Dr. Andreas Brauchlin is a globally renowned specialist in cardiology and internal medicine and a member of the SIP Medical Family Office® Medical Advisory Board.
Managing their health is on an all-time high on the priority list of global citizens and high-net-worth individuals. It is not surprising that evaluating the impact on one’s health and wellbeing when considering a change in residence is also high on the agenda in the global mobility sector. As the quality of public and private healthcare, the advancement of medical research, and access to the most modern medical infrastructure and technology varies extensively worldwide, migrants also aim to enhance the healthcare environment. Correspondingly, the pandemic and its aftermath have revealed the flaws, weaknesses, and limitations of the healthcare systems in many countries.
Among other factors, a country’s life expectancy is one measurement that indicates how favorable an environment is for its residents’ wellbeing. Since 1960, the world population’s life expectancy at birth has increased from about 53 years to 72 years. However, the differences between countries remain significant.
While more than 20 countries report a life expectancy of more than 80 years, less favorable places indicate life expectancies of less than 60 years. Some of the countries with the lowest expected life spans include Chad, Lesotho, Nigeria, and Somalia. The list of countries and economies with the highest life expectancy is headed by Asian jurisdictions such as Japan, Macao (SAR China), and residence by investment hosts Hong Kong (SAR China) and Singapore. Also with an expected life span of more than 80 years, the leading countries in Europe include Malta, Norway, and Switzerland.
Portugal, which has one of the most popular residence by investment programs, promises a life span at birth of 81 years. In contrast, citizenship by investment host country Montenegro has a life expectancy of only 76 years. Among the Caribbean citizenship by investment islands, Antigua and Barbuda is leading with 77 years, followed by St. Lucia with 76 years, Grenada with 72 years, and St. Kitts and Nevis with 71 years. The UAE — the country with the highest influx of millionaires currently and a residence by investment host country — offers a life expectancy of 78 years at birth.
Without further elaboration, we can see the extent to which people’s residential environment influences their health and wellbeing. The underlying reasons are diverse and range from the quality of a country’s healthcare system, to environmental exposure, to nutritional habits, to the quality of foods and water available.
One of the countries that struggled the most during and post the main waves of the Covid-19 pandemic is the UK, which also has a residence by investment program. In earlier days, the country’s National Healthcare System (NHS) was renowned for its high quality. Today, public satisfaction with the NHS has reached a 25-year low, as thousands of patients wait months for appointments and surgeries. As one of the hottest topics of our generation, it is expected that the number of diagnoses of cancer at a developed stage will increase because routine controls and cancer screenings were postponed for several months during the pandemic. With this huge backlog and pressure on the NHS, the private healthcare sector in the UK is also pressured and must still cope with the remains of the pandemic peaks.
Other European countries that host residence and/or citizenship by investment programs such as Malta, Portugal, and Switzerland, on the other hand, have recovered well and present stable public and private healthcare systems with increasing quality and accessibility once again.
In contrast, one can observe massive differences in the quality of healthcare provided in the private and public healthcare systems in Dubai. All residents and applicants for the Dubai Golden Visa must prove that they have health insurance that is compliant with the Dubai Health Authority (DHA) requirements. Because of the minimalist coverage and support, and limited access to the best — and usually private — medical facilities in Dubai, most people combine the mandatory DHA insurance with universal private medical insurance that gives unrestricted access to the best facilities such as the American Hospital, Medcare Hospital, Mediclinic, and the Saudi German Hospital. Pre- and post-Covid, the healthcare system has grown extensively in Dubai, while large gaps in the quality of services and doctors in the public and private spheres remain. Overall, the country offers healthcare above the global average. However, it does not yet live up to its aim to become one of the top healthcare destinations globally, on par with Germany, Switzerland, the UK, or the USA.
Despite its attractive offerings for residence, citizenship by investment host nation Montenegro is not a priority destination for some individuals who have reached a certain age. This lower level of interest is because the overall infrastructure there is insufficient. For instance, the entire country has not one single highway, the airports are small, and the hospital infrastructure — in particular, in the tourist region of the coast — is underdeveloped.
Halfway around the globe in the West lie the Caribbean islands, which host five citizenship by investment programs. The nature of being an island allows governments to control the spread of infectious diseases. Restrictions on incoming and outgoing flights and commutes on the islands are highly effective, which partly account for the limited fatalities during the recent pandemic.
However, one of the biggest challenges for the Caribbean islands remains their dependence on other islands and countries during testing times for the regional and global healthcare environments. Another disadvantage of being an island is the difficulty of having to balance bottlenecks, as the primary healthcare system does not offer a widespread landscape with adequate resources to buffer the breakdown, closure, or capacity limit of key facilities.
Building a solid and robust primary healthcare system together with international relationships through the Caribbean Public Health Agency and the Organisation of Eastern Caribbean States will be key to ensuring resilience when it comes to the availability of medical equipment, highly qualified staff for complex procedures and resource-intense patients, and emergency evacuation corridors.
Health and wellbeing considerations will remain an essential element when discussing alternative residence or citizenship. The increasing aim among affluent individuals to achieve longevity and enjoy a high quality of life for as long as possible will most likely also impact the movement of the global elite.