferred medication through alternative channels.

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6/ Can your doctor prescribe an alternative?

If your medication is banned or unavailable, or if you believe the supply will be undependable, you may wish to speak to your doctor about other options. Tell your doctor about your plans to move to another country, and see whether they might be able to prescribe an alternative medication.

7/ Can you get your medication through other means?

If your preferred medication is not widely available in your new home country, you may be able to find it via alternative channels. 

If your new home country has a national formulary, this will list available, licensed drugs that can be prescribed as alternatives, or imported. A GP should be able to prescribe and/or procure these drugs for you. Unfortunately, many developing countries do not have national formularies, meaning you may need to try other routes.

If the same drug is not available and there is no equivalent alternative, you may need to consider these options to find a replacement:

• Contact a travel medicine specialist or a pharmacist in your home country. They will be able to access international drug databases to find exact or equivalent products that suit your needs.

• Contact your national embassy. They may be able to point you towards trusted pharmacies, or import drugs on your behalf.

• Contact your international health insurance provider – they may be able to point you in the direction of specialists.

• Check reliable, regulated online stores to see whether you can personally and safely purchase your medication and have it shipped to you.

Finding a pharmacy overseas

Once you arrive in your new home, the first thing you should do is search for your nearest pharmacy. You may wish to pay them a visit sooner rather than later to show them your prescription and set up an account, which will make it easier for you to procure your essential medication moving forward. 

You can also take this opportunity to start building a relationship with your new pharmacist – having a good rapport with your pharmacist can be very beneficial, especially if you will be visiting regularly and want to be seen quickly!

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Types of pharmacy to look for

While living abroad, you may come across several different types of pharmacy. The type of pharmacy you will need will depend on your circumstances.

Retail pharmacy

Also known as a community pharmacy or high street pharmacy, this is a typical pharmacist’s shop that can be found in town centres, shopping centres, village high streets and so on. They may be independent or part of wider chains, such as Boots in the UK. Retail pharmacies employ pharmacists who work behind the counter serving prescriptions, prescribing medications for minor conditions and offering advice on medications.

Hospital pharmacy

Large hospitals have their own pharmacies, which are responsible for managing medications on behalf of the hospital. Hospital pharmacists work closely with healthcare professionals elsewhere in the hospital, synthesising drugs, filling prescriptions, hosting clinical trials, and consulting patients. If you require emergency medication, a hospital pharmacist may be able to fill your prescription.

Clinical pharmacy

Like hospital pharmacies, clinical pharmacies exist in smaller facilities, dentists offices and patient care homes. While visiting one of these facilities, you may be administered a prescription, which can be filled by the on-site pharmacist. You may also be able to attend a clinical pharmacy in an emergency.

Ambulatory care pharmacy

For people who live in remote and rural regions, or who have mobility issues that prevent them from attending a pharmacy in person, an ambulatory pharmacy may exist to help bring medications to their doorstep. The ambulatory pharmacist may also check in with patients to monitor the efficacy of treatments. Ambulatory care pharmacists may also respond to patients in an emergency.

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Which symbols to look for

Pharmacies are generally easy to spot while out and about, but different countries may use different symbols to identify their pharmacies. These symbols are derived from centuries of tradition, and may be helpful in identifying reputable and legitimate pharmacies.

Paying for your prescription

As a foreign national, it is likely that you will have to pay for your prescriptions out-of-pocket when you first arrive in a foreign country. Depending on the type of medication you need, you may find the cost of drugs to be considerably higher than it was in your home country. However, there are several options available to help you manage the cost of your prescription abroad.

Seeking reimbursement

You may be able to claim back the costs of any prescription medication abroad from the national health insurer of your home country. While you will still need to pay the full cost of the medication at the point of sale, you will be entitled to claim back the full costs of any medications bought when you return to your home country.

Your access to this scheme will depend on the type of health insurance you have in your country of citizenship. For instance, EU citizens who are in possession of a valid European Health Insurance Card (EHIC) will be able to claim back all expenses for any prescription medication bought anywhere in the world, so long as they are able to submit a receipt to the health insurer in their local country. For this reason, it is important you keep hold of any receipts given along with any medication.

Signing up to your local health system

Another way to reduce or manage the costs of your prescription medication abroad is to sign up with the local healthcare system. There are various steps you may need to take in order to achieve this, including gaining residency and paying healthcare taxes or national insurance. This process may not be possible in countries that use an out-of-pocket system for health insurance, such as the United States, where you may need to sign up to a private health insurance provider.

Claiming through international health insurance

As mentioned previously, if you have international health insurance, you will be covered for the cost of any new prescriptions you have written while living abroad. Find out more about how to make a claim through international health insurance here.

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Start your new life abroad with William Russell

At William Russell, we have over 30 years’ experience helping expats just like you settle into their new lives overseas.

We offer flexible policies to suit your needs, offering you access to a network of over 40,000 private medical facilities, hospitals and clinics across the globe.

Find out more about our international health insurance policies and get a quote online in under two minutes today.

The post Getting A Prescription Abroad: How To Use Pharmacies Overseas appeared first on William Russell.