The World's Friendliest Countries

In the December 1, 2009 Forbes article "World's Friendliest Countries," Rebecca Ruiz reports on a survey of 3,100 expatriates that ranks countries by friendliness.

The Middle East has long had a reputation for being one of the world's perennial trouble spots. But for expatriates, the tiny Persian Gulf county Bahrain ranks as one of the most welcoming places to work.

That's the surprising result of a new survey of 3,100 expatriates conducted by HSBC Bank. Bahrain ranked first in one key measure of how easy it is for expatriates to set up a new life for their families. It received high marks from expats who like the country's easy access to modern health care, decent and affordable housing, and network of social groups that expatriates can join.

Canada, which ranked first in a similar survey last year, fell to second place on HSBC's integration score, which measures how easily foreigners and their families can settle into a new country. Australia, Thailand and Malaysia rounded out the top five. Foreign workers in these countries found it easy to make local friends and said they enjoyed a higher quality of life than in their native countries.

Behind the Numbers

HSBC's Expat Explorer survey was conducted between February and April 2009. Survey respondents were from the U.S., Europe and elsewhere and lived in more than two dozen countries and on four continents. They ranked their new homes based on 23 factors, including food, entertainment, health care, commute and education. Of those measures, HSBC selected eight to create its so-called "integration score," a snapshot of which countries are most welcoming to expats.

It is possible that Bahrain's first-place finish is a fluke. Only 31 expats working in Bahrain participated in the survey, vs. more than 450 respondents from the United Kingdom. Bahrain ranked as the best country to join local community groups and coordinate health care. Respondents found it less easy to make local friends and learn the languages (Arabic, Farsi and Urdu), but the country ranked in the top five when it came to finding a home, setting up finances, and finding good schools.

The United Arab Emirates and the United Kingdom received some of the poorest scores on the integration scale. Expats in the Emirates reported finding it difficult to join local community groups; only 39% of respondents made local friends compared to 76% of respondents living in other countries. Foreign workers in England complained about the challenges of finding affordable housing.

Suzanne Garber, COO of the Americas Region for International SOS, a firm that provides medical and logistical assistance to overseas employees, says surveys like these give potential expats an overarching view of living in various countries.

But she says that family life is the leading indicator of whether or not an expat assignment will be successful. Many overseas stints end prematurely because an employee's family feels disconnected from the new country and has trouble handling basic tasks like refilling prescriptions, driving around town or dealing with the local police.

"The concerns are pretty much the same no matter where you are," says Garber. "You have to make sure the family's life is stable and secure."

Click here to see full list.

Rank - Country - Making Friends - Making Local Friends - Joining Community Groups - Organizing School For My Children - Organizing My Finances - Organizing My Health Care - Finding Somewhere To Live - Setting Up Utilities
1 Bahrain 5 20 1 5 3 1 2 4
2 Canada 11 2 3 6 7 8 5 2
3 Australia 10 6 9 7 1 7 11 5
4 Thailand 1 16 18 4 11 2 1 9
5 Malaysia 4 14 19 1 3 3 4 13
6 South Africa 6 2 8 3 14 6 3 14
7 Hong Kong 3 17 12 17 2 5 8 3
8 Singapore 7 18 24 13 6 4 13 1
9 Spain 12 8 13 18 10 9 7 8
10 United States 15 7 4 12 20 24 10 7

Methodology

The Expat Explorer survey was commissioned by HSBC Bank International and conducted by the research company FreshMinds. More than 3,100 expatriates were surveyed between February and April 2009.The respondents were asked to rate 23 factors related to their quality of life, including food, entertainment, transportation, health care, finances, education and their ability to make friends. Each criterion is equally weighted to arrive at a score. The overall ranking is based on the average score for a country across the criteria. Eight measures were also selected to comprise the integration score: organizing school for my children; organizing my finances; organizing my health care; finding somewhere to live; making friends; making local friends; setting up utilities; and joining local community groups. The integration score was used to determine the friendliest countries.

Study: Australians Have the World's Biggest Homes

In the December 1, 2009 Reuters article "Study: Australians Have the World's Biggest Homes," Belinda Goldsmith reports that "Australia has overtaken the United States, the heartland of the McMansion, to boast the world's largest homes, according to a report by the Commonwealth Bank of Australia."

Research commissioned by the bank's broking arm, CommSec, shows the Australian house has grown on average by 10 percent in the past decade to 214.6 square meters (2,310 sq ft) -- nearly three times the size of the average British house.

By contrast, the average size of new homes started in the United States in the September quarter was 201.5 square meter (2,169 sq ft), down from 212 square meter (2,282 sq ft), with the average U.S. home shrinking for the first time in a decade due to the recession.

In Europe, Denmark has the biggest homes, which takes into account houses and flats, with an average floor area of 137 square meter, followed by Greece at 126 square meter, and the Netherlands at 115.5 square meter.

Homes in Britain are the smallest in Europe at 76 square meter. But according to data from the Australian Bureau of Statistic issued by CommSec, while Australian houses are getting bigger, so are the families.

The number of people in each household has risen to 2.56 from 2.51, the first such rise in at least 100 years.

"It makes sense. Population is rising, as is the cost of housing and the cost of moving house, so we are making greater use of what we've got," CommSec's Craig James said in a statement widely reported in the Australian media.

"Children are living at home longer with parents and more people are opting for shared accommodation ... Generation Y is already baulking at the cost of housing, choosing to stay at home longer with parents."

The 2009 Corruption Perceptions Index

Click on the map above to enlarge it.

In the November 17, 2009 Fast Company article "Infographic of the Day: The 2009 Corruption Perceptions Index," Cliff Kuang says "Transparency International releases the 2009 edition of its signature study of international corruption--this time with infographics. How does the U.S. fare? Not great, actually." He goes on to explain:

Transparency International has just released its 2009 Corruption Perceptions Index, the preeminent, annual study of governmental corruption levels around the world.

This time, they've added a nice little interactive map--not much too it, besides the fact that mousing over the country gives you the numeric value. But it does give you a great indication of what countries do well, relative to their neighbors and what countries are basically sinkholes of graft and fraud. For example, Uraguay and Botswanna do far better than the countries around them--no wonder that Botswanna in particular is a prime example of economic development that works.

The CPI is a survey of surveys, which combines indexes found in 13 feeder studies with the expertise of academics who follow these issues. (Experts are polled on questions like how well a country's courts work, and the effectiveness of its watch dog agencies.)

If you're new to the study, the most surprising thing will be how poorly the U.S. does, relative to its first world peers. We're basically just a shade above some pretty dicey governments. The reasons are complex, but you can point to the influence of lobbying on our lawmaking and the ongoing controversy over how we've prosecuted the war on terror, among other things.

Want prosperity? Index ranks Finland as place to be

In the October 27, 2009 Reuters article "Want prosperity? Index ranks Finland as place to be," Miral Fahmy and Ron Popeski summarize the findings of a 2009 report on global prosperity.

SINGAPORE (Reuters Life!) – For those who value their freedom of expression as much as health, wealth, and prosperity, then Finland is the place to be, with an index ranking the Nordic nation the best in the world.

The 2009 Legatum Prosperity Index, published on Tuesday and compiled by the Legatum Institute, an independent policy, advocacy and advisory organization, ranked 104 countries which are home to 90 percent of the world's population.

The index is based on a definition of prosperity that combines economic growth with the level of personal freedoms and democracy in a country as well as measures of happiness and quality of life.

With the exception of Switzerland, which came in at number 2, Nordic countries dominated the top 5 slots, with Sweden in third place followed by Denmark and Norway.

The top 10 were all also Western nations, with Australia (6th place) and Canada (7th place) both beating the United States, ranked 9th. Britain came in at number 12.

In Asia, Japan was the region's highest ranked country at number 16, followed by Hong Kong (18th place) and Singapore (23rd place) and Taiwan (24th place).

Dr. William Inboden, senior vice president of the Legatum Institute, said the lower rankings for Asian nations were largely due to their weak scores for democracy and personal freedoms.

"Many Asian nations have good economic fundamentals, but the Index tells us that true prosperity requires more than just money," Inboden said in a statement.

"Democratic institutions and personal freedom measures are letting some Asian nations down. Furthermore, countries which have low levels of economic stability, such as Cambodia, finish even further down in the overall rankings."

Cambodia came in the 93rd slot while China, with its tight political controls, came in 75th despite booming economic growth.

And the world's least prosperous country? According to the Legatum Index, it is Zimbabwe, with Sudan and Yemen close runners-up.

The index combines objective data and subjective responses to surveys. More details can be found on http://www.prosperity.com.

The World's Best Countries - complete rankings

Human Development Report 2009 - Human Development Index (HDI) rankings

Very High Human Development

1. Norway
2. Australia
3. Iceland
4. Canada
5. Ireland
6. Netherlands
7. Sweden
8. France
9. Switzerland
10. Japan
11. Luxembourg
12. Finland
13. United States
14. Austria
15. Spain
16. Denmark
17. Belgium
18. Italy
19. Liechtenstein
20. New Zealand
21. United Kingdom
22. Germany
23. Singapore
24. Hong Kong, China (SAR)
25. Greece
26. Korea (Republic of)
27. Israel
28. Andorra
29. Slovenia
30. Brunei Darussalam
31. Kuwait
32. Cyprus
33. Qatar
34. Portugal
35. United Arab Emirates
36. Czech Republic
37. Barbados
38. Malta

High Human Development

39. Bahrain
40. Estonia
41. Poland
42. Slovakia
43. Hungary
44. Chile
45. Croatia
46. Lithuania
47. Antigua and Barbuda
48. Latvia
49. Argentina
50. Uruguay
51. Cuba
52. Bahamas
53. Mexico
54. Costa Rica
55. Libyan Arab Jamahiriya
56. Oman
57. Seychelles
58. Venezuela (Bolivarian Rupublic of)
59. Saudi Arabia
60. Panama
61. Bulgaria
62. Saint Kitts and Nevis
63. Romania
64. Trinidad and Tobago
65. Montenegro
66. Malaysia
67. Serbia
68. Belarus
69. Saint Lucia
70. Albania
71. Russian Federation
72. Macedonia (the former Yugoslav Republic of)
73. Dominica
74. Grenada
75. Brazil
76. Bosnia and Herzegovina
77. Colombia
78. Peru
79. Turkey
80. Ecuador
81. Mauritius
82. Kazakhstan
83. Lebanon

Medium Human Development

84. Armenia
85. Ukraine
86. Azerbaijan
87. Thailand
88. Iran (Islamic Republic of)
89. Georgia
90. Dominican Republic
91. Saint Vincent and the Grenadines
92. China
93. Belize
94. Samoa
95. Maldives
96. Jordan
97. Suriname
98. Tunisia
99. Tonga
100. Jamaica
101. Paraguay
102. Sri Lanka
103. Gabon
104. Algeria
105. Philippines
106. El Salvador
107. Syrian Arab Republic
108. Fiji
109. Turkmenistan
110. Occupied Palestinian Territories
111. Indonesia
112. Honduras
113. Bolivia
114. Guyana
115. Mongolia
116. Viet Nam
117. Moldova
118. Equatorial Guinea
119. Uzbekistan
120. Kyrgyzstan
121. Cape Verde
122. Guatemala
123. Egypt
124. Nicaragua
125. Botswana
126. Vanuatu
127. Tajikistan
128. Namibia
129. South Africa
130. Morocco
131. São Tomé and Principe
132. Bhutan
133. Lao, People's Dem. Rep.
134. India
135. Solomon Islands
136. Congo
137. Cambodia
138. Myanmar
139. Comoros
140. Yemen
141. Pakistan
142. Swaziland
143. Angola
144. Nepal
145. Madagascar
146. Bangladesh
147. Kenya
148. Papua New Guinea
149. Haiti
150. Sudan
151. Tanzania, U. Rep. of
152. Ghana
153. Cameroon
154. Mauritania
155. Djibouti
156. Lesotho
157. Uganda
158. Nigeria

Low Human Development

159. Togo
160. Malawi
161. Benin
162. Timor-Leste
163. Côte d'Ivoire
164. Zambia
165. Eritrea
166. Senegal
167. Rwanda
168. Gambia
169. Liberia
170. Guinea
171. Ethiopia
172. Mozambique
173. Guinea-Bissau
174. Burundi
175. Chad
176. Congo (Democratic Republic of the)
177. Burkina Faso
178. Mali
179. Central African Republic
180. Sierra Leone
181. Afghanistan
182. Niger

Note: This 2009 HDI represents statistical values for the year 2007.

The World's Best Countries

The October 5, 2009 article "Norway is best place to live, China moves up: UN" reports on the United Nations' rankings of the best countries in which to live:

PARIS (AFP) – Norway takes the number one spot in the annual United Nations human development index released Monday but China has made the biggest strides in improving the well-being of its citizens.

The index compiled by the UN Development Programme (UNDP) ranks 182 countries based on such criteria as life expectancy, literacy, school enrolment and gross domestic product (GDP) per capita.

Norway, Australia and Iceland took the first three spots while Niger ranks at the very bottom, just below Afghanistan.

China moved up seven places on the list to rank as the 92nd most developed country due to improvements in education as well as income levels and life expectancy.

Colombia and Peru rose five spaces to rank 77th and 78th while France -- which was not part of the top 10 last year -- returns to the upper echelons by moving up three places to number 8.

The UNDP said the index highlights the grave disparities between rich and poor countries.

A child born in Niger can expect to live to just over 50, which is 30 years less than a child born in Norway. For every dollar a person earns in Niger, 85 dollars are earned in Norway.

This year's index was based on data from 2007 and does not take into account the impact of the global economic crisis.

"Many countries have experienced setbacks over recent decades, in the face of economic downturns, conflict-related crises and the HIV and AIDS epidemic," said the UN development report's author Jeni Klugman.

"And this was even before the impact of the current global financial crisis was felt."

Afghanistan, which returns to the list for the first time since 1996, is the only Asian country among the bottom ten which also include Sierra Leone in the 180th spot, just below the Central African Republic.

The top ten countries listed on the index are: Norway, Australia, Iceland, Canada, Ireland, the Netherlands, Sweden, France, Switzerland and Japan.

The United States ranks 13th, down one spot from last year.

World Health Organization (WHO) Assessment of the World's Health Systems

[For just the list of rankings, see "Listing by Rank" or "Alphabetical Listing."]

According to a 2000 World Health Organization (WHO) report "World Health Organization Assesses the World's Health Systems":

The World Health Organization has carried out the first ever analysis of the world's health systems. Using five performance indicators to measure health systems in 191 member states, it finds that France provides the best overall health care followed among major countries by Italy, Spain, Oman, Austria and Japan.

The findings are published today, 21 June, in The World Health Report 2000 – Health systems: Improving performance*.

*Copies of the Report can be ordered from bookorders@who.ch.

The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of GDP on health services, ranks 18 th . Several small countries – San Marino, Andorra, Malta and Singapore are rated close behind second- placed Italy.

WHO Director-General Dr Gro Harlem Brundtland says: "The main message from this report is that the health and well- being of people around the world depend critically on the performance of the health systems that serve them. Yet there is wide variation in performance, even among countries with similar levels of income and health expenditure. It is essential for decision- makers to understand the underlying reasons so that system performance, and hence the health of populations, can be improved."

Dr Christopher Murray, Director of WHO's Global Programme on Evidence for Health Policy. says: "Although significant progress has been achieved in past decades, virtually all countries are under- utilizing the resources that are available to them. This leads to large numbers of preventable deaths and disabilities; unnecessary suffering, injustice, inequality and denial of an individual's basic rights to health."

The impact of failures in health systems is most severe on the poor everywhere, who are driven deeper into poverty by lack of financial protection against ill- health, the report says.

"The poor are treated with less respect, given less choice of service providers and offered lower- quality amenities," says Dr Brundtland. "In trying to buy health from their own pockets, they pay and become poorer."

The World Health Report says the main failings of many health systems are:

-Many health ministries focus on the public sector and often disregard the frequently much larger private sector health care.
-In many countries, some if not most physicians work simultaneously for the public sector and in private practice. This means the public sector ends up subsidizing unofficial private practice.
-Many governments fail to prevent a "black market" in health, where widespread corruption, bribery, "moonlighting" and other illegal practices flourish. The black markets, which themselves are caused by malfunctioning health systems, and low income of health workers, further undermine those systems.
-Many health ministries fail to enforce regulations that they themselves have created or are supposed to implement in the public interest.

Dr Julio Frenk, Executive Director for Evidence and Information for Policy at WHO, says: "By providing a comparative guide to what works and what doesn't work, we can help countries to learn from each other and thereby improve the performance of their health systems."

Dr Philip Musgrove, editor-in-chief of the report, says: "The WHO study finds that it isn't just how much you invest in total, or where you put facilities geographically, that matters. It's the balance among inputs that counts – for example, you have to have the right number of nurses per doctor."

Most of the lowest placed countries are in sub-Saharan Africa where life expectancies are low. HIV and AIDS are major causes of ill-health. Because of the AIDS epidemic, healthy life expectancy for babies born in 2000 in many of these nations has dropped to 40 years or less.

One key recommendation from the report is for countries to extend health insurance to as large a percentage of the population as possible. WHO says that it is better to make "pre-payments" on health care as much as possible, whether in the form of insurance, taxes or social security.

While private health expenses in industrial countries now average only some 25 percent because of universal health coverage (except in the United States, where it is 56%), in India, families typically pay 80 percent of their health care costs as "out-of- pocket" expenses when they receive health care.

"It is especially beneficial to make sure that as large a percentage as possible of the poorest people in each country can get insurance," says Dr Frenk. "Insurance protects people against the catastrophic effects of poor health. What we are seeing is that in many countries, the poor pay a higher percentage of their income on health care than the rich."

"In many countries without a health insurance safety net, many families have to pay more than 100 percent of their income for health care when hit with sudden emergencies. In other words, illness forces them into debt."

In designing the framework for health system performance, WHO broke new methodological ground, employing a technique not previously used for health systems. It compares each country's system to what the experts estimate to be the upper limit of what can be done with the level of resources available in that country. It also measures what each country's system has accomplished in comparison with those of other countries.

WHO's assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system's financial burden within the population (who pays the costs).

"We have created a new tool to help us measure performance," says Dr Murray. "As we develop it further and strengthen the raw data used for these measures in the years to come, we believe this will be an increasingly useful tool for governments in improving their own health systems."

Other findings in the annual WHO report include:

-In Europe, health systems in Mediterranean countries such as France, Italy and Spain are rated higher than others in the continent. Norway is the highest Scandinavian nation, at 11th .
-Colombia, Chile, Costa Rica and Cuba are rated highest among the Latin American nations – 22nd, 33rd, 36th and 39th in the world, respectively.
-Singapore is ranked 6th , the only Asian country apart from Japan in the top 10 countries.
-In the Pacific, Australia ranks 32 nd overall, while New Zealand is 41st .
-In the Middle East and North Africa, many countries rank highly: Oman is in 8 th place overall, Saudi Arabia is ranked 26th , United Arab Emirates 27th and Morocco, 29th.

In 1970, Oman's health care system was not performing well. The child mortality rate was high. But major government investments have proved to be successful in improving system performance. "Oman's success shows that tremendous strides can be accomplished in a relatively short period of time," says Dr Murray.

Information in the WHO report also rates countries according to the different components of the performance index.

Responsiveness: The nations with the most responsive health systems are the United States, Switzerland, Luxembourg, Denmark, Germany, Japan, Canada, Norway, Netherlands and Sweden. The reason these are all advanced industrial nations is that a number of the elements of responsiveness depend strongly on the availability of resources. In addition, many of these countries were the first to begin addressing the responsiveness of their health systems to people's needs.

Fairness of financial contribution: When WHO measured the fairness of financial contribution to health systems, countries lined up differently. The measurement is based on the fraction of a household's capacity to spend (income minus food expenditure) that goes on health care (including tax payments, social insurance, private insurance and out of pocket payments). Colombia was the top-rated country in this category, followed by Luxembourg, Belgium, Djibouti, Denmark, Ireland, Germany, Norway, Japan and Finland.

Colombia achieved top rank because someone with a low income might pay the equivalent of one dollar per year for health care, while a high- income individual pays 7.6 dollars.

Countries judged to have the least fair financing of health systems include Sierra Leone, Myanmar, Brazil, China, Viet Nam, Nepal, Russian Federation, Peru and Cambodia.

Brazil, a middle-income nation, ranks low in this table because its people make high out-of-pocket payments for health care. This means a substantial number of households pay a large fraction of their income (after paying for food) on health care. The same explanation applies to the fairness of financing Peru's health system. The reason why the Russian Federation ranks low is most likely related to the impact of the economic crisis in the 1990s. This has severely reduced government spending on health and led to increased out-of-pocket payment.

In North America, Canada rates as the country with the fairest mechanism for health system finance – ranked at 17-19, while the United States is at 54-55. Cuba is the highest among Latin American and Caribbean nations at 23-25.

The report indicates – clearly – the attributes of a good health system in relation to the elements of the performance measure, given below.

Overall Level of Health: A good health system, above all, contributes to good health. To assess overall population health and thus to judge how well the objective of good health is being achieved, WHO has chosen to use the measure of disability- adjusted life expectancy (DALE). This has the advantage of being directly comparable to life expectancy and is readily compared across populations. The report provides estimates for all countries of disability- adjusted life expectancy. DALE is estimated to equal or exceed 70 years in 24 countries, and 60 years in over half the Member States of WHO. At the other extreme are 32 countries where disability- adjusted life expectancy is estimated to be less than 40 years. Many of these are countries characterised by major epidemics of HIV/ AIDS, among other causes.

Distribution of Health in the Populations: It is not sufficient to protect or improve the average health of the population, if - at the same time - inequality worsens or remains high because the gain accrues disproportionately to those already enjoying better health. The health system also has the responsibility to try to reduce inequalities by prioritizing actions to improve the health of the worse-off, wherever these inequalities are caused by conditions amenable to intervention. The objective of good health is really twofold: the best attainable average level – goodness – and the smallest feasible differences among individuals and groups – fairness. A gain in either one of these, with no change in the other, constitutes an improvement.

Responsiveness: Responsiveness includes two major components. These are (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider).

Distribution of Financing: There are good and bad ways to raise the resources for a health system, but they are more or less good primarily as they affect how fairly the financial burden is shared. Fair financing, as the name suggests, is only concerned with distribution. It is not related to the total resource bill, nor to how the funds are used. The objectives of the health system do not include any particular level of total spending, either absolutely or relative to income. This is because, at all levels of spending there are other possible uses for the resources devoted to health. The level of funding to allocate to the health system is a social choice – with no correct answer. Nonetheless, the report suggests that countries spending less than around 60 dollars per person per year on health find that their populations are unable to access health services from an adequately performing health system.

In order to reflect these attributes, health systems have to carry out certain functions. They build human resources through investment and training, they deliver services, they finance all these activities. They act as the overall stewards of the resources and powers entrusted to them. In focusing on these few universal functions of health systems, the report provides evidence to assist policy- makers as they make choices to improve health system performance.

The World Health Report 2000 consists of a message from the WHO's Director-General, an overview, six chapters and statistical annexes. The chapter headings are "Why do health systems matter?", "How well do health systems perform?", Health services: well chosen, well organized?", "What resources are needed?", "Who pays for health systems?", and "How is the public interest protected?"

Comparative Economic Development

Why do some countries have a high standard-of-living while others do not?

Do prosperous countries have something in common?  Do policy choices make a difference?