Bupa health pulse 2011: international healthcare survey

G l o B a l t r e n d s, at t i t u d e s a n d influences

contents

fo r e Wo r d

foreword introduction Background 1. the health status of people and their families 2. health influences 3. health information 4. health: Whos responsibility? conclusions research Methodology Bupa around the World

2 3 4 6 12 16 18 22 25 26

healthcare systems around the world are facing the challenge of ageing populations, increased chronic disease prevalence, rising costs and growing demand for quality treatment and the latest drugs. clinical and technological developments will meet some of these challenges, but as the old saying goes prevention is better than cure. unhealthy lifestyles are the cause of many preventable health problems. at Bupa we provide a broad range of healthcare services, support and advice to help our 10.7 million customers identify their healthcare risks and to support them to make lifestyle changes that will positively affect their health. We believe that to support our customers it is vital to understand their relationship with their health now and in the future and to see this within the context of the ever changing cultural, social and economic environment within which they live. the Bupa health pulse 2011 international healthcare survey explores peoples attitudes to and perceptions of health and healthcare in 12 countries around the world. We hope that you find it insightful.

Dean Holden
Bupa Divisional Managing Director, International Markets

introduction

the Bupa health pulse 2011 report focuses on research in 12 developed and developing countries in europe (spain and the uK), the americas (Brazil, Mexico and the us), the Middle east (saudi arabia), asia (china, india, hong Kong and thailand) and australasia (australia and new Zealand) and examines the key factors that influence peoples behaviour with regard to their health. it is based on interviews in 2011 with 13,373 adult members of the general public aged 18+. the report aims to deepen understanding not only of the trends but also the influences, attitudes, perceptions and behaviours which, on every continent, account for those trends and which potently determine the quality of health of individuals and of nations.

The survey invesTigaTes four key areas: 1. The Health Status of People and their Families 2. Health influences 3. Health information 4. Health: Whose Responsibility?

B a c KG r o u n d : h e a lt h c a r e s y s t e M s and spendinG in countries surveyed

Healthcare systems in the 12 markets surveyed in the Bupa Health Pulse research vary widely in the extent to which national or regional provision is publicly or privately funded.1 Likewise, individual estimates of nations healthcare spending, public and private, as a proportion of gross domestic product (GDP) also vary: median values range from 3.3% in Thailand to 17.4% in the United States.

United States

Spain

United Kingdom

Saudi Arabia

China

Hong Kong

ources: S

Mexico

Brazil

India

Thailand

Australia

New Zealand

Economist Intelligence Unit www.eiu.com E Health of Nations report http://www.healthofnations.com/ G countries/profile/name of country Individual health departments by country

Australia (population 22.6 million, total healthcare spending 9.1% of Gdp). all australian citizens are eligible for free or low cost healthcare under the Medicare healthcare system, in which contributions are funded through 1.5-2.5% levies based on taxable income. about half the population is covered by private health insurance. Brazil (population 190.7 million, total healthcare spending 8.4% of Gdp). Most (56%) healthcare spending is funded privately through insurance or is paid for using income or savings. Just under half of the population (44%) depend on the governments sistema nico de sade system. Municipalities and states administer healthcare; the federal government provides financial and technological support. China (population 1.4 billion, total healthcare spending 5.8% of Gdp). the vast majority of patients in both cities and rural areas pay for medical costs in full as required. for about 200 million people with no health insurance, the only option is to self-fund or to rely on family. planned healthcare reforms propose universal access to healthcare funded through national health insurance by 2020. Hong Kong (population 7 million, total healthcare spending 5% of Gdp). healthcare is funded by tax through public and private provision. thirty-eight hospitals are government-operated; 13 are private. all citizens have access to essential healthcare irrespective of their financial means and healthcare standards are widely regarded as being among the worlds best. India (population 1.2 billion, total healthcare spending 5% of Gdp). approximately 80% of healthcare spending is self-pay. only one-tenth of the population has health insurance, and spending on healthcare is a major cause of indebtedness. several social insurance systems exist but these cover a tiny proportion of the population and account for only about 5% of government expenditure on health. the private sector accounts for three-quarters of total health spending. Mexico (population 112 million, total healthcare spending 6.5% of Gdp). healthcare is provided under a federal government system via public institutions, private entities or private physicians. all who can afford it may purchase private provision, however, only 4.5% of Mexicans are covered by private health insurance.

New Zealand (population 4.4 million, total healthcare spending 10.3% of Gdp). about three-quarters of health spending is funded by general taxation. treatment for both immediate and major medical problems is free but there is a fee-for-service for primary healthcare. about 40% of patients have private medical insurance. Saudi Arabia (population 27.1 million, total healthcare spending 4.5% of Gdp). around 75% of all healthcare spending is financed by the public sector, chiefly by the Ministry of health. the government also funds healthcare through subsidies to private sector institutions. nationals receive free public healthcare; expatriates (one-quarter of the population) require private insurance. Spain (population 46 million, total healthcare spending 9.5% of Gdp) provides public funding for near-universal, free health services at the point of use, with some services co-financed by users. however, because demand for medical attention outstrips public sector supply, private health insurance continues to thrive and has approximately 8 million subscribers. the state itself is an important client of the private healthcare sector, which has 454 private hospitals with 51,000 beds. Thailand (population 68 million, total healthcare spending 3.3% of Gdp). nearly half the population is covered by a universal health programme, 20% have private healthcare, 20% have civil service benefits and 13% belong to social security schemes. over the past three decades, thailands healthcare system has expanded to provide free or low-cost co-pay cover for all its citizens. UK (population 62 million, total healthcare spending 9.8% of Gdp). the national health service (nhs) funds healthcare for all permanent residents from general taxation. it is largely free at the point of use but some routine services attract charges. private healthcare and insurance organisations run alongside the state system. US (population 312 million, total healthcare spending 17.4% of Gdp). the us spends proportionally more money on healthcare than any other country but government healthcare, even if recent proposed reforms are effected, is not universal. the private sector accounts for more than threequarters of healthcare spending.

1 . t h e h e a lt h s tat u s o f p e o p l e a n d t h e i r fa M i l i e s

how healThy people feel

FIGURE 1:

PEoPlE claImInG to bE hEalthy and PEoPlE claImInG to havE a lonG tERm hEalth condItIon

internationally, almost two-thirds (62%) of those surveyed consider themselves and their husband, wife or partner (65%) to be healthy. far fewer internationally consider themselves (13%) or their husband, wife or partner (also 13%) to be unhealthy.

100% 90%
84%

respondents in saudi arabia (84%) and Brazil (81%) lead the field in saying that they consider themselves healthy (very or fairly healthy). they also top the table in considering their husband, wife or partner to be healthy (saudi arabia, 83%, Brazil, 82%). in Brazil, nearly half of respondents (47%) say they are very healthy, proportionally four times more than the uK (12%), well over twice as many as the us (20%) and nearly five times as many as in china (10%). two-thirds (66%) of the over-65s across the world say that they feel healthy considerably more than those who are under 65. this is particularly so in australia, where three-quarters (75%) of the over-65s think they are healthy. in the uK, more respondents (22%) say they are unhealthy than in any other country. the us follows, with 17% saying they are unhealthy. also in the uK, over 45s are significantly more likely to consider themselves to be unhealthy.
percentage

80% 70% 60% 50%

46%

81% 76% 71% 68% 67% 64% 60% 59% 54% 49% 45% 41% 39% 32% 28% 26% 28% 38% 38% 39% 40% 38% 30% 62%

40% 30% 20% 10% 0%

internationally, 62% of people consider themselves to be healthy, yet 38% of people report having a long term health condition (figure 1)

Sa

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People who claim to be healthy

People who claim to have a long term health condition

prevalence and fears abouT long Term healTh condiTions

figure 2:

prevalence of long Term condiTions and fears abouT long Term healTh condiTions, inTernaTional averages

FIGURE 2:

PREvalEncE oF lonG tERm condItIons and FEaRs aboUt lonG tERm hEalth condItIons, IntERnatIonal avERaGEs

More than a third of people (38%) in the 12 countries surveyed state that they are suffering from a long term health condition. 35%

35%
32%

30% 25%
percentage

in all countries except india (26%), Brazil (28%), thailand (30%) and spain 30% (32%) more than a third of respondents claim they suffer from a long term health condition. in hong Kong, almost a half (49%) say they have a long term health condition (figure 25% 1).

32%

20% 15% 10%

19%

pErcENtaGE

people are more worried about getting cancer than any other health condition (32% overall). in spain and Mexico, more than half (53%) of 20% 19% respondents say it is their most worrying fear. despite this, of the major conditions which respondents suffer from, only 1% of respondents 15% reported suffering from cancer (figure 2). 13% Worldwide, obesity is the most prevalent long term health condition 10% (BMi over 30) with nearly one in five respondents (19%) reporting that 7% they suffer from it. depression is the second most common long term health condition, with 13% of people worldwide stating that they suffer from it. depression 1% 0% incidences are highest in australia with a fifth of people (19%) stating they have it, and lowest in thailand (7%). obesiTy depression asThma Worldwide, 4% of people say that they suffer from heart disease, this ranges from 6% in the us and china, to 2% in Brazil. for 11% of people, heart disease is the illness that they are most worried about getting.

13% 11% 9%
7%

12%

5%
9%

5%

11% 4%
1%

6% 4%

12%

4% 1% 1% 1%

5%

5%

0% 6%

4%

obEsIty

dEPREssIon 4%

asthma 4%

dIabEtEs

hEaRt dIsEasE

bRonchItIs

cancER

dEmEntIa

1%

1%

1%

Long term heaLth probLem

diabeTes hearT bronchiTis Long term disease health conditions people are suffering from LoNG tErm HEaLtH probLEm

cancer demenTia Long term health conditions people are most worried about getting

long term health conditions people are suffering from

long term health conditions people are most worried about getting

t h e B u pa h e a lt h pulse report is Based on research in 12 countries a r o u n d t h e Wo r l d

obesiTy and eXcess weighT percepTions and realiTy

FIGURE 3:

PEoPlE who thInk thEy aRE ovERwEIGht comPaREd wIth PEoPlE who aRE ovERwEIGht

there are wide gaps between peoples perception and the reality about obesity and excess weight. We asked people for their height and weight and calculated their BMi. separately, we asked respondents whether they considered themselves to be overweight (figure 3).

100% 90% 80% 70%

64% 64% 60% 59% 59% 56% 52% 49% 43% 41% 33% 26% 42% 36% 33% 44% 36% 28% 25% 21% 49%

Worldwide, almost half of all people surveyed (49%) are overweight (BMi > 25 or more). yet only a third of people (36%) think they are overweight. in all countries other than thailand, hong Kong and china, more people are overweight than think they are. only 40% of americans and 43% of saudi arabians believe theyre overweight. however nearly two-thirds of americans (64%) and saudi arabians (64%) are overweight. of those who are overweight, most are obese (BMi > 30), this is the case for 48% of americans and 34% of saudi arabians. the predominately english speaking countries australia (60%), the uK (59%) and new Zealand (59%) have the highest proportion of people who are overweight after the us and saudi arabia. yet only 33%, 40%, 41% respectively believe they are overweight. in contrast, relatively few chinese (21%) weigh too much although a quarter (25%) think that they do. although only 5% of respondents overall regard becoming obese as the health problem they worry most about, more than ten times as many (52%) say that they want to lose weight. people from new Zealand (62%) and saudi arabia (59%) are most keen to become slimmer and almost as many say they want to lose weight in Mexico (56%), thailand (53%), Brazil (52%), the uK (52%) and australia (51%). lowest BMis are reported in asia with only (21%) of chinese people being overweight, followed by thailand (28%), hong Kong (28%) and india (32%).

60%
percentage

50% 40% 30% 20% 10% 0%

40% 40%

32% 28% 25%

US

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People who are overweight

People who think they are overweight

a r o u n d t h e Wo r l d, J u st ov e r half of respondents feel confident aBout BeinG aBle t o G e t h e a lt h c a r e W h e n t h e y need it

figure 4:

people who feel posiTive abouT Their healTh in The neXT 6-12 monThs and people who are confidenT abouT Their access To healThcare in The neXT 6-12 monThs

fuTure healTh prospecTs

100%

FIGURE 4:

PEoPlE wHo FEEl PoSITIvE ABoUT THEIR HEAlTH IN THE NEXT 6-12 MoNTHS AND PEoPlE wHo ARE CoNFIDENT ABoUT THEIR ACCESS To HEAlTHCARE IN THE NEXT 6-12 MoNTHS

looking ahead to the next 6-12 months, most respondents (51%) feel 90% positive about their health, only 12% feel negative. of those with children, 42% feel positive about their childrens health in the next 6-12 months and only 3% feel negative.

100% 90% 80%

80%

four times more of hong Kongs respondents (48%) than elsewhere (12% internationally) say they feel negative about their own health in the 71% 70% coming 6-12 months and 21%, seven times more than elsewhere (3%), feel negative about their childrens health during that time. 63%
60% 62%

pErcENtaGE

percentage

71% 59% 58% 70% 53% of people around the world 60%confident about their ability 58% 59% feel to get 56% 56% 55% healthcare when they need it. 54% 54% 53% 52% 52% 53% 63% 52% 62% 51% 60% 50% 60% 59% india is prominent in this respect, with almost two-thirds of respondents 58% 58% 59% 56% 55% (62%) saying they feel positive about their access to healthcare; only 4% 54% 44% 53% feel negative. 40% 50% 40%

51%
53% 52% 52%

53%

56% 51%

54%

52% 44%

51%

53%

the only exception is thailand where, although only 6% are negative, fewer than a third of respondents (30%) feel positive about getting healthcare when they need it. 30%

38% 30%

40% 30%

40%

38% 30%

20%

18%

over half of respondents (51%) feel 10% positive about their future health and 0% their ability to access healthcare when meX bra they need it (53%) figure 4 ind spa

20% 10% 0%

18%

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people who feel positive about their health

People who feel positive people who feel confident about about their health their access to healthcare

People who feel confident about their access to healthcare

11

2 . h e a lt h i n f l u e n c e s

Respondents in all 12 surveyed markets say the most positive influence on their attitude towards their health comes far more from their partners than anyone else. Overall, celebrities top the list as a negative influence.

posiTive influences

By and large, respondents feel that the most positive influence on their health is their partner (26%). partners are a particularly positive influence in hong Kong (39%) and china (34%) they are least influential in thailand (20%). internationally, 10% of respondents consider their doctor to be the most positive influence on their health. doctors are seen as a more positive influence on attitudes to health in australia (16%), followed by saudi arabia (15%) and the us (14%). parents are the most positive influence for 21% of respondents overall, ranging from 36% in Mexico to 10% in australia. friends are thought to be the most positive influence by 8% overall, ranging from 14% in new Zealand and 10% in australia and india, down to 3% in spain and 4% in Mexico. respondents children are said to have a particularly positive influence 13% overall, ranging to as high as 23% in thailand, followed by 17% in new Zealand and 16% in australia.

negaTive influences

Nine percent of people think that celebrities have a negative influence on their health more than any other specified group. this is particularly true in the four predominately english-speaking countries new Zealand (18%) australia (14%), the uK (14%) and the us (11%). the chinese regard employers (20%) as having the most negative influence on their attitudes to their health, followed by 13% in hong Kong and 11% in saudi arabia. internationally 8% of people feel this way. in thailand, 20% of people believe that friends and 15% believe that colleagues have had the most negative influence on their attitudes towards their health. the international figures are 7% and 5% respectively.

12

less than a fifth of people W o r l d W i d e s ay t h at t h e i r pa r e n t s r e G u l a r ly t o o K exercise When they Were G r oW i n G u p

2 . h e a lt h i n f l u e n c e s
figure 5: people who were encouraged To lead a healThy lifesTyle when growing up
parenTal influences
FIGURE 5: PEOPLE WHO WERE ENCOURAGED TO LEAD A HEALTHY LIFESTYLE WHEN GROWING UP

100%

Worldwide, a fifth (21%) of people credit their parents as having the most 90% positive influence on their attitude to their own health. Lifestyle

100% 90%

More respondents in india than anywhere else (79%) say that they learnt 76% about the benefits of a healthy lifestyle when growing up worldwide this figure is 56%. in only three countries, australia, the uK and the us (all 70% 68% predominately english-speaking), do fewer than half of the respondents 64% agree that they were taught about the benefits of a healthy lifestyle when growing up (figure 5).

80%

79%

80% 70%
57%
percentage

79% 76% 68% 64%

60%

pErcENtaGE

Smoking

60% 50% 40% 30% 20% 10% 0%

one third internationally (34%) say that one or both parents regularly 50% smoked in front of them. this is particularly so in the four predominately english-speaking countries uK (50%), the us (46%), australia (44%), new Zealand (43%). By contrast, only 10% of respondents in india and 40% 13% in thailand said their parents regularly smoked in their presence. the number of respondents whose parents regularly drank to excess when 30% they were growing up varied widely between countries, from 23% in new Zealand and 21% in australia, Brazil, Mexico and the us to just 6% in india.

54%

53%

57%

56%
54% 53% 56% 51% 50% 49% 43% 41%

51%

50%

49% 43%

41%

Drinking

Diet

20%

over a third (37%) of respondents overall say that when they were growing up, one or both parents consistently ate healthy diets. respondents in 10% eastern countries did best in this respect, with around half of parents eating very healthily in india (53%), thailand (52%) and china (47%). only a quarter of respondents in the us and Brazil stated that their 0% parents consistently ate a healthy diet when they were growing up.

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14

figure 6:

people who Think They had good access To healThcare when growing up compared wiTh people who disagree

Exercise

100%
FIGURE 6: PEoPlE who ThINk ThEy had Good accEss To hEalThcaRE whEN GRowING UP comPaREd wITh PEoPlE who dIsaGREE
100% 90%
70% 69%

internationally, less than a fifth (19%) of respondents say that their parents regularly took exercise90% they were growing up. india and when new Zealand top the table in this respect with 30% and 28% respectively saying their parents exercised regularly. - nearly half of respondents80% 77% overall (46%) agree that their parents actively encouraged them to do a lot of sport or physical activity; 72% 72% 29% disagree. 71% - Well over half of indian (67%), chinese (66%), thai (62%) and Mexican (59%) respondents agree that their parents actively encouraged them to do a lot of sport or physical activity. 60% But two-fifths of respondents in the us (42%), Brazil (41%) and the uK (40%) disagree.

70%

80% 70% 60%

percentage

66%
77% 72%

64%
72%

64% 58% 71%

70%

pErcENtaGE

69% 66% 64% 58% 52% 64%

52% 49%

Access to healthcare

50%

Most respondents internationally (64%) say that they had good access to healthcare when growing up (figure 6). 40% in only two markets, hong Kong (49%) and saudi arabia (36%), do fewer than half think that their access to healthcare when growing up was good. More than a third of respondents (38%) in saudi arabia and a quarter in Brazil (25%) do not consider that their access to healthcare when growing up was good. internationally, on average only 15% hold that view. 20%
14% 10%

50%
36%

38%

49%

30%

40%
36%

38%

25%

30%
16% 16% 18%
16% 10% 9% 11% 8% 13% 25%

10% 0%

8%

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8%

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14% 8%

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16% 18% 15%

10% 0%

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people who think they had good access to healthcare when growing up

Peoplepeople who dont good they had good who think they had think People who dont think they had good access access to healthcare when growing access to healthcare when growing up to healthcare when growing up up

15

3 . h e a lt h i n f o r M at i o n

Of the surveys 13,373 respondents, 83% say they often or sometimes search the Internet for information and advice about their health, medicines or medical conditions.

in all 12 countries that were surveyed, the overwhelming majority (83%) say that they use the internet to access health information. interestingly, lower percentages of respondents in western countries (uK 70%, spain 71% and australia 77%) say that they look for health information online. however, greater percentages of respondents in emerging economies (china 94%, thailand 93% and saudi arabia 91%) use the internet for this purpose (figure 7). internationally, nearly a quarter of respondents (23%) have posted a comment or question about a health condition on the internet. the chinese do this most frequently with 53% posting a question online, followed by india (33%), thailand (33%), saudi arabia (31%) and Mexico (25%). overall, well over a third (39%) seek out information to make a self diagnosis about a half do so in new Zealand (52%) and the us (49%). a large number of respondents 38% internationally, 49% in thailand and 43% in china search for details of other peoples experiences of a condition online. respondents in the uK (10%), spain and australia (both 13%) are least likely to post comments or questions online. overall, around a quarter of respondents (23%) use social networking websites such as facebook and Myspace to find out about healthcare matters. in china, almost a third of respondents (29%), far more than elsewhere, use social media to read about or post comments on healthcare (compared with only 1% in the uK and 3% in the us). the vast majority (93%) of people say they check their sources to make sure theyre reputable but only 44% always check their sources; nearly half (49%) check them only sometimes. Moreover, of those who do use the internet to look for health information, 7% never check their sources. this rises to 10% in new Zealand and 9% in hong Kong.

a quarter of respondents (23%) use social networking websites to find out about health. however, only half of people always check their online sources of health information

16

figure 7:

people who use The inTerneT To access healTh informaTion and people who posT commenTs abouT healTh online

100%
94% 91% FIGURE 7: PEOPLE WHO USE THE INTERNET TO ACCESS HEALTH INFORMATION AND PEOPLE WHO POST COMMENTS ABOUT HEALTH ONLINE 90% 89% 90% 87% 93%

100% 90% 80%

82%

83% 80% 80% 77%

80%
94% 93% 91% 90%

70% 60%

89%

87% 82% 80% 80% 77%

71%
83%

70%

pErcENtaGE

70%

53%

71%

70%

50% 40% 30%

60%
percentage

53%

50%

33%

31%

33% 25%

40% 30% 20% 10% 0%

23% 18% 18% 14% 15% 13% 13%

23%

20% 10%

33%

31%

33% 25% 18%

10%

18% 14% 15% 13% 13% 10%

0%

chi
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people who use the internet to access health information

People who use the Internet to access health information

people who post comments or questions about health online

People who post comments or questions about health online

17

4 . h e a lt h : W h o s e r e s p o n s i B i l i t y ?
figure 8: why people wanT To live healThily, inTernaTional averages

Respondents in the 12 countries surveyed vary significantly2% in how much priority they give to their own health and wellbeing and have widely different reasons for wanting to live healthily.
healTh and wellbeing

1%
FIGURE 8: Why pEoplE Want to lIVE hEalthIly, IntERnatIonal aVERaGEs

12%

24%

2% 12% 12%

1%

12%

24%

internationally, 73% of respondents say that their health and wellbeing is a top or high priority. only 4% give it low or no priority. More than anyone else, thais (91%) and Mexicans (84%) give high priority to their health and wellbeing. respondents in new Zealand (61%) and the uK (62%) are at the bottom of this scale.

12% 13%

24%

12% 13%

24%

reasons for wanTing To live healThily

To feel happier (24%)

people highlight two leading reasons for wanting to live healthily. firstly, To avoid geTTing ill (24%) to avoid getting ill 24% internationally (40% in thailand, 36% in spain). secondly, to feel happier also 24% overall 37% in india, 35% in china To live longer (13%) (figure 8). living longer is a stronger motivation for living healthily than either be a burden To oThers (12%) To noT avoiding illness or feeling happier in the us (23%). longevity is the least important reason in saudi arabia (3%) and china (7%). To keep my independence (12%)

to FEEl happIER (24%) to aVoId GEttInG Ill (24%) to lIVE lonGER (13%) to not bE a bURdEn to othERs (12%)

More than anywhere else, respondents in hong Kong rate not being a burden to others as their chief motivation for living healthily To look beTTer/more aTTracTive (12%) to kEEp my IndEpEndEncE (12%) (27%). this is also significantly higher than the international average (12%) in thailand to look bEttER/moRE attRactIVE (12%) (18%), india (17%) and saudi arabia (17%). not being a burden to others is (2%) donT know rated least important by Mexicans (4%) and Brazilians (5%).
none for Maintaining personal independence (12% overall) is more importantof The above (1%) saudis (28%) and respondents in the uK (17%) than elsewhere.
dont knoW (2%) nonE oF thE aboVE (1%)

18

the MaJority of respondents in 7 out of the 12 countries s u r v e y e d t h i n K t h at i t i s t h e r e s p o n s i B i l i t y o f e ac h i n d i v i d u a l t o e n s u r e t h at they Keep Well

figure 9:

barriers To living healThier lives, inTernaTional averages

4% 6%

1% 18% barriers to living healthier lives, international averages

4% 1% 6% 6% 18%

barriers To making healThier lifesTyle choices

6% 9%

figure 9:

internationally, 62% of people say they would like to exercise more, 54% say they would like to eat a healthier diet and 52% would like to lose weight. however, respondents cite several significant barriers to making healthier lifestyle choices. top of the list (figure 9) are:

17% 11% 13% 15%

- lack of motivation, 18% internationally (27% in new Zealand, - the expense, 17% internationally (26% in Brazil and Mexico,
7% in india) 8% in china)

9% 17% 11% 13% 15%

- lack of time, 15% internationally (25% in spain, 7% in the uK) - Work commitments 11% internationally (20% in india, 6% in spain)of moTivaTion (18%) lack

small but not insignificant percentages internationally and 17% in china say that a lack of good quality health information is a barrierThemaking to eXpense (17%) healthier lifestyle choices. lack of Time (15%) laCk of motivation (18%) the majority of respondents in seven of the 12 surveyed countries say that it is the responsibility of each individual to ensure that they keep well. none (already making healThy choices) (13%) the expense (17%) however, in five countries, either a majority or sizeable minorities say that the government or the state should take most responsibility (figure 10). laCk of time (15%) work commiTmenTs (11%) the view that the government or state should take most responsibility for keeping people well is most strongly held in china (56%), followed by none (already making healthy ChoiCes) (13%) lack of energy (9%) Brazil (52%), hong Kong (44%), thailand (43%) and saudi arabia (38%).
work Commitments (11%) conflicaTing informaTion (unsure whaT advice individuals responsibility for their own health is rated lowest in Brazil is correcT) (6%) (40%) and china (40%), followed by saudi arabia (42%), hong Kong laCk of energy (9%) (48%) and thailand (49%). lack of good qualiTy healTh informaTion (6%) ConfliCating information (unsure what adviCe in the uK, the overwhelming majority (88%) say that individuals should is CorreCt) (6%) take most responsibility. respondents in Mexico (83%), the us (82%), donT this new Zealand (78%), spain (77%) australia (76%) and india (73%) rateknow (4%)

almost as highly.

laCk of good quality health information (6%)

lack of inTeresT in being healThy (1%) even though the uK has a long-established comprehensive state-run dont know (4%) health service, fewer respondents there than anywhere else (8%), consider the state has primary responsibility for keeping people well that is an laCk of interest in being healthy (1%) even lower proportion than the us (10%), where the state accounts for barely a quarter of overall healthcare spending.

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figure 10: people who Think individuals should Take mosT responsibiliTy for keeping Themselves well compared wiTh people

TiTle

who Think The governmenT should Take mosT responsibiliTy

100% FIGURE 10: PEoPLE wHo THINK INDIvIDUALS SHoULD TAKE MoST RESPoNSIBILITy FoR KEEPING THEMSELvES wELL CoMPARED wITH PEoPLE TITLE wHo THINK THE GovERNMENT SHoULD TAKE MoST RESPoNSIBILITy 90%
100% 90% 80% 70% 60%
percentage
83%

88%

80%
73%

82%

77%

78%

76%
88% 83% 82%

70% 60%
56%
73% 77% 78%

67%

76%

pErcENtaGE

50%
56% 40%

52% 48% 44% 40%

52% 48% 49% 43% 38% 42% 44% 40% 40%

49% 43% 38% 42%

67%

40%

50% 40% 30% 20% 10%

30% 20% 10% 0%

26% 19% 18%

17%

17% 14% 10%

26%

19%

18%

8%

17%

17% 14% 10%

chi
CHI BRA

bra
HK

hk
THA

Tha
SA

sa
IND

ind
SPA

spa
NZ

nZ
AUS

aus
MEX US

meX

8%

us
INT

uk

inT

0%

UK

people who think the government is most responsible for keeping people well
People who think the government is most responsible for keeping people well

people who think individuals are most responsible for keeping themselves well
People who think individuals are most responsible for keeping themselves well

21

conclusions

1 the survey shows that although millions of people in almost all countries are living longer, living more healthily and enjoying better healthcare generally than ever before, many are still suffering from considerable health problems.

Many people in every surveyed country believe they are overweight yet, in most of these countries, even more are overweight (defined as having a BMi greater than 25). More than a third of respondents internationally (38%) say that they suffer from a chronic illness.

5 fewer respondents in predominately english-speaking countries than anywhere else say that they were taught about the benefits of a healthy lifestyle when growing up. in the same countries, more than almost anywhere else, respondents say that their parents set bad examples by drinking excessively and smoking in front of them. 6 despite wanting to exercise more, eat more healthily and lose weight, respondents cite barriers to doing so as lack of motivation, the expense, lack of time and work commitments. 7 of respondents who search the internet for information or advice about their health, medicines or medical conditions 83% of those surveyed under half check their sources only sometimes and some never check their sources at all. 8 small but not insignificant percentages of respondents internationally say that poor or conflicting healthcare information leaves them unsure of what advice is correct. 9 the majority of respondents in seven of the 12 surveyed countries say that individuals should take most responsibility for keeping well (in the uK 88%), whereas in five countries, either a majority or sizeable minorities say the government or the state should take most responsibility (in china 56%).

2 obesity is witnessed on an epidemic scale chiefly (though not only) in the predominately english speaking countries. 64% of american respondents are overweight but far fewer think they are overweight. By contrast, the lowest body mass index counts are reported in asian countries china, hong Kong, india and thailand. 3 cancer is the most feared long term health condition but affected relatively few respondents. 4 More than twice as many respondents internationally say that their partner is a more positive influence on their health than their doctor.

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r e s e a r c h M e t h o d o lo Gy

ipsos Mori interviewed 13,373 members of the General public across 12 countries between 22nd april and 23rd May 2011. these were: australia, Brazil, china, hong Kong, india, Mexico, new Zealand, saudi arabia, spain, thailand, uK and us. all interviews took place through ipsos online panels and ipsos panel partners. Quotas were set as to ensure all data is as nationally representative of the offline population as possible. data are weighted. for more information please visit www.bupa.com/healthpulse

United States 1000 respondents

Spain 1048 respondents

United Kingdom 2001 respondents

Saudi Arabia 1025 respondents

China 1005 respondents

Hong Kong 1019 respondents

Mexico 1046 respondents

Brazil 1001 respondents

India 1025 respondents

Thailand 1000 respondents

Australia 1203 respondents

New Zealand 1000 respondents

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B u pa a r o u n d t h e W o r l d

Bupas purpose is to help people lead longer, healthier, happier lives. A leading international healthcare group, we offer personal and company health insurance, run care homes for older people and hospitals, and provide workplace health services, health assessments and chronic disease management services, including health coaching, and home healthcare. With no shareholders, we invest our profits to provide more and better healthcare. We are committed to making quality, patient-centred, affordable healthcare more accessible in the areas of wellness, chronic disease management and ageing. Employing over 50,000 people, Bupa has operations around the world, principally in the UK, Australia, Spain, New Zealand and the USA, as well as Hong Kong, Thailand, Saudi Arabia, India, China and across Latin America. Australia Bupa australia pty limited proudly provides health insurance to more than three million australians under the well known health insurance brands MBf, hBa, and Mutual community. it also provides complementary healthcare services through Bupa health dialog, peak health Management and Blink optical. www.bupa.com.au Bupa care services pty limited is an aged care provider with 47 facilities around australia. Hong Kong in hong Kong, Bupa provides health insurance to over 230,000 customers. www.bupa.com.hk/en India Bupa offers health insurance in india through a joint venture with Max india. www.maxbupa.com International Bupa international is a leading international expatriate health insurer with customers in over 190 countries. www.bupa-intl.com Latin America Bupa latin america, based in Miami, provides international health insurance for customers in latin america and the caribbean. www.bupalatinamerica.com New Zealand in new Zealand, our retirement villages, homes and hospitals care for 2,800 residents. telecare, Bupas personal alarm network, is used by 12,000 people. www.bupa.co.nz

Saudi Arabia in saudi arabia, Bupa is the kingdoms largest health insurer. www.bupa.com.sa Spain Bupa, under the sanitas brand, is spains leading healthcare insurer. in 2009, health dialog launched its health coaching service in spain, with a focus on chronic disease management. www.sanitas.es sanitas also provides hospitals, clinics and health services. in 2009, sanitas opened a hospital in to provide acute and primary care services through an innovative public private partnership with the valencian regional government. in spain we care for 4,700 residents across 42 care homes. Thailand Bupa is thailands leading private and corporate health insurer, serving over 30,000 individual customers and 2,200 businesses. www.bupa.co.th UK in the uK, Bupa offers a portfolio of services including health insurance, health assessments, health at work services and insurance protection products. health dialog works closely with its health insurance business and uK health authorities to organise and interpret patient data. www.bupa.co.uk Bupa cromwell hospital is a leading 128-bed london hospital caring mainly for health insurance, self-pay and embassy sponsored customers. Bupa home healthcare provides out-of-hospital care in the uK to over 13,600 nhs patients, satisfying patients desire to be treated in their own homes and helping to relieve stretched nhs resources. in the uK, we are the biggest provider of dementia care, looking after around 18,000 residents. 70% of Bupas uK residents receive state funding. US Bupa provides healthcare analytics and decision support services to around 19 million people in the us, through its health dialog team, based in Boston. health dialog also helps people stay well by identifying high risk groups and offering proactive, targeted health advice. www.healthdialog.com

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registered office: Bupa house 15-19 Bloomsbury Way, london Wc1a 2Ba Bupa 2011

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