Safeguarding expatriate health is key

Staff wellbeing is now well documented as a key indicator of productivity.


If you read nothing else, read this…

  • An expatriate health and wellbeing strategy must accommodate every family member.
  • The most likely cause of expat staff ill-health is a pre-existing condition.
  • Air pollution, infectious diseases, altitude, humidity and temperature all contribute to local environmental health issues.

For example, the winners of PruHealth and Mercer’s Healthiest Company Awards in June 2013 had sickness absence levels just one-third of the industry average. This becomes even more important for organisations that operate or send staff overseas, away from familiar services and infrastructure.

Employees who are selected for overseas assignments are usually highly skilled or qualified, and well established in their careers. This means they are also likely to have accompanying family members whose health and wellbeing are equally important to the success of the assignment. An expatriate health and wellbeing strategy must accommodate every family member. 

Risk assessment strategies

Employers need to develop pre-assignment health risk assessment strategies that work in partnership with reputable organisations, such as the National Health Service, which have access to the latest research and advice to help expatriate employees make informed choices about their assignment.

Many employers mistakenly opt for self-insurance, or obtain basic travel insurance to cover emergency medical treatment for their employees. They then discover too late that the most likely cause of ill-health among their staff is a pre-existing condition and that treatment is not covered by the policy. 

Variations in the cost of a routine medical procedure are reported annually by the World Health Organisation and the Organisation for Economic Co-operation and Development, which provide key information to help employers plan for unforeseen healthcare costs in overseas locations.

It is helpful to start from the position of an employer’s duty of care, which is enshrined in good HR practice. There are a number of key questions to consider, as follows.

Quality of care

What is your organisation’s person profile for an expatriate assignment?  In addition to investing to encourage the use of local fitness facilities, do you offer an emotional resilience toolkit? What is the level of quality of care and access to services? Does the healthcare system operate defensively, therefore costing more in tests and investigations? How does the local health system perform and compare with home country experience?

Medical supplies and services can be an issue if, for example, an employee’s child develops diabetes and needs specific monitoring equipment. An article in The Daily Telegraph (Cost-cutting bosses send staff abroad without health cover, 11 April 2014) reported that 27% of businesses said their staff had used medical evacuation when treatment was not available locally.

Air pollution, infectious diseases, altitude, humidity, temperature, UV (ultra-violet) exposure, sewage and waste disposal all contribute to local environmental health issues. Asthma and respiratory problems rank second in the list of ailments affecting expatriate families and air quality remains a key health concern for residents of major cities worldwide.

Endemic diseases

Does the organisation have an immunisation and disease management policy to protect against endemic diseases in the destination country, such as malaria or tuberculosis?

And what about an employee’s family? If they are unhappy, this will be a distraction at best and a source of ongoing stress for the employee. A comprehensive employee assistance programme will offer information and advice to avoid stress and support when that stress is unavoidable.

What is the level of hardship in the destination country, according to data such as Mercer’s Quality of Living survey , published in February 2014? How does the transport system work? Are the emergency services able to fast-track through traffic? Or are they forced to wait in queues, risking life, for up to three hours, as I personally experienced while working in Moscow?

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Expatriate healthcare packages need to be administered centrally from the UK. If they are handled by a locally employed administrator who is not on expatriate terms and conditions, this can sabotage the implementation of the strategy locally and damage local working relationships.

Lucy Kenyon is a specialist consultant in health and expatriate wellbeing services