Key Findings

• Dublin ranks 3^rd  in Europe and 20^th  in the world for health and sanitation

• Calgary scores highest for health and sanitation; Baku in Azerbaijan scores lowest

• Zurich scores highest for overall quality of living; Baghdad ranks lowest

The tower clock of St. Peter's church in Zurich, has Europe's largest clock dial

The 2007 Worldwide Quality of Living Survey by Mercer Human Resource Consulting has found that four of the world’s five top-scoring cities for health and sanitation are in North America.  Calgary ranks top with a score of 131.7, followed by Honolulu, which scores 130.3.   Helsinki – the only European city in the top five – follows closely in the rankings with a score of 128.5.  Ottawa and Minneapolis take fourth and fifth places with scores of 127.2 and 125.7 respectively.

Scores are based on the quality and availability of hospital and medical supplies and levels of air pollution and infectious diseases.  The efficiency of waste removal and sewage systems, water potability and the presence of harmful animals and insects are also taken into account.   

Cities are ranked against New York as the base city which has an index score of 100.  The analysis is part of Mercer’s Worldwide Quality of Living Survey, covering 215 cities, which is conducted to help governments and major companies to place employees on international assignments. 

“Companies managing a global workforce must take into account a range of factors when structuring remuneration packages for their expatriate employees,” said Yvonne Sonsino, principal at Mercer.  “Organisations can struggle to find suitably qualified local staff when operating overseas and so rely on benchmark data to ensure the rewards they offer encourage employees with transferable skills to accept international assignments.”

The lowest-ranking city for health and sanitation is Baku in Azerbaijan, which scores just 27.6.  Other low-scoring cities include Dhaka in Bangladesh, Antananarivo in Madagascar and Port Au Prince in Haiti, which score 29.6, 30.1 and 34 respectively. 

“Poor countries often lack adequate medical infrastructure including hospitals and health networks.  Furthermore, provision of care is hampered by poor sanitation and unsafe water facilities in many areas,” said Slagin Parakatil, senior researcher at Mercer.  “The development of efficient waste removal and sewage systems, coupled with government investment in medical infrastructure, will be key to avoiding pandemic outbreaks of diseases and for improving general living standards.” 

Europe, Middle East and Africa

Almost half of the 30 top-scoring cities surveyed are in Western Europe.  Helsinki has the highest score for the region, at position 3 with a rating of 128.5.   Dublin is ranked 3^rd in Europe for health and sanitation and 20^th in the world  with a score of 122.9, comparing very favourably to closest neighbour London, which is ranked 63^rd  in the world with a score of 111.2.

Irene Goldrick, Head of Marketing for Mercer in Ireland noted: “The survey results are very encouraging. Dublin remains in the top percentile of the world’s most leading cities to work and live in ranking 8^th in Europe and 27^th in the world for overall quality of living”.

Most Eastern European cities have relatively low scores, except for Prague in the Czech Republic which scores highest, at position 75 with a score of 101.3.  Russian cities have the poorest scores in this area.  Moscow, St Petersburg, Novosibirsk and Kazan take positions 201,184, 182 and 174 respectively with ratings of 43.4, 50.5, 51.1 and 54. 

Abu Dhabi and Dubai are the highest-ranking Middle Eastern cities and share position 58 with a score of 112.9.  African cities typically rank in lower positions than their European and Middle Eastern counterparts, with many appearing in the 20 bottom-scoring cities.

“The availability of public and private hospital care, together with modern medical infrastructure, means healthcare standards in Europe are generally very high.  Medical provision in the Middle East, especially the United Arab Emirates, has also benefited from substantial government investment,” said Parakatil.  “In impoverished countries - where medical care and sanitation are often poor - it can be advisable for expatriates to seek private treatment.”    

Americas

All of the Canadian cities covered by the survey appear in the top 25 rankings for health and sanitation.  Calgary is followed by Ottawa in position 4 with a score of 127.2.  Montreal and Vancouver both rank in 10^th place (score 123.7).  Toronto is at position 21 with a rating of 122.4.   

In the US, Honolulu ranks highest followed by Minneapolis in 5^th place scoring 25.7.  Boston, Lexington and Pittsburgh rank joint 10^th with a score of 123.7.  Mexico City scores poorly at position 211 with a rating of 37.7; geographical issues and a high level of air pollution explain this low ranking.  Other low-scoring cities in North America are Atlanta and Houston, in positions 96 and 103 respectively with scores of 92.3 and 85.2.  

Parakatil said: “Growing traffic congestion, industrial plants and other pollutants reduce air quality in some American cities, which may undermine the otherwise pleasant living standards.”

Cities in Central and South America tend to feature much lower in the rankings than those in North America.  San Juan in Puerto Rico ranks highest in 67^th place (score 108.9).  Port Au Prince is the lowest-ranking city in the region, in position 212 with an index of 34.

Asia-Pacific

Auckland and Wellington in New Zealand rank in joint 18^th place, with a rating of 123.1.  All the Australian cities covered by the survey rank higher than New York, the base city.  Adelaide is the highest-scoring city in Australia at position 35 (score 119.5) while Sydney is the lowest in 62^nd place (score 111.3).

Japan is home to the five highest-rated cities in Asia.  Katsuyama leads in 9^th position with a score of 123.8, followed by Kobe and Omuta in joint 25^th place (score 122).  Tokyo, Nagoya and Osaka come in joint 53^rd place and score 113.5. 

Elsewhere in this region, Singapore ranks in 50^th place with a score of 114, while Hong Kong is at position 117 and scores 80.8.   Shanghai and Beijing are China’s highest and lowest-ranking cities in 134^th and 166^th place respectively (scoring 73.8 and 60.3).  Modernisation of medical infrastructure has improved living standards in these Chinese cities.  However, air pollution and inadequate waste removal and sewage systems are still a concern – particularly in Beijing.   

Indian cities score relatively poorly for health and sanitation, with scores ranging from 52.8 for Chennai (position 177) to 38.2 for Mumbai (position 209).  Most Indian cities are densely populated with poor waste removal and sewage systems.  These issues, combined with increasing air pollution, contribute to their relatively low ratings.

“Expatriates on assignment in some locations - for example Africa, the Middle East and some parts of Asia, Europe and Latin America - can face harsher living conditions and lower standards of medical care and facilities than they are accustomed to,” commented Parakatil.  “The threat of infectious diseases and environmental risks are very real in some cities and should be taken into account. Migration and mobility can exacerbate the transmission of diseases, and this should be a top concern for employers managing international assignments.”

Rankings for overall quality of living

Mercer’s overall ranking for quality of living has revealed that Zurich again ranks as the world’s top city, with a rating of 108.1.  The city narrowly out-ranks Geneva, which scores 108.  Vancouver and Vienna follow in joint third place and score 107.7.    

Cities in Europe and Australia continue to dominate the top end of the rankings for overall quality of living.  Auckland and Düsseldorf share joint fifth place and score 107.3 points.  Frankfurt and Munich follow with scores of 107.1 and 106.9 respectively.  Bern and Sydney both score 106.5 points and share joint 9^th place. 

The analysis is based on an evaluation of 39 quality of living criteria for each city including political, social, economic and environmental factors, personal safety and health, education, transport and other public services. 

Baghdad remains the world’s least enticing city for expatriates with a score of 14.5.  Other low-scoring cities for overall quality of living include Brazzaville in Congo (29.5), Bangui in the Central African Republic (30.6) and Khartoum in Sudan (31). 

Parakatil concluded: “In recent years, the gap between low-ranking and high-ranking cities has widened.  While standards have improved in some regions, there remains a stark contrast between those cities where overall quality of living is good and those experiencing political and economic turmoil.”

Mercer’s study is based on detailed assessments and evaluations of 39 key quality of living determinants, grouped in the following categories:

Political and social environment (political stability, crime, law enforcement, etc)

Economic environment (currency exchange regulations, banking services, etc)

Socio-cultural environment (censorship, limitations on personal freedom, etc)

Health and sanitation (medical supplies and services, infectious diseases, sewage, waste disposal, air pollution, etc)

Schools and education (standard and availability of international schools, etc)

Public services and transportation (electricity, water, public transport, traffic congestion, etc)

Recreation (restaurants, theatres, cinemas, sports and leisure, etc)

Consumer goods (availability of food/daily consumption items, cars, etc)

Housing (housing, household appliances, furniture, maintenance services, etc)

Natural environment (climate, record of natural disasters)

EU capital city rankings for health and sanitation*