Cigna Healthcare 2026 International Health Study: Turning Global Mobility into a Performance Edge

The Cigna Healthcare 2026 International Health Study explores the unique well-being and productivity of individuals working outside their home countries. This report introduces the Evernorth Vitality Index, a metric used to compare the physical, emotional, and social health of the globally mobile workforce against the general population. Findings indicate that while these employees possess a distinct vitality advantage, they simultaneously face acute stressors such as loneliness, financial strain, and healthcare barriers. To maintain this performance edge, the research suggests that organizations must prioritize pre-move support and simplified access to medical care. By fostering a sense of belonging and resilience, employers can fully unlock the professional potential of their international talent. Strategic recommendations focus on utilizing digital health solutions and community-building initiatives to bridge existing support gaps.

Executive Summary

The 2026 Globally Mobile Edition of the Cigna Healthcare International Health Study reveals a significant "vitality advantage" among employees living and working abroad. Globally mobile workers consistently outscore the general population in all measured well-being dimensions, with an average vitality score of 68.9 compared to 63.2. This cohort is characterized by a strong drive for learning, adaptability, and resilience—attributes that organizations can harness to drive productivity and gain a competitive edge.

However, this advantage is threatened by acute stressors and systemic barriers. Approximately 80% of globally mobile employees report feeling stressed, often driven by financial concerns, loneliness, and the loss of familiar routines. Furthermore, 73% of these employees expressed a desire for more comprehensive pre-move support, and nearly half reported that delays in healthcare access have negatively impacted their work-life balance. By addressing these gaps through structured social anchors, simplified healthcare navigation, and personalized relocation support, employers can transform global mobility from a logistical challenge into a durable performance advantage.

Leadership Perspectives

Jason Sadler, President, International Health at Cigna Healthcare, said: “Living and working abroad has shaped how I approach leadership. I’ve seen first-hand how the right support can determine whether a globally mobile employee merely copes or truly thrives. When organizations invest in meaningful preparation, accessible care, and a sense of belonging, they create the conditions for people to thrive—professionally and personally—wherever their work takes them.”

Sevda Esenturk, Human Resources Officer, Cigna Healthcare International Health said, “Relocating from Turkey to Bahrain and then to Dubai expanded my perspective on leadership and global collaboration. Exposure to different cultures and ways of working strengthened my confidence, resilience, and ability to lead across complexity.”

Leah Cotterill, CEO of Middle East and Africa (Outside KSA), Cigna Healthcare International Health said, “Fellow expats are an invaluable source of support — sharing practical advice on everything from schools and housing to healthcare and sports clubs. Tapping into the local expat network is like having a personal concierge when settling into a new country.”

The Evernorth Vitality Index (EVI)

To measure how individuals thrive abroad, the study utilizes the Evernorth Vitality Index (EVI), developed in partnership with psychologist Dr. Richard Ryan. The index provides a comprehensive score of "whole person health" by evaluating three core psychological needs—autonomy, competence, and relatedness—across eight interdependent dimensions:

• Emotional
• Physical
• Social
• Financial
• Intellectual
• Environmental
• Spiritual/Purpose
• Occupational

Well-being Pillars: A Comparative Analysis

Globally mobile individuals consistently rate their well-being higher than the general population across every pillar measured in 2025.

Percentage of Respondents Rating Well-being as "Excellent" or "Very Good"

Stress, Resilience, and Social Dynamics

Despite their high vitality scores, 80% of globally mobile employees experience stress. These pressures are often more acute than those of the general population due to the lack of local community support and the challenge of navigating unfamiliar environments.

Key Drivers of Stress

• Financial Pressures: Cost of living (56%), personal finance (57%), and family finance (43%).
• Social Isolation: Approximately 50% report feelings of loneliness or social exclusion, frequently exacerbated by homesickness.
• Future Uncertainty: Uncertainty about the future affects 33% of respondents.

Impact on Daily Activities

The study notes that mental and physical health challenges cause greater disruption to daily activities for globally mobile staff than for the general population:

• Mental Health Impact: 60% of globally mobile employees say mental health affects daily activities (vs. 53% general population).
• Physical Health Impact: 64% say physical health impacts daily activities (vs. 58% general population).

Barriers to Care and Digital Innovation

Access to healthcare is a critical friction point. Delays and unfamiliar systems can cause employees to avoid seeking treatment, potentially eroding their productivity.

• Chronic Conditions: 52% of globally mobile employees manage a chronic condition, making continuity of care and prescription access essential.
• Care Delays: 48% say work-life balance was impacted due to waiting times, and 33% are likely to avoid care altogether due to concern over delays.
• Digital Receptivity: There is a significant appetite for technology-led solutions. 56% view AI in healthcare positively, citing potential for shorter waiting times and improved clinical support.

Pre-Move Support: The Relocation Gap

The relocation period is a high-pressure phase that sets the foundation for an assignment's success. Currently, a significant gap exists between employee needs and provided support.

• Unmet Needs: 73% of respondents wished they had more pre-move support.
• Current Challenges: 76% encountered at least one challenge preventing them from thriving in their new country, including language barriers, culture shock, and administrative hurdles.
• Key Requirements: Employees prioritize housing assistance, clear healthcare navigation, and employer guidance.

Strategic Recommendations for Employers

To maintain the "vitality advantage," the study suggests that organizations move beyond basic logistics to provide "meaningful preparation" and "accessible care."

Strengthening Resilience and Belonging

• Social Anchors: Establish buddy programs, expat clubs, and newcomer welcome rituals.
• Financial Clarity: Clearly communicate relocation stipends, reimbursement frameworks, and provide financial counselling.
• Early Integration: Provide multiple community-building opportunities (e.g., welcome lunches) within the first 90 days.

Improving Healthcare Access

• Cross-Border Solutions: Provide clear guidance on coverage and simplify access to in-network providers through virtual triaging.
• Digital-First Care: Enable remote care and expand virtual mental health resources and culturally competent counselling.
• Predictable Experiences: Minimize uncertainty by providing straightforward guidance on navigating local healthcare systems.

Enhancing Pre-Move Support

• Comprehensive Guides: Offer resources covering housing, banking, taxation, and schooling.
• Family Inclusion: Extend support to partners through school searches, caregiver resources, and language courses.
• Personalized Onboarding: Conduct health benefits walkthroughs to ensure employees understand their coverage from day one.

About the Research

The study surveyed over 11,000 respondents across 13 markets (including the US, UK, UAE, Singapore, and Hong Kong) between May 5 and May 30, 2025. Conducted in collaboration with YouGov, the research has tracked global health and vitality since 2015.