Vienna, Austria, keeps its #1 spot for another year. Top 10 cities worldwide for quality of living are:

1. Vienna, Austria
2. Zurich, Switzerland
3. Geneva, Switzerland
4. Vancouver, Canada
5. Auckland, New Zealand
6. Dusseldorf, Germany
7. Frankfurt, Germany
8. Munich, Germany
9. Bern, Switzerland
10. Sydney, Australia

The first US city on the list is Honolulu, at #31. Singapore, at #28, tops the list for Asia. Central and South America and Africa are no shows, at least among the top 50 choices.



Mercer’s results show Paris, France at #34, a far cry from France’s high rankings on most quality of life indices.

Mercer bases their rankings on “detailed assessments and evaluations of 10 key categories and 39 criteria or factors” including:

• Political and social environment
• Medical and health considerations
• Public services and transport
• Consumer goods
• Economic environment
• Schools and education
• Recreation
• Housing
• Socio-cultural environment
• Natural environment

Mercer’s goal is to help companies and governments figure out how much to pay their international employees — so they really don’t evaluate the 221 cities on their list in the same way you or I would when choosing a place to live.

You can read more about their methodology here.

This year, Mercer also provided an Eco-Ranking for the first time, rating cities on such environmental concerns as water availability, water potability, waste removal, sewage, air pollution and traffic congestion.

Top 10 Green Cities include:

1. Calgary, Canada
2. Honolulu, US
3. Ottawa, Canada
4. Helsinki, Finland
5. Wellington, New Zealand
6. Minneapolis, US
7. Adelaide, Australia
8. Copenhagen, Denmark
9. Kobe Japan and Oslo, Norway (tied)

Singapore again topped the list of Asian cities, coming in at #22. Africa was represented by Capetown, South Africa, #30. South America almost made the list, with Point-A-Pitre, Guadaloupe (one of the Windward Islands in the eastern Caribbean) coming in at #49.

While these lists provide some interesting comparisons and information, don’t take them as gospel in deciding where you might like to live as an expat.

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Belgium, Spain, Switzerland, Canada, Malta and France all received positive comments. One poster said Japan’s was “the worst I ever experienced.” The US was mentioned favorably, but “only if you have good insurance. Prices are about 5 to 10 times the costs of France or Belgium.” This kind of anecdotal information is interesting, but not all that useful.

Of course to most expats and would-be expats, especially those of us who are approaching retirement age, health care is an important consideration in where we choose to live. What is its quality? Is it at least as good as what I’m used to? How expensive is it? How accessible is it? Will I have to be in a major city to have quality care available?

So what’s a concerned health care consumer to do?

There’s an interesting bubble chart on the Columbia University website, showing the average life expectancy and health care spending by country.

The US is way off by itself as the biggest spender. But our life expectancy (77 years) lags behind Japan (85), Switzerland, Australia, France, Canada, Norway, Spain, New Zealand, Austria, Korea, Portugal, UK, Luxembourg and Denmark, all of whom spend considerably less (around half!) than we do per capita.

The WHO (World Health Organization) has published a listing of medical care by country. Compiled in the year 2000, it’s a bit outdated, but might provide a good starting point. You can see it here.

A Few Considerations

First, I think it’s safe to assume that the care you’ll receive in rural areas will not be as up-to-date or comprehensive as the care you can receive in major cities. That’s true in the US just as much as anywhere else.

If living in a bustling metro area is not your taste, how fast and easy is transportation to those areas you’re considering? Use your common sense – if your dream retirement is on a remote beach or mountain-top retreat that’s an 8-hour drive over mostly dirt roads to get to the nearest city, that will be an issue in accessing quality health care. If it’s an hour or two over good roads, you’ll have significantly better access.

Are there hot spots of medical tourism in the country you’re considering? If so, you can be pretty well assured those doctors will speak English, have up-to-date training and use modern equipment. According to Business Week:

“The low cost and high quality of medical service is a big selling point for Singapore and Thailand, which have heavily promoted medical tourism in recent years. Hospital costs are as much as one-half what they would cost in the U.S.” Read the entire article here

Other popular medical tourism destinations include Panama, Mexico, Argentina, Brazil, Malaysia, South Korea, India and Israel. There are plenty of websites which discuss medical tourism, as any Google search will show.

Once you’ve narrowed down some possible destinations with health care facilities that will meet your needs, conduct your own research. When you visit the area, ask a lot of questions, find out what other expats do for health care, visit the hospitals and clinics if you can.

Ultimately, as with any other aspect of your move, you need to just do it.

1. France (was #1 last year as well)
2. Australia (moved up from #5 in 2009)
3. Switzerland (down one spot)
4. Germany (up from the #8 spot in 2009)
5. New Zealand (up from #9)
6. Luxembourg (down from #4)
7. USA (down from #3)
8. Belgium (down from #6)
9. Canada (a big jump up, from #19)
10. Italy (down from #7)

Top Ten Retirement Havens from Live and Invest Overseas

1. Argentina
2. Belize
3. Chile
4. Croatia
5. Dominican Republic
6. France
7. Malaysia
8. Panama
9. Uruguay
10. Vietnam

Mercer’s Best Cities for 2009:

1. Vienna, Austria (1st)
2. Zurich, Switzerland (2nd)
3. Geneva, Switzerland (3rd )
4. Vancouver, Canada (tied 4th)
5. Auckland, New Zealand (tied 4th)

Forbes list of The World’s Most Expensive Cities to Live. According to Forbes, the 10 most expensive cities are:

1. Tokyo, Japan
2. Osaka, Japan
3. Moscow, Russia
4. Geneva, Switzerland
5. Hong Kong, China
6. Zurich, Switzerland
7. Copenhagen, Denmark
8. New York, USA
9. Beijing, China
10. Singapore

2009 Best Retirement Havens, according to International Living:

1. Cuenca, Ecuador
2. Merida, Mexico
3. Coronado, Panama
4. Punta del Este, Uruguay
5. Calitri, Italy

So there you have it. Some highly respected lists from 2009, and one for 2010.

Best wishes for a happy expat New Year!

Vienna State Opera

Forbes Magazine has published a list of the top 20 cities in the world to live in. Europe took the most honors, with three of little Switzerland’s cities (Zurich, Geneva and Bern) in the Top 20 and Vienna, Austria at the top of the list. There were two from Australia (Melbourne and Sydney) and two from New Zealand (Auckland and Wellington). Canada was represented by three provincial capitals, Ottawa, Toronto and Vancouver. The USA, Central and South America, Asia and Africa were conspicuous by their absense. Read the whole article.

The study was conducted by Mercer, and you can read their version here.