Health Security Assessment Ratings (HSARs)*
WorldAware’s Health Security Assessment Ratings (HSARs) are the proprietary evaluation of the overall health security of a given country or city. *Labeled “Health and Medical” within the pre-trip reporting travel map dropdown menu
Each Health Security Assessment Rating is determined by combining weighted assessments of six main health categories with multiple sub-categories within a particular region. Each category is rated on a scale of 1-5, with 1 being an area with minimal health threat and 5 having a very high health threat. The following are the six main categories used to determine the HSARs:
- Chronic Disease: Includes life expectancy data, infant mortality averages, tuberculosis and HIV rates, and other national averages of chronic health concerns as factors in the rating of general national health.
- Environmental Health: Assesses water scarcity issues or usable water availability, improved access to water and sanitation, biodiversity, environmental policies, air quality, and altitude risks. Environmental issues, particularly water and air quality, directly impact resident and traveler health for both long and short-term stays.
- Health infrastructure: Measures national expenditure on health concerns, physician density ratios, hospital beds per capita, advanced diagnostic capability, multilingual communication, patient strategy, and other factors.
- Mental Health: Includes suicide rate, substance abuse rates, and availability of mental health resources.
- Outbreaks: Considers current disease outbreaks, their rate of transmission, percentage of the population affected, perceived and actual severity, and expected duration; this is the most dynamic indicator in the list.
- Physical Security/Transportation: Reflects road infrastructure and traffic fatalities, public transportation safety and availability, and crime rates and personal security issues as they may translate to health care issues (sexual assault, healthcare disruptions, and other factors).
Based on category assessments, an overall rating is assigned to a country or city. Each of the ratings are defined as follows:
Good to excellent medical infrastructure exists with general and certified specialty physician access widely available and ample support staff in all disciplines. Clinics and hospitals are available with advanced diagnostic capability. Government spending on healthcare encourages ample vaccine coverage, patient education and public health. There is a low risk of trauma, screened and available blood products, and low threat to physical violence that necessitates medical or mental health treatment. There is has a high life expectancy, very low infant mortality, and relatively low non-communicable disease rate. Outbreaks of infectious disease rarely reach epidemic threshold, and there are counter measures if a highly transmissible contagion circulates. There is ample potable water available with improved water and sanitation services and a low rate of air pollution. Community mental health centers are available with some in-patient treatment programs. Suicide rates are very low and substance abuse rates are also low.
Good medical infrastructure exists with general and specialty physician access available, typically in urban areas. Certified support staff in nursing and clinical therapists are available, as are clinics and hospitals with advanced diagnostic capability in some areas. Government spending on healthcare encourages public health initiatives. There is a low risk of trauma, screened blood products, and overall low threat of physical violence that necessitates medical or mental health treatment. The area has a moderate to high life expectancy, low infant mortality, and relatively low non- communicable disease rate. Outbreaks of infectious disease may reach epidemic threshold, however, there are counter- measures if a highly transmissible contagion circulates. There is a high supply of potable water available with improved water and sanitation services and low rate of air pollution. Community mental health centers are typically available with some in-patient treatment programs. Suicide rates are low and substance abuse rates are also low to moderate.
Average medical infrastructure with general physician access is available, including some specialties at tertiary medical centers. Support staff in nursing and some clinical therapists are available, as are clinics and hospitals with advanced diagnostic capability in tertiary facilities. Government spending on healthcare provides at least a minimum level of support. There is a moderate risk of trauma, screened blood products that meet minimal WHO standards, and overall average threat of physical violence that necessitates medical or mental health treatment. The area has a globally average life expectancy, average infant mortality, and relatively moderate noncommunicable disease rate. Outbreaks of infectious disease may reach epidemic threshold, with many being vaccine preventable diseases. There is a moderate supply of potable water available with improved water and sanitation services, particularly in affluent areas, and an average or seasonally elevated rate of air pollution. Community mental health centers are scarce; however, large hospitals typically provide in- and out-patient psychiatric treatment. Suicide rates are average and substance abuse rates are moderate.
The region has generally poor medical infrastructure with reduced physician access available, mostly found only in urban areas. Support staff in nursing and clinical therapists may be poorly trained and not certified; clinic and hospital availability may only be found in urban areas; advanced diagnostic capability is reduced; and government spending on healthcare is generally poor compared to first-world countries. There is an increased risk of trauma, screening of blood products is not universal or routine, and an overall elevated threat of physical violence that necessitates medical or mental health treatment. The area has a low to high life expectancy, high rate of infant mortality, and relatively high rate of non-communicable disease. Significant outbreaks of infectious disease may reach epidemic threshold, with little to no plan or support for control. There is a low per capita supply of potable water with improved water and sanitation services only found in major urban areas, with disparity of access, and higher rate of air pollution. Community mental health centers are typically not available, with occasional inpatient treatment programs found at major hospitals. Suicide rates are elevated, and substance abuse rates are high, especially with adulterated alcohol or drugs.
Very High Threat
The region has very poor medical infrastructure with significantly reduced physician access, typically found in urban areas. Scant support staff in nursing and nearly negligible clinical therapists available; clinic and hospital availability is poor with rare advanced diagnostic capability; and government spending on healthcare is very low. There is a very high risk of trauma, particularly transportation accidents, blood products are typically not screened, and overall threat of physical violence that necessitates medical or mental health treatment is high. The area has a very low life expectancy, very high infant mortality, and high non-communicable disease rate. Outbreaks of infectious disease that reach epidemic threshold are quite common, and control measures are significantly reduced. There is a very low to critical supply of potable water available with improved water and sanitation services rarely found, and a typically high rate of air pollution. Community mental health centers are non-existent and in-patient treatment programs are very rare. Suicide rates may be high and substance abuse rates are also elevated, especially with adulterated alcohol and drugs.
Assessing the HSARs
The HSARs are reviewed and analyzed quarterly based on vetted resources from international agencies, laboratories, and other sources. The WorldAware Health Team uses the WHO, US CDC, UK Travel Health Pro (exNaTHNaC), ministries of health data, and media sources. WorldAware aims to combine hard data, which takes longer to collect (weekly epidemiological reports are usually at least several weeks behind), with reputable media sources (WorldAware consistently collaborates with regional teams to ensure media sources area appropriate). In some countries, media reports are all that is available, as many times a Minister of Health may do press conferences, but not update their website. In addition, sites such as YouTube may have the latest information on an ongoing outbreak, directly from government staff.
Country/City Security Assessment Ratings (CSARs)*
WorldAware’s Country/City Security Assessment Ratings are the proprietary evaluation of the security profile of a given country or city. *Labeled “Health and Medical” within the pre-trip reporting travel map dropdown menu
Quick, informative, and reliable, WorldAware’s threat assessment ratings give you an immediate picture of the threat environment in locations across the globe. With the assurance of extensive analytical coverage and pressure tested methodologies, the ratings are continually monitored, and provide you a clear picture of when concerns exist, and if precautions or contingencies may be needed for safe travel or operations. WorldAware’s Country/City Security Assessment Ratings (CSARs) are composed of several sub-ratings, which serve to inform an overall rating. These sub-rating categories include Crime, Security Services, Civil Unrest, Terrorism, Kidnapping and Geopolitical. Each is rated on a 1-5 scale; specifically, Minimal, Low, Moderate, High or Very High, giving you a clear and transparent indicator of the level of threat.
The crime rating assesses the nature and extent of crime in the location. This includes assessing whether crime that takes place is predominantly petty in nature or if violent crime is commonplace. It also considers other types of crime, such as property, sexual, organized, hate, fraud, and economic crime, and whether the threat is localized or prevalent throughout the country or city.
The security services rating assesses security-related services (such as police, firefighters and military) in the location for levels of corruption, abuse, resourcing, response capabilities, language capabilities, and other concerns.
The civil unrest rating assesses a range of event types that could be categorized as civil unrest, including protests, rallies, demonstrations, strikes, sickouts, work stoppages, riots, ethnic unrest, sectarian unrest, religious unrest, and separatist unrest. This rating also considers the impact and frequency of such events, whether the threat is intrinsic or dynamic, and if violence is likely.
The terrorism rating takes into consideration factors such as the presence of terrorist groups in the location, motivation for groups (whether domestic, regional or international) to carry out attacks in the location, threats made, and the scale and frequency of attacks. This rating recognizes the fact that terrorism can include violent incidents that expose people to physical threat, as well as non-violent operations but which could expose individuals to reputational, financial, or other non-physical threat.
The kidnapping rating is an analysis of the frequency, severity and nature of the kidnapping threat in the location and which individuals or groups are most targeted. The category includes kidnapping for profit, for concession, and trafficking. The threat value focuses predominantly on the threat to foreign nationals visiting the location and whether the extent is localized or countrywide.
This sub-rating category is almost always assessed at a country-level only, with cities within the country inheriting the country-level rating. The rating reflects the general stability of the location’s political system and those threats which may have security-related implications on the stability of the country. The rating considers factors internal to the location such as government stability, economic conditions, and rule of law, as well as external factors such as relations with neighboring countries, likelihood of armed conflict, and border disputes.
Most areas in this category will have a stable political infrastructure and economic system with some unemployment. These countries or cities have low crime rates. Violent crimes are rare and usually involve associated persons. Petty crimes such as theft and pick pocketing are a concern and travelers may be directly targeted. Risks can usually be mitigated with simple security measures. Police and military services are well trained and trustworthy but may lack adequate investigative equipment. Incidents of civil unrest such as strikes and demonstrations may disrupt daily life but are usually non-violent and well-coordinated. These geographic areas may experience rare instances of domestic terrorist activity but are not threatened by international terrorism. Anti-government groups may be present but have little or no impact.
Most countries or cities in this category will have a somewhat stable political infrastructure and economic system but unemployment and rising inflation cause some instability. These territories have moderate levels of crime. Violent crimes such as sexual assault and murder occur, but few are random incidents. Petty crimes, especially theft or destruction of unattended property, are common. Incidents of armed assault also occur. More threatening crimes are usually limited to certain urban areas or specific parts of the country. Police and military services may suffer from corruption and lack of training but are generally adequate for investigations. Strikes and demonstrations can disrupt daily life and may easily spur violence. A variety of organized and outspoken antigovernment and domestic terrorist groups may conduct incidents of violence. Small cells of international terrorist organizations exist but incidents of terrorism are not common.
Most countries or cities in this category have unstable political infrastructure and an economic system with high rates of unemployment and inflation. Violent and petty crimes are common in most areas and random acts of violence do occur. Some areas may have a general state of lawlessness. Traveling alone, especially at night, should be avoided. There will be a large infiltration of arms in the population. Police and military services lack training and equipment. Both institutions are prone to corruption. Strikes and demonstrations are common and usually violent. Domestic terrorist and insurgent groups are active and well organized. They conduct bombings and other violent acts against government, local and international interests. International terrorist groups exist and may conduct activities locally and abroad. Countries in this threat level may be involved in cross-border warfare.
Very High Threat
Most territories in this category lack a political infrastructure with any democratic premise and have a high rate of corruption. The economy is unstable with a high rate of unemployment. There is a very high rate of violent and petty crime. A general state of lawlessness exists in most areas. Overland travel through the country must be avoided. Many domestic terrorist or rebel groups exist and are frequently active; areas may be controlled by rebel factions. International terrorist operations may be well organized and active. Anti-government actions and large demonstrations are common and violent. Cross border and internal warfare occur.
WorldAware has 120+ analysts and subject matter experts with proficiency in more than 25 languages, operating on a 24/7 basis to gather and assess intelligence that is used in determining CSAR ratings. Analysts come from a variety of backgrounds including the military, government intelligence agencies, academia, NGOs, and the private sector; the analytical team combines both experience and understanding to provide exceptional insight and deliver accurate and actionable intelligence. The CSAR ratings are based on information assessed from over 25,000 sources, including both human and online repositories. Information used with permission from WorldAware
LGBTQ+ Assessment Ratings
Most countries in this category have explicit prohibitions limiting the expression and rights of LGBTQ individuals. Enforcement is common, and typically involves the death penalty or lengthy imprisonment. Much of society is highly opposed to the LGBTQ population.
Most areas in this category have explicit or implicit legal restrictions limiting the expression and rights of the LGBTQ community, or there are no legal prohibitions, but government and social treatment is extremely poor. Typical punishments include heavy fines or imprisonment, though enforcement may be inconsistent. Society is either unaccepting of or violently opposed to the LGBTQ community.
Most territories in this category either do not have laws or ordinances banning LGBTQ individual’s expression and rights or, if they do, they are not enforced. However, there are few or no laws protecting LGBTQ individuals from discrimination. Crimes targeting LGBTQ individuals are not generally seen as hate crimes. Social attitudes are mixed with some public anti-LGBTQ statements from prominent social or government figures.
Most locations in this category legally permit LGBTQ expression and have laws in place ensuring some equal rights. Violence against an individual for his or her sexuality is sometimes considered a hate crime. Social acceptance varies.
Most countries in this category have laws that provide equal rights for LGBTQ individuals. There are no official limitations on the expression or rights of LGBTQ individuals, and violence against an individual on the basis of sexuality is considered a hate crime. Social attitudes are largely accepting of LGBTQ individuals.
Legislation explicitly bans same-sex relations for one or more genders, transgender expression, gender reassignment, or a combination of all three. If not explicitly prohibited, other laws are used to target LGBTQ individuals.
Influential officials or the ruling government publicly state opinions, plans, or policy promises to prohibit or eliminate LGBTQ rights. The government actively arrests and prosecutes LGBTQ individuals for violation of gender or sexuality laws and seeks maximum punishments in the forms of execution, extended imprisonment, physical abuse, or maiming.
Government does not protect, extend, or guarantee basic civil rights to LGBTQ individuals.
Legislation explicitly bans same-sex relations for one or more genders, transgender expression, gender reassignment, or a combination of all three. If not explicitly prohibited, other laws are used to target LGBTQ individuals. LGBTQ-focused legislation may be in place to limit the rights of the community when same-sex relations are explicitly legal.
The government occasionally arrests and prosecutes LGBTQ community members in response to appeals from the public or in an attempt to win public favor. Enforced sentences for breaking gender or sexuality laws include imprisonment, fines, or physical punishment, such as beatings or public shaming. If not illegal, other laws are used to prosecute and punish LGBTQ individuals.
Government does not protect, extend, or guarantee basic civil rights to LGBTQ individuals.
Legislation makes transgender expression or same-sex relations illegal, either explicitly or implicitly, but the government has a limited history of enforcing the law or has explicitly stated the law will not be enforced. In countries where homosexual relations are legal, public support of the legislation remains mixed.
Where homosexuality is illegal, enforcement rarely occurs. Where legal, officials may use other laws to harass the community. If the government has a pro-LGBTQ position, officials may inconsistently respond to reports of hate crimes.
Countries where homosexuality is illegal, when enforcement occurs, punishments are either applied using more lenient charges or with the minimum sentence under the legal code. Where legal, police may use other laws to harass or punish LGBTQ individuals, or to elicit bribes.
Government protections or guarantees of basic civil rights are inconsistent or limited.
Same-sex relations are explicitly legal or legislation banning same-sex relations has never existed. Issues concerning the recognition of transgender expression are unresolved.
Authorities prosecute hate crimes targeting the LGBTQ community, though inconsistently. Punishments do not exist or are not applied.
Government protections or guarantees of basic civil rights are robust, but not fully equal to their heterosexual or cisgender counterparts.
There are few to no legal prohibitions against transgender expression and same-sex relations.
Hate crimes targeting the LGBTQ community are consistently prosecuted.
Punishments do not exist or are not applied.
Government protections or guarantees of basic civil rights are robust, nearing full equality or are already fully equal to those afforded to their heterosexual or cisgender counterparts.
Society is highly intolerant of LGBTQ individuals.
Hate crimes are frequent and violence is severe or deadly when it occurs. Reported hate crimes and violence are likely to be absent from official records and media reports.
There is a majority presence of influential or trusted anti-LGBTQ groups or organizations. Civic or religious authorities encourage violence against members of the LGBTQ community.
Media outlets promote, encourage, and produce negative and denigrative portrayals of LGBTQ individuals, or publicly expose them with expressed or implied intent to harm those individuals.
Pro-LGBTQ groups are prohibited, absent, or operate clandestinely.
Societal tolerance of the LGBTQ community ranges from highly intolerant to intolerant.
Hate crimes are frequent and violence is severe. It is possible that reported hate crimes and violence are absent from official records and media reports.
There is a majority presence of influential or trusted anti-LGBTQ groups or organizations. Civic or religious authorities encourage discrimination and occasional violence against members of the LGBTQ community.
Media outlets promote, encourage, and produce negative, denigrative, slanderous, or libelous portrayals of LGBTQ individuals.
Pro-LGBTQ groups are absent or have a small support base.
Societal tolerance of the LGBTQ community ranges from intolerant to mixed tolerance.
Hate crimes range from verbal abuse to murder and do not occur at consistent rates throughout the country. Certain segments of the LGBTQ community are victimized at higher rates than others.
Both pro-LGBTQ advocacy groups and counteradvocacy groups that promote cisgender identities and heterosexual relationships are present. Civic or religious authorities occasionally encourage discrimination against members of the LGBTQ community.
Media outlets rarely promote, encourage, or produce negative, denigrative, slanderous, or libelous portrayals of LGBTQ individuals. Outlets may largely forego reports on LGBTQ issues altogether.
Pro-LGBTQ groups have a large LGBTQ member support base and are capable of affecting policy changes. Occasional backlash from activities, events, and public positions on policies occurs.
Societal tolerance of the LGBTQ community ranges from mixed tolerance to tolerant.
Hate crimes are more often verbal and non-verbal (vandalism, harassment, letters, etc.) than physical violence. Members of society do not praise hate crimes and can respond in support of the victim.
There is a majority presence of influential or trusted pro- LGBTQ individuals, groups, or organizations. Anti-LGBTQ groups and organizations still hold influence on a few issues. Certain civic or religious authorities may encourage discrimination while others may promote tolerance.
Media outlets portray the LGBTQ community and individuals in a realistic manner, and hate crimes are reported accurately.
Pro-LGBTQ groups are present and are seen as legitimate groups in society. Support for the groups comes from the LGBTQ community and the non-LGBTQ community.
Societal tolerance ranges from tolerant to accepting.
Hate crimes often take the form of non-verbal harassment. Violence is rare. Much of the population does not praise hate crimes, but harshly criticizes them and sometimes protests them.
There is a majority presence of influential or trusted pro-LGBTQ individuals, groups, or organizations. Civic or religious authorities rarely encourage discrimination and may even promote tolerance.
Media outlets portray the LGBTQ community and LGBT individuals in a realistic manner, and hate crimes are reported accurately.
Pro-LGBTQ groups are present and are seen as legitimate groups in society. Support for the groups comes from the LGBTQ community and the non-LGBTQ community. The groups’ activities may extend beyond LGBTQ issues.
Terms and abbreviations used in this report
Legal Environment refers to ways in which laws, legal codes, or ordinances are used to suppress the rights and expression of LGBTQ individuals. Three subvariables determine the threat of legal harassment:
- Legality - whether homosexuality is criminalized (I) = Illegal - The practice of homosexuality is illegal for males and/or females. (L) = Legal - The practice of homosexuality is legal for both genders.
- Legal Specificity - how clearly the language of the law is written (M) = Implicit - Refers to laws that use phrases or terms like: “acts against the order of nature,” “unnatural offences,” “deviant sexual intercourse,” “indecent practices,” “act of gross indecency,” “sodomy,” or “buggery” (unless male-male relationships are explicitly mentioned). (E) = Explicit - Refers to laws that use phrases like: “homosexual act,” “sexual relations with someone of the same sex.”
- Government Harassment - refers to actions by government agencies (i.e., police, immigration agencies, courts) that harass, detain, or restrict protections to the LGBTQ community. Government harassment may involve, for example, the questioning of sexual orientation, the application of laws on indecency or public disturbance against homosexuals, or the lack of prosecution against individuals who commit crimes against LGBTQ victims. (N) = No Reports - No incidents were revealed. (S) = Sporadic - Incidents are rare or do not suggest systemic government harassment. (C) = Common - Incidents are common and do suggest systemic government harassment.
Punishment refers to the type of sentencing typically applied to individuals found guilty of violating local laws against homosexuality.
Enforcement refers to the rate at which laws are enforced and punishments applied. This assessment examined enforcement rates of laws with both explicit and implicit legal language. An enforcement rate assessed to be “unlikely” does not necessarily correlate with acceptance of LGBTQ behavior. A lack of officially sanctioned enforcement may actually suggest that social norms favor local community action over those by the government against LGBTQ individuals. Such actions may include ostracism, discrimination, or physical abuse.
This report divides enforcement rates into two categories:
• Likely - Reports of recent enforcement.
• Unlikely - Enforcement is rare, or no documented evidence of enforcement was revealed.
Social Acceptance refers to the degree to which society accepts the open expression of LGBTQ sexual orientation.
• Mixed Tolerance - Society does not have a discernible consensus on homosexuality and the LGBTQ community. Some individuals and extremists may hold negative views about the LGBTQ community. Some radical leaders and politicians may disparage the LGBTQ community publicly. Violence against the LGBTQ community is possible, but rare.
• Intolerance - There is a prevailing social consensus that rejects the rights of LGBTQ individuals to express their sexuality openly. Many individuals hold negative views about the LGBTQ community. Some leaders may disparage the LGBTQ community publicly. Police and other authority figures may not always protect the LGBTQ community. Violence against the LGBT community occurs with some frequency.
High Intolerance - A large majority of the population rejects the rights of LGBTQ individuals to express their sexuality openly. Most individuals hold negative views about the LGBTQ community. Prominent leaders and media outlets are highly likely to disparage the LGBTQ community publicly. Police and other authority figures are highly unlikely to protect the rights of LGBTQ individuals and may specifically harass and target them. Violence against the LGBTQ community is common.
By combining these indicators, we can assess with high confidence the level of threat LGBTQ travelers are likely to encounter when visiting a given