women's health and well-being

1 © The Economist Intelligence Unit Limited 2015

Women’s health and well-being: Evolving definitions and practices

Contents

About this research 2

Executive summary 4

I. What is well-being? 6

Box: OECD Better Life Index: Better to be a woman than a man 9

Box: The long-term effects of recession: Better to be a man than a woman 12

II. Managing your own health and well-being 14

Box: Mexican obesity vs Brazilian beauty: Government and consumer responses to local problems 16

III. Accessing information on health and well-being 18

Box: Can the Internet help the seriously ill? 18

Conclusion: Management matters 22

Appendices 23

Appendix 1 – Survey of female consumers – full-sample results 23

Appendix 2 – Survey of public officials – full-sample results 28

Appendix 3 – Bibliography – Defining and measuring female health and well-being 34

Appendix 4 – Bibliography – How consumers access information on health and well-being 37



About this research

Over many decades, the definition of “health” in population studies has expanded beyond the notion of “absence of disease or infirmity” to include a more comprehensive and positive view combining physical, mental and social well-being. Concurrently, a body of research is emerging on how this broader view of health and well-being—focusing on the nexus of family, friends and personal resilience in determining well-being—applies in particular to women.

With this as background, The Economist Intelligence Unit, sponsored by Merck Consumer Health, undertook a programme of research focusing on women’s health and well-being at different life stages and in different parts of the world. The emphasis is on how broadly or narrowly women’s well-being is perceived and defined in different cultures and at different life stages, and the role that women play in enhancing their own well-being. In particular, the study considers whether the well-being of women is seen mainly in terms of physical health and wellness, or is understood more broadly. The study also considers the ways in which women in different cultures and at different life stages access information, services and products related to their health and well-being, and it looks at government approaches, programmes and strategies to enhance women’s health and well-being.

The research is based on two online surveys—one with female consumers in five countries, and the other with public officials concerned with women’s well-being in the same five countries—as well as on extensive desk research and on in-depth interviews with experts on women’s well-being.

l Female consumers survey In March and April 2015 The Economist Intelligence Unit surveyed 453 female consumers concerning their views on well-being. The respondents are roughly evenly divided among five countries: France, Germany, Brazil, Mexico and India. They are also more or less evenly divided among four age groups: 15-30, 31-45, 46-60, and 61-plus. However, the 15-30-year-old age group was further divided during the data analysis stage into teenagers aged 15-20 and young adults aged 21-30, to reflect differences in the preferences of these two sub-groups.

l Public officials survey In March and April 2015 we surveyed 100 public officials on their strategies and approaches to enhancing women’s well-being. The officials are roughly evenly divided among the same five countries as the female consumers. All have responsibility for, or knowledge of, their departments’ programmes aimed at supporting women’s health and well-being. Sixty percent of the officials are male and 40% are female. Almost all (87%) have annual budgets under US$100m. Some 70% have the title of “manager”, and 91% work in regional and local government.

l In-depth interviews Also in March and April 2015, we carried out interviews with 27 individuals with expertise in the topics under study. We would like to thank the following participants in the in-depth interview programme for their time and insights:



l Carlotta Balestra, policy analyst [Well-Being Index], OECD. France

l Doris Bartel, senior director, gender and empowerment, CARE USA

l Sanghita Bhatacharyya, senior public health specialist, Public Health Foundation of India

l Amanda Bourlier, research analyst, Mexico Consumer Health, Euromonitor, US

l Hilke Brockmann, professor, School of Humanities and Social Sciences, Jacobs University Bremen, Germany

l Jan Delhey, professor of sociology/macrosociology, Otto-von-Guericke University Magdeburg. Germany

l Rachel Dodge, education consultant focusing on well-being in secondary schools; PhD candidate, School of Health Sciences, Cardiff Metropolitan University, UK

l Tim Evans, senior director for health, nutrition and population, World Bank, US

l Tracy Francis, director, healthcare practice in Latin America, McKinsey, Brazil

l Katja Iversen, CEO, Women Deliver [global advocate for girls’ and women’s health, rights, and well-being], US

l Sophie Janinet, co-founder, Georgette Sand [Feminist organisation], France

l Elard Koch, founder and director, MELISA Institute, Chile [Molecular Epidemiology in Life Sciences Accountability: a private non-profit institution for advanced biomedical research; author of report on link between abortion legislation and maternal health outcomes in Mexico]

l Vittoria Luda di Cortemiglia, programme co-ordinator for the UN Interregional Crime and Justice Research Institute, Italy [A UN entity focused on preventing crime and facilitating criminal justice; editor of report, “The impacts of the [financial] crisis on gender equality and women’s well-being in EU Mediterranean countries”]

l Katarzyna Mol-Wolf, editor-in-chief, Emotion [German women’s magazine]

l Meika Nakamura, research manager, Euromonitor International, Brazil

l Divesh Nath, editor, Women’s Era magazine, Delhi Press, India

l Clarissa Nicklaus, lead analyst—research, Euromonitor, Germany

l Patricia O’Hayer, global director of external relations and strategic partnerships, RB (formerly known as Reckitt Benckiser), UK [a multinational producer of health, hygiene and home products focusing on well-being]

l Natacha Ordioni, associate professor of sociology, University of Toulon

l Catrin Schulte-Hillen, leader, Working Group on Reproductive Health, Médecins Sans Frontières (Doctors Without Borders), Switzerland

l Angela Spatharou, principal, Mexico office, McKinsey

l Farrah Storr, editor-in-chief, Women’s Health magazine, UK

l Michael Thomas, partner, Global Pharmaceutical Practice, AT Kearney, UK [also author of “Winning the Battle for Consumer Healthcare”]

l Paul Wicks, vice-president—innovation, and Amy Fees, Patient Advisory Board, PatientsLikeMe, US [an online patient network for information, support and research]

l Dr Tim Wilson, lead partner, Health Industries Consulting, PwC, UK

l Alexandra Wyke, CEO, PatientView, UK [a research and publishing group]

The Economist Intelligence Unit bears sole responsibility for the content of this report. The findings and views expressed in the report do not necessarily reflect the views of the sponsor. Michael Kapoor, an independent business journalist, was the author of the report, and Aviva Freudmann, research director, EMEA Thought Leadership for The Economist Intelligence Unit, was the editor.

http://cardiffmet.academia.edu/RachelDodge

http://cardiffmet.academia.edu/

http://en.wikipedia.org/wiki/Multinational_corporation



In its original Millennium goals for the period to 2015, the UN set a fairly narrow focus on some of the crucial development issues for women, notably slashing the number of deaths in childbirth (most of which are entirely preventable). In formulating its next set of goals, though, the UN took a much broader view of women’s well-being. A general pledge to achieve gender equality was backed up by specific targets, such as eliminating violence against women. More generally, the emphasis shifted towards issues such as access to education, crucial to female empowerment, as well as economic and social development.

In this report, we ask how women’s well-being is defined and then we ask both women and policy-makers for their views on the important contributors to well-being, and how well they feel they are doing. The answers vary from person to person, but there is some degree of consensus about many of the essential contributing factors, from the importance of education and basic healthcare to giving women in poorer countries more autonomy, the need for stress management and a work-life balance for mothers in developed countries.

Above all, however, our surveys find that both women and policy-makers define women’s well-being mainly in terms of physical health and fitness. Many analysts add that women need to take active control over lifestyle factors such as diet and exercise, and our survey suggests that women themselves believe that they are doing so. Our research goes on to ask what women are

doing to improve their well-being, how they find the necessary information for doing so, whether there is convincing evidence that women are taking more responsibility for their own wellness, and if wellness indicators are improving as a result. Focusing on women’s well-being in five countries (France, Germany, India, Mexico and Brazil), this research reaches the following key findings:

1. The definition of women’s well-being varies according to income and immediate circumstances. Poorer people, and people in some poorer countries, will be concerned with immediate necessities, sometimes as basic as adequate food supplies and, for women, access to education and independence. These considerations will be the chief determinants of well-being for women in those circumstances. However, above a certain income level—around US$75,000 a year in developed countries, according to one estimate—higher incomes are not associated with increased well-being. Professional women in richer countries may be concerned with balancing family life and work, and with managing the stress from a busy lifestyle, for example. Women’s definition of well-being is not necessarily changing, therefore, but it does evolve with circumstances.

2. Women can feel a lot better or worse off than their objective situation might suggest. Our survey finds that women in rich countries such as France can feel worse off (and even less financially secure) than women in poorer places such as India. Equally, women’s self-assessments

Executive summary



of their health tend towards the bullish, even in countries with weak health statistics. Subjective feelings of well-being can overpower objective measures such as health, income and national security levels as women react to their immediate situations, and compare themselves to their peers rather than to people in poorer countries.

3. Women and policy-makers—along with academic experts on well-being—recognise that well-being goes beyond health concerns, but health still dominates their thinking. Broadly speaking, our survey finds that policy-makers’ priorities echo women’s concerns over everything from physical security to emotional stability. However, both still make physical health their main measure of well-being, and policy-makers tend to track physical health indicators all but exclusively. The emphasis of policy-makers on health may overshadow wider well-being issues when developing programmes aimed at women.

4. Women say that they actively manage their well-being, but broader trends do not support this claim for health. Our survey finds that many women recognise the need to manage their well-being actively, but that their activities in connection with well-being tend towards the communal (such as cultural activities). For health, the focus is on cutting back on bad habits such as smoking, more than on making lifestyle changes such as exercising or eating healthily. On a broader level, stagnant sales of consumer health products such as vitamin pills and over-the-counter medicines in Europe, and high levels of obesity and lifestyle-related diseases such as diabetes, even in some poorer countries, do not suggest that women are managing their own, and their families’, health more actively.

5. Higher-income groups are more likely to take an active approach towards health management than lower-income ones. In both developed and developing countries people with higher incomes are more likely to be concerned with lifestyle and health management than poorer people, who largely ignore questions of exercise

and healthy lifestyle. Our survey finds that such lifestyle management increases with feelings of financial security. Consumer health market trends suggest that in developing countries, less affluent people concentrate on basics such as diet supplements (for example, vitamin pills), but richer people, including the emerging middle classes, are increasingly concerned with questions of healthy diet and exercise.

6. Despite their broad agreement with female consumers over the definition of well-being, public officials’ priorities ignore some of women’s core concerns. Despite some differences in the intensity of their views, the women and the public officials surveyed broadly agreed that physical health, emotional stability and a sense of accomplishment in life were important to feelings of well-being (although public officials ranked physical security much more highly than women generally). However, public officials listed their activities as focused on public-health campaigns, along with community building. Some areas, such as child-care provision, essential for empowering women, were almost entirely ignored.

7. Women actively research their health and well-being, but discussion with family and with doctors remains as important as new media such as the Internet. Our survey finds that most women actively seek out information on their health and well-being. Overall, the Internet is now the most popular single source of information and is expected to become more important over the next few years. However, discussion with others, including asking friends and medical personnel, remains of central importance, and the use of new media varies according to respondents’ age. It was considered of most importance in developing countries such as Brazil and Mexico, where Internet access remains poor in comparison with developed countries but where younger people use social media heavily. Generally, people use the Internet to inform themselves before discussion with a medical professional (or to research an existing condition) rather than for self-diagnosis.



For a few young women, well-being means having a bicycle. Some regional governments have started to give them to girls in the very poor northern states of India. The bikes, among other things, allow the girls to get to school safely. And access to education (along with a government drive to improve access to basic healthcare) means that they may have a chance of finding work, of achieving independence, and of escaping a grinding cycle of child marriage and poverty. “[Well-being] is about empowerment,” concludes Sanghita Bhatacharyya, a senior public health specialist at the Public Health Foundation of India.

For the poorest women, this is not an unusual conclusion. Tim Evans, senior director for health at the World Bank, lists the Bank’s priorities for developing countries as “addressing inequalities; improving access to essential services such as health and education; and working with governments to improve the societal environment.” Doris Bartel, a senior director of Care USA, says that: “Women’s demand for empowerment goes back to the 1960s and the feminist movement. Since then they have taken increasing control over their and their families’ health. But in some countries—the lowest quintile by income—that is not the case; women are not empowered.”

The debate over what constitutes women’s well-being and how best to enhance it, is different in richer countries such as Germany and France. Here, despite some continued inequalities, for example over pay rates, women have long enjoyed good access to basic services such as

health and education. For them, and for better-off women in countries such as India and Brazil, well-being debates can centre on day-to-day problems such as trying to juggle careers and family. Despite being well-off by objective measures, women in these circumstances can feel pressured or beleaguered, as they judge their immediate situations and compare themselves against their peers. “Subjective assessments can be more powerful than objective measurements such as income and physical health,” says Hilke Brockmann, a sociology professor at Jacobs University in Germany, adding that feelings of well-being “can change from moment to moment”.

This is an important point to bear in mind when assessing the factors that contribute to well-being. Nonetheless, overarching measures of well-being, taking into account both objective and subjective factors, have been attempted. One widely accepted framework comes from the OECD, a rich-nation club that measures its members’ well-being according to a variety of criteria, ranging from the subjective (‘how well do you feel?’) to objective measures such as health, income and education (see OECD illustration). “On average, women’s scores tend not to differ markedly from men’s,” says Carlotta Balestra, a policy analyst at the OECD. However, women and men do emphasise different factors, with women more likely to cite work-life balance and personal security.

Alexandra Wyke, chief executive of the research and publishing group PatientView, says that many women view their well-being in terms of

Part I – What does well-being mean? 1



a series of concentric rings, all of them equally important. “In the innermost circle are the issues to do with the home,” she says, including housing, nutrition, family life, money and mental health. Beyond that there is the immediate social sphere, including work or school issues, access to healthcare and education, the ability to travel, communicate with friends and feel physically secure. Finally, well-being is connected with society and the way the individual is perceived by society, a factor that includes elements of gender equality as well as women’s social and financial status.

These are highly subjective measures and, as Jan Delhey, professor of sociology at Otto-von-Guericke University in Magdeburg, Germany, points out: “Feelings of well-being are partly relative.” You might be healthy and wealthy by global standards but you may still feel somewhat disadvantaged if you believe you cannot “keep up with the neighbours”.

That of course helps to explain why women in different countries, and in different age and income groups within countries, emphasise different factors when discussing well-being.

Source: http://www.oecd.org/statistics/measuringwell-beingandprogressunderstandingtheissue.htm

Quality of Life

INDIVIDUAL WELL-BEING[Population averages and differences across groups]

SUSTAINABILITY OF WELL-BEING OVER TIMERequires preserving different type of capital:

Material Conditions

Natural capital Human capitalEconomic capital Social capital

Health status

Work-life balance

Education and skills

Income and wealth

Jobs and earnings

Housing

GDP Regrettables

Social connections

Civic engagementand governanceEnvironmental quality

Personal security

Subjective well-being

Source: OECD, 2013.



Katarzyna Mol-Wolf, editor in chief of German women’s magazine, Emotion, says that her middle-aged, affluent, female readers are most concerned with freeing more time to spend with their families or on their own, for example. In India, Divesh Nath, founder of MassCoMedia and editor-in-chief of Women’s Era magazine, points to a new generation of Indian women, skilled, living away from home and comprising part of the country’s burgeoning middle class. Their concerns are a mixture of local issues, such as strained family relations as they move away from the traditional family model, and the sort of things listed by both Ms Mol-Wolf and Farrah Storr, editor-in-chief of Women’s Health magazine in the UK: managing the stress of busy lives, along with physical health and fitness.

These relatively affluent women living in poor countries express few concerns about basics such as access to education, healthcare and adequate nutrition. Nor is income a major concern for them, even in countries where they may be surrounded by poverty. Ms Brockmann of Jacobs University says that the effect of higher income on well-being flattens off above US$75,000 a

year; beyond that level—or the equivalent in poor countries, once cost-of-living adjustments are made—individuals are more likely to be concerned with work-life balance and other matters unrelated to income. The findings of our surveys need to be seen in this context: the indicators of women’s well-being vary by age and income even within countries.

Overall, the women surveyed for this report are quite cheerful: 62% say they feel good or excellent in their daily lives, with just 8% saying they feel negative. While—as several in-depth interviewees noted—feelings of well-being can change according to daily circumstances, these survey results provide a useful snapshot of how respondents feel in general, thereby highlighting differences between women in different geographies and different life stages.

Strikingly, the women’s self-assessments bear only a very loose resemblance to the reality of their situations. On the whole, the rich and healthy generally feel happier than the norm. However, women surveyed in two wealthy countries, France and Germany, were gloomier than the average, with 60% in France and 51% in Germany saying they feel “good or excellent”—compared with 74% in India, despite India’s severe social and poverty problems at a national level.

On a scale of 1-5, with 1 meaning“excellent” and 5 meaning “terrible”,please tell us how you feel in yourdaily life (% respondents)

Feeling fine, thank you

Source: The Economist Intelligence Unit.

Good

Average

Poor

53%

Excellent9%

30%

7%

Terrible

1%

France

Brazil

Mexico

India

Germany

On a scale of 1-5, with 1 meaning“excellent” and 5 meaning “terrible”,please tell us how you feel in your dailylife; % replying “excellent” or “good”

Gloom amongst riches


(% respondents)

74%

62%

62%

60%

51%



By far the gloomiest group were the middle-aged respondents aged 46-60, even though they are generally healthy and affluent compared with the general population. “Age has more of an impact on feelings of well-being than gender or changes in income,” says Ms Brockmann, with respondents in middle age rather grumpy compared with perky youngsters or contented older people. By their 60s people have often outlived the stress of their careers and of caring for elderly parents and younger children.

Our survey finding that socially and financially privileged women can sometimes feel more unhappy than poorer people, despite their objectively better circumstances, is echoed in wider studies involving international comparisons. The OECD says that national (as opposed to personal) wealth levels determine how sustainable a country’s well-being ranking is, but is not in itself a direct determinant of a country’s, or a person’s, score. And of course people compare themselves to their peers, not to individuals in far-away societies very different from their own. (See Box: OECD Better Life Index: Better to be a woman than a man]

Local culture plays a part, too, in different national perceptions of well-being, says Natacha Ordioni, a sociologist at the University of Toulon. The OECD rankings show that Latin Americans such as Brazilians and Mexicans tend to say they are much happier than their objective rankings would justify, above even a rich and stable European country such as France. So the good showing for the poorer countries in our survey confirms both that well-being is subjective, and that respondents are measuring themselves against their peers and their past rather than against any global norms.

Age 46-60

Age 31-45

Age 21-30

Age 15-20

Age 61 plus

On a scale of 1-5, with 1 meaning“excellent” and 5 meaning “terrible”,please tell us how you feel in your dailylife; % replying “excellent” or “good”

Middle-aged blues


(% respondents)

66%

65%

63%

56%

62%

Every year, the OECD ranks its 34 relatively wealthy member countries in order of life satisfaction, or well-being. It takes a broad view, looking at 11 topics spanning both subjective and objective measures [housing, income, jobs, community, education, environment, civic engagement, health, life satisfaction, safety and work-life balance]. Generally speaking, there are few surprises in a list that ranks Australia top and Mexico bottom for life satisfaction; richer, stable countries tend to score more highly with poorer, sometimes crime-ridden states at the bottom.

There is little difference between the overall scores for men and women, according to OECD policy analyst Carlotta Balestra, although

women tend to score slightly higher than men in well-being, and to emphasise different things: personal security and work-life balance are more important to them, for example.

One striking point, however, is that people’s reported levels of life satisfaction, specifically, were often inconsistent with their countries’ overall situations, with people in Latin American countries generally content despite low incomes and some social problems, and those in wealthy European countries gloomier than expected.

In terms of the individual countries considered in The Economist Intelligence Unit’s study, the OECD does not cover India, but Mexico is ranked last, behind troubled states such as

OECD Better Life Index: Better to be a woman than a man



A second major finding of our survey is that most individuals define their well-being primarily in terms of physical health, and view wider well-being factors mainly as secondary in nature. That helps to explain why respondents tend to view the effectiveness of public policy aimed at promoting well-being through the lens of health service performance—rather than considering

governments’ wider efforts to, for example, foster community life or cut down on crime.

Nearly two-thirds (64%) of respondents to our survey of female consumers define well-being as “feeling healthy and physically fit”. The overall result is boosted by responses in Germany and in India, where 77% and 75%, respectively, link well-being primarily to health and fitness. However, some of the broader concerns noted by analysts and the OECD are acknowledged, too; a sense of accomplishment is ranked second, reflecting analysts’ comments that women need a sense of empowerment. Emotional security comes third, again reflecting the importance of mental health and stress management. Financial security ranks a distant fifth.

Here, our results seem directly influenced by the relative performance of the countries’ economies. Germans, well off and in a stable economy, are least likely among the respondents in the five countries to rank financial security as directly linked to well-being. Comparably

Turkey, Russia and Greece. Brazil ranks just five places higher. In both countries, women score noticeably better than men. Germany and France appear in mid-table, with economically stable Germany a few places above France and little difference in the score for men and women in either country.

The reasons for Mexico’s poor score are straightforward: incomes are only around half the OECD average, unemployment is high, and those with jobs work far more hours than in other OECD countries. The country scores poorly across almost all the other measures, from community engagement to pollution. There is, however, one rather remarkable exception: subjective life satisfaction. Despite all the country’s problems, Mexicans rate their life satisfaction at 6.7 out of ten, above the OECD average of 6.6.

It is a similar pattern in Brazil, although scores are generally higher than in Mexico (albeit below the OECD average for basics such as income and education). Again, Brazilians’

sense of life satisfaction is out of kilter with their overall results, rated at an above average seven out of ten. “It is a cultural thing,” says Ms Balestra. “Latin American countries generally report positive feelings.”

She draws a contrast with France, which reports above-average scores for everything from income to working hours. Women score slightly higher than men on average; despite some concerns over pay disparity and slightly lower employment levels, they work fewer hours and are as well educated as men. But France’s life satisfaction score of 6.2 puts it behind the much poorer countries of Brazil and Mexico, and below the OECD average.

Life satisfaction is higher in Germany at 8.1, reflecting a healthy economy and high scores in all areas. Here, the biggest concerns are over the very high levels of income disparity between the richest and poorest people, with the top 20% of the population earning more than four times as much as the bottom 20%.

Feeling optimistic about thefuture of myself and my family

Feeling emotionally secureand balanced

Feeling a sense ofaccomplishment or satisfaction

Feeling healthy andphysically fit

Feeling financially secure

Which of the following best describes your understanding of thephrase “feeling well”? Please select up to three

What makes you happy?


(% respondents)

64%

45%

39%

23%

21%



rich French people battered by recession and worried about employment security are the most likely among the five countries to rank financial security as directly related to well-being. “Money does not necessarily determine well-being,” says Mr Delhey, although he adds that “people will often say that more money would make them feel more content.”

To that extent, our survey results broadly fit with the consensus among analysts concerning contributors to well-being. However, our respondents do ignore some of the things deemed important by both academic experts and policy-makers. For example, only 16% of respondents link well-being to “feeling connected to others”, although academic experts have explored and documented the importance of family and community life to feelings of well-being. Other factors, such as physical security and feeling optimistic about the future of your community or country, are all but ignored.

Public officials tend to track the female consumers’ definitions of well-being, but with differing degrees of emphasis. Generally, public officials emphasise health provision, and concentrate on measuring aspects of physical health such as life expectancy, to gauge the effectiveness of policy. Close to three-quarters list physical health as the most important subjective measure of well-being; they emphasise public health campaigns on healthy living topics such as good nutrition; and three-quarters say that they are focused on illness prevention, and that they measure progress primarily in terms of physical health and fitness in the target population.

This fits well with our consumers’ concentration on health, as noted above. Yet the women surveyed for the study tend to be lukewarm about the success of their governments (national, regional or local) in supporting their health and well-being. Only 6% describe those efforts as “very successful, compared with 25% who say these efforts are “very unsuccessful”.

One reason for this lack of enthusiasm may be the differences in views on what contributes most to well-being. For example, while 64% of female consumers link well-being to “feeling healthy and physically fit”, some 74% of public officials do so. Public officials seem much more focused on women’s physical security than the women are themselves. And whereas 45% of the women surveyed link well-being to “feeling a sense of accomplishment”, only 26% of officials do so.

Interestingly, the highest approval ratings for government efforts are given by women in countries making major efforts to improve healthcare provision. In India, for example, 59% of female consumers say government efforts are “moderately successful”—far higher than the sample average of 38% giving this response. The high approval rating for Indian officials may reflect the efforts of the prime minister, Narendra Modi, to introduce universal health insurance from April of 2015. Despite some stumbles over India’s reform efforts since our surveys were conducted in March-April 2015, this is an important step for a country where

How would you rate the success of yourgovernment (either national, regionalor local) in supporting your health andwell-being? (% respondents)

Unimpressed


Moderatelysuccessful

Moderatelyunsuccessful

Veryunsuccessful

Don’t know

4%Very successful

6%

38%

27%

25%



life expectancy is more than ten years below and infant mortality rates ten times higher than in wealthy countries. In absolute terms, healthcare provision may be dreadful, but Indian respondents are applauding the progress.

In contrast, consumers in European countries have seen (still very good) healthcare provision dented by austerity, and here the survey responses rating government efforts as “very

successful” or “moderately successful” are slightly below the sample average. Women’s advocates in these countries contend that in the long term, recession could have a significant detrimental effect on female well-being. (See Box: The long-term effects of recession: Better to be a man than a woman.)

Similarly, less than one-third of Brazilian and Mexican women surveyed rate government

While the OECD Better Life index shows, among other things, that women tend to score slightly more highly than men in terms of their well-being, some policy-makers warn that the long-term effects of recession hit women harder than men. “The 2008 financial crisis is considered by many economists to be the worst financial crisis since the Great Depression of the 1930s,” according to a recent report on the effects of the crisis on women’s rights in France, Italy, Greece and Spain published by the UN Interregional Crime and Justice Research Institute (UNICRI), a UN entity focused on preventing crime and facilitating criminal justice. “Regrettably, political and economic reforms now run the risk of weakening women’s rights.” *

UNICRI commissioned a series of economists to report on the situation in the individual countries and the conclusion, predictably, was that the more badly a country was affected by the financial crisis of 2008, the worse the damage to women’s well-being. Programme co-ordinator Vittoria Luda di Cortemiglia points to certain cuts in public services, which hit women disproportionately hard, from child benefits to health. Women also saw their financial independence badly affected, as banks dramatically reduced lending and many women were forced into badly-paid, part-time work. Women are also more likely to work in the public sector than men, she says, and as a consequence were disproportionately affected by cuts in the

The long-term effects of recession: Better to be a man than a woman

Women Public officials

Different priorities

Feeling healthy andphysically fit

Emotional securityand stability

Feeling physicallysecure

Feeling a sense ofaccomplishment

Women’s survey: Which of the following best describes your understanding of the phrase“feeling well”? Please select up to three (N=453 respondents)Public officials: In your view, what are the most important subjective measures of well-being? Please select up to three (N = 100 respondents)(% respondents)


64%

39%

11%

45%

74%

51%

50%

26%



efforts as effective, despite having health systems that are far more developed than India’s. Latin American states have health provision that is “split into two halves,” says Tracy Francis, director of McKinsey’s healthcare practice in Latin America. For perhaps a quarter of people covered by private insurance, provision is adequate; for most it remains grossly ineffective, which probably explains the low approval ratings in our survey.

That said, both female consumers and public officials show that they are aware that well-being extends beyond health and fitness considerations. Yet the emphasis on physical health does raise some questions about how effectively women monitor and manage their health, as well as their wider wellness. The next chapter discusses the research findings on those issues.

number of state jobs. Furthermore, the loss of financial independence may make it harder for some women to divorce, leading to greater levels of unhappiness. “Women’s well-being has taken a step back,” she says.

In some of the harder-hit countries, such as Greece, the effects have been severe, as a country flirting with bankruptcy sees social as well as financial problems escalate. A more intriguing example, though, is France, which has been affected by austerity and a flat economy albeit nowhere near as severely as some of the other countries considered. “The same general patterns can be observed [as in the other countries],” she says, “but there is a delay.”

“The objective indicators show that the situation of women has become worse in France since the crisis,” says Natacha Ordione, a sociologist at the University of Toulon. “None of the problems are new but they have become more acute.”

As well as health cuts, she points to a shortage of state housing, rising female unemployment as public-sector jobs are cut and a growing gap in wages between men and women. “It is harder to escape bad marriages,” she adds, although the divorce and birth rates have not changed (in fact, some three-quarters of first children are born outside of marriage in France, which has one of the lowest marriage rates in Europe).

She also points to a growing mismatch between

liberal legislation at national level (a Woman’s Act last year guaranteed basic rights, such as equal pay, for example) and increasing social conservatism on the ground. Sophie Janinet, one of the founders of the feminist co-operative Georgette Sand, also points to the increase in the number of women forced to take poorly paid part-time jobs, and to the rise of the far-right National Front whose leader, Marine le Pen, has said, among other anti-liberal statements, that abortion is too easy. “There has been a regression in recent years as the rise of the National Front gives far-right views media prominence,” she says.

Women’s rights are well established in France, and well-being levels generally high, but a weak economy and high unemployment could nonetheless dent more than living standards. Ms Ordione describes the problems as “cyclical”, pointing to women’s equal access to education and high-powered jobs as reasons to believe that women’s well-being will bounce back. And, in fact, the OECD well-being ranking has not shown a fall in well-being in France since the financial crisis. Yet if the European downturn proves as long-lived as many fear, then women’s de facto rights could be affected, and women’s well-being could suffer disproportionate declines.

*The impacts of the crisis of gender equality and well-being in the Mediterranean EU countries, UN Interregional Crime and Justice Research Institute



Dr Tim Wilson, health industry consulting lead with PwC and a practicing doctor, tells an anecdote about an African village involved in a solar-power project. As part of the project, some of its women were sent abroad for training, turning them into the village experts on power production. This increased their status and their voice in the village, and consequently they reported greater levels of well-being. The point, he says, is about “the importance of empowering women, and allowing them to manage their own life and well-being more actively.”

It is a point borne out by several of the analysts interviewed for this report, who speak both of the importance of empowering women in

Part II – Managing your own health and well-being2

developing countries to make them more self-sufficient, and of the importance of control to stress management and well-being in developed countries. Our surveys suggest that women themselves recognise this: some 85% say that they actively try to ensure a sense of well-being.

“On a broader scale they simply are not doing it,” counters Michael Thomas, a partner at AT Kearney’s global pharmaceutical practice. He points out that, for all the talk of women taking a more active role in managing their own health, for example through a healthy diet and exercise, obesity levels have not fallen in the UK (nor in Germany and Mexico, where the problem is also significant), and there is no sign of improvement in related diseases such as diabetes. In fact, far from taking charge of their health to avoid such problems, well over half of UK diabetes sufferers do not even take their medication as they should, let alone reduce their sugar intake and lose weight to improve their health. In Europe, sales of over-the-counter drugs and health products like vitamins are flat or falling. The broader figures suggest that people are apathetic about health management.

In Germany, at least, business research company Euromonitor does not expect that to change. As in France, “austerity-hit consumers are looking to minimise health costs,” says Clarissa Niklaus, who covers consumer health markets in Germany for Euromonitor. Certainly, they are unwilling to spend more in the hope of feeling better. In developing countries, the pattern is more mixed. Those on higher incomes take a broader view of health and well-being. The rest show little

Keeping in mind your understandingof the phrase “feeling well”, howactive are you in trying to ensure asense of well-being in your daily life? (% respondents)

Actively involved


Somewhat active

Somewhatinactive

53%

Very active

Very inactive

1%

32%14%



interest in broader well-being, although poorer people do look to supplement sometimes meagre diets with nutritional products.

There are some common trends across the three developing countries that we consider in this report—Brazil, Mexico and (significantly poorer) India. First, Euromonitor expects the rapid growth of consumer markets for food and health products such as vitamins to continue—unsurprisingly, as disposable income grows with the economy. Poorer people concentrate on basics such as nutritional supplements in all three countries (Brazil and Mexico are both seeing rapid growth of vitamin sales, for example), as well as some basic over-the-counter drugs essential in countries where state health provision remains patchy. In Mexico and India, more than three-quarters of healthcare spending remains out of pocket.

Consequently, most people concentrate first and foremost on maintaining their health or dealing with illness. “Slimming and exercise are restricted to the educated middle classes,” says Angela Spatharou, a principal in McKinsey’s Mexico office. She points out that, as in Brazil, only people with private insurance (less than one-third of the Mexican population) enjoy good basic healthcare. In particular, the emerging middle classes in big cities across the three countries are driving the growth of health and wellness products.

The rest of the population in these countries, in contrast, tends to follow long-standing habits rather than spending more money on well-being products. Brazilians, for example, spend more heavily on beauty products and treatments than on their health. In Brazil, “beauty still outweighs health”, says Meika Nakamura, Euromonitor’s research manager in Brazil. In Mexico, an explosion of fast-food consumption suggests a lack of interest in adopting a healthy diet and has prompted the government to impose a tax on sugary drinks, hoping to reduce the widespread incidence of obesity. The evidence from these countries suggests that women will spend on

their health only to plug gaps in state provision—and that they will only start to worry about wider concerns such as physical fitness when basic healthcare is assured, often through private insurance. (See Box: Mexican obesity vs Brazilian beauty: Government and consumer responses to local problems)

“For policy-makers the big challenge is to encourage people to manage their own health,” says Mr Thomas, adding that increasingly stretched health systems in developed countries can no longer afford to cover all health needs. There is, he says, some evidence that comprehensive state provision of healthcare deters people from buying their own medicines, and actively managing their own health, creating a culture of dependency and reliance on free care even for minor ailments.

Indeed, our survey shows that the respondents with the greatest stated enthusiasm for managing their own health and well-being are in India and Brazil, two countries with inadequate national health coverage. The reason for these respondents’ stated preference for managing their own health and well-being may be simple necessity—ie, the government is not providing them with the help that they need—or that they are part of the emerging middle classes, which are driving increased sales of wellness products. The second explanation is the more likely one: overall, nearly all the respondents who consider themselves financially secure, regardless of the country in which they live, say that they actively manage their health and well-being.

The ways that women go about improving their well-being also suggest a certain absence of active management. Survey results show that women will make an effort to avoid problems, but are less inclined to make positive lifestyle changes to become healthier. Asked what they do to promote their own sense of well-being, most women, especially in developing countries, say that they avoid unhealthy activities. Other popular measures include taking preventive measures such as medical check-ups. Only about



one-third of respondents say that they keep physically fit (with the lowest responses in this category found in Brazil and Mexico).

Moreover, the broader factors related to well-being receive scant attention. Only around one-quarter (26%) of respondents say that they focus on building and maintaining good family

Brazil, says Meika Nakamura who covers consumer health in the country for Euromonitor, is a country with a tropical climate and a beach culture. “Across all income brackets women are very concerned with appearance—it is the third biggest market for beauty products in the world.” This has not yet translated into concern for wider health and well-being, she adds. “With the exception of the rich, there is little concern with diet and exercise.” This is starting to change as people on lower incomes feed a surge in the number of low-cost gyms.

In both Brazil and Mexico there is little sign of a focus on managing one’s well-being, or even of engaging in sound health practices. Brazilian consumers spend more on cosmetic products than do consumers in far richer countries such as France and Germany. This is despite a health system described by Tracy Francis, director of healthcare practice at McKinsey Brazil, as “overburdened, with long waiting lists even for cancer care.” Brazilians remain more interested

in managing their beauty than their health, it seems.

In some ways it is a similar story in Mexico, where people are generally less concerned with their appearance than in Brazil but are fonder of junk food. This has led to problems with obesity and related diseases such as diabetes. Despite recent government campaigns to cut down on junk-food consumption by taxing sugary drinks, obesity levels have continued to rise, with three-quarters of women considered medically overweight, although sales of sugary drinks have fallen.

As in Brazil, this suggests that few Mexicans are taking a more active role in managing their health and fitness. In fact, except for the relatively small number of people who have access to good healthcare through private insurance, Mexicans concentrate their spending and well-being on buying over-the-counter drugs and nutritional supplements.

Mexican obesity vs Brazilian beauty: Government and consumer responses to local problems

Germany

Brazil

Mexico

India

France

Keeping in mind your understandingof the phrase “feeling well”, howactive are you in trying to ensure asense of well-being in your daily life?Percent saying “very active” or "somewhat active"

Actively involved, by country


(% respondents)

95%

86%

86%

84%

75%

Keeping in mind your understandingof the phrase “feeling well”, howactive are you in trying to ensure asense of well-being in your daily life?Percent saying “very active” or“somewhat active”

Actively involved, by personal wealth


(% respondents)

Alwaysinsecure

Ofteninsecure

Mostlysecure

Verysecure 98%

85%

86%

65%



I am physically activeand try to keep fit

I take preventivehealth measures

I avoid unhealthfulactivities

What, if anything, are the main things you do to promote yourown sense of well-being? Please select the top three

How to feel better


(% respondents)

48%

38%

35%

relationships, an area vital to emotional stability. This response is lowest in India (17%), where a growing number of young women leave home and their extended families for careers in the big cities. Equally, relatively few (17%) of the female consumers surveyed say that researching health matters is among the top three measures they take to promote their well-being. This response, however, ranked relatively highly in Brazil (28%) and Mexico (24%), countries with poor Internet access but good community advice from pharmacists and others (see Part III – Accessing information on health and well-being).

In some ways this is a confused picture. Respondents recognise the need to take charge of their well-being, but are rather blasé about some of the measures that they acknowledge are important to their well-being. Asked

about the main barriers to better well-being, respondents place insufficient sleep, lack of exercise and poor diet at the top of the list. Yet none of these problems figure prominently in the list of actions that respondents say they are targeting to improve their well-being. Emotional pressures and family problems are cited relatively frequently in India, where respondents also say that they do little to ensure healthy family relations. These results suggest that women are perhaps not targeting the areas that they should if they want to improve their well-being.

Our survey of public officials does suggest a wider level of awareness among policy-makers, however. Asked about their spending priorities, most public officials emphasised health, echoing the main concerns of women. Illness prevention and health education dominate. However, public officials also say that their departments focus on community-building activities aimed at women, on fitness and sports programmes, and on offering women emotional support, which our female respondents did not flag as important.

Public officials also say that they emphasise programmes aimed at higher-risk female groups, such as those in distressed situations and teenagers. However, relatively few (34%) respondents to the survey of female consumers say that they take part in government programmes, and those that do tend to emphasise community activities such as culture and sport, especially in developed countries.

From our survey results one potential glaring gap in provision is that for elderly people (although this might be handled by a different department). Overwhelmingly, programmes are aimed at young adults aged 21-45. None of the public officials surveyed say that they target women above 61, and a worryingly small number (6%) focus on 15-20 year olds, despite accepting the importance of problems such as teenage pregnancy. Women’s issues span everyone from the very young to the very old, making this an eccentric finding.

Emotional support/psychotherapy

Community building activities

Health related information

Illness prevention

Physical fitness/sports

What is the focus of programmes that your department or agencycurrently offers, or plans to offer, to women to promote theirhealth and sense of well-being? Please select up the three

What’s on offer: Focus of government programmes


(% respondents)

73%

54%

52%

50%

42%



At the very least, our survey suggests that women are self-confident: they rate themselves highly for health and well-being, and they believe that they are doing an effective job of managing their wellness themselves. They are equally confident that they are well informed about health and wellness matters, with good access to information across all of the countries.

In some ways this is not that surprising, with the Internet offering a plethora of information on most conditions, from the very common to the most obscure. However, our survey suggests that the Internet is now regarded as just one piece of the puzzle when it comes to health information, with a continued reliance on other, face-to-face sources, such as family and medical professionals.

“There is too much information available over the web,” says AT Kearney’s Mr Thomas, pointing

out that health is now the second most popular subject on the web. “The problem for most consumers is how to navigate it for reliable sites and information. A key opportunity is to speak in a language that consumers will understand and relate to, without the need for a medical qualification.” That can be seen in the success of sites such as PatientsLikeMe. (See box: Can the Internet help the seriously ill?). The urgency of establishing credibility can also be seen in the changing focus of many women’s magazines, both print and online, with these now emphasising the use of hard data and external experts to support their discussion and advice. As Internet usage matures, women are growing to understand its place in relation to other sources of health information, and increasingly use it for specific aims, such as informing themselves before or after seeing a doctor.

Part III – Accessing information on health and well-being3

Our survey of female consumers finds two things about people in poor health. First, as might be expected, they consider their levels of well-being to be low. And second, they find information harder to obtain than healthier people do, despite the glut of information now available online.

An American website provides a useful model for how this situation could improve, offering itself as a platform for discussion and for distributing pooled patient information. PatientsLikeMe was set up in 2004 as a medical-data-sharing platform by relatives and colleagues of a

young man suffering from a rare degenerative condition, Lou Gehrig’s disease. It now has more than 300,000 users globally, more than 70% of them female, allowing people with rare diseases to find other patients like themselves. “Mainstream problems can be discussed online, over Mumsnet or even Facebook,” says its vice-president of innovation, Paul Wicks, “but we offer anonymity, hard data, and access to people with rare conditions.”

Patients submit their diagnosis, symptoms, medications and other details to provide a core of hard data for site users and for research.

Can the Internet help the seriously ill?



Overall, a remarkable 85% of the women surveyed say that health and well-being information is readily available, falling to 75% for those in very poor health or with insecure finances. Predictably, the Internet was cited as the most popular source of information, but the gap between use of online and offline sources was less emphatic than might have been expected. Some two-thirds picked the Internet as one of their top three sources, but more than half (54%) chose medical doctors and 41% cited family and friends. The Internet is a valuable new source of information, but women do not see it as a replacement for traditional sources.

A look at the information sources that women expect to use over the next three years confirms this impression. Some 78% say they will rely on online sources at least slightly, compared with 66% currently, with a marked increase in Brazil and Mexico (the countries that consider the Internet of most importance in general). But

They also measure their quality of life through a standard questionnaire for all illnesses, giving their subjective judgements.

One user of the site is Amy Fees, who suffers from a rare condition called Fabry’s disease, meaning she has a faulty enzyme that prevents the breakdown of a specific cellular waste. She says that the site gave her “access to a group of fellow patients that would have been impossible before the Internet”. That pool of knowledge, she says, “empowers” her when speaking with

doctors “who often have no experience of the condition.”

Equally important, she says, is that she has made good friends with fellow patients on the site. This means that she can post about feeling unwell, having the sort of open discussion that is difficult even with family members. “Mental health is a big priority for users,” she says. “You can sense there is a stigma attached to being ill and that you need to be a brave soldier in public.”

Family and friends

Medical doctors,hospitals, clinics

Online sources includingsocial media

Where do you get information related to your health andwell-being? Please select the top three

Consider the source


(% respondents)

66%

54%

41%

a greater proportion—82%—cite friends and family, and a large proportion also cite doctors (78%) or pharmacists (65%).

Several factors may explain these results. First, the more balanced view of the Internet’s role might reflect its increased maturity, with people now asking how it is useful as well as which sites are reliable. Paul Wicks, vice-president of innovation at PatientsLikeMe, an online patient network for information, support and research, says that the site measures objective things such as patients’ reaction to certain types of medication, for example, as well as asking them about their subjective well-being. Pooling the information from its 300,000 users makes it a reliable source of medical information, he says, as well as a way for people with rare conditions to swap notes.

In print media, Farrah Storr, editor of Women’s Health magazine in the UK, says that women want practical, reliable advice. “We try to offer them a practical point in every paragraph, and make a point of backing up claims or product reviews with expert opinion and [external] scientific tests. They are looking for information we can show is reliable.” Katarzyna Mol-Wolf, editor of Germany’s Emotion magazine, backs up Ms Storr’s point, using respected external experts such as psychologists and coaches to discuss aspects of well-being, as well as giving her readers a chance to exchange views.

Such comments reflect a growing sophistication among Internet users and magazine readers,



who are looking for reliable information to help them discuss problems with a doctor, or to understand a diagnosis once made. They also want to compare notes with people suffering from similar conditions. Brazil may not have the best-developed Internet infrastructure yet, but Brazilians are already among the heaviest users of social media such as Facebook, says Ms Nakamura. This could help to explain the perceived importance of web and social media research and discussion there and in Mexico.

With Internet usage maturing into a source of background research, data and discussion, the continued importance of professional advice from doctors and pharmacists becomes self-evident. However, with health systems stretched in developed countries and often inadequate in developing ones, people are looking beyond public health professionals for information and advice.

Some of that information and advisory gap is being filled by manufacturers of well-being products, particularly where state healthcare coverage is scant. Leaving aside India, where so far most healthcare has been private by default, Mexico and Brazil already operate hybrid public-private health systems. Around one-quarter of the population enjoys good standards of care through private insurance, but the remainder receive very basic coverage from an over-stretched state system, with long waiting periods even for serious, and urgent, treatment.

“Accessing high-quality primary care in many parts of the country continues to be an issue,” says Angela Spatharou, a principal at McKinsey’s office in Mexico.

This has left much of the healthcare bill to be funded out of pocket. For many poorer people this means buying over-the-counter medicines, along with nutritional supplements. Mexico in particular has developed an efficient system wherein drug manufacturers sell directly to consumers, who often rely on their network of sales agents for basic medical and treatment advice. In the cities, some pharmacies have followed US practice to have a doctor located in store to give immediate advice. Where healthcare systems are broken, people already look beyond the formal healthcare system for medical advice.

Patricia O’Hayer, global director of external relations and strategic partnerships at consumer health company RB (formerly known as Reckitt Benckiser), says that consumers in different parts of the world are not necessarily asking for different products. The emphasis may vary from country to country; in India, for example, RB is backing campaigns to improve notoriously poor sanitation, which it sees as an investment to

Looking ahead over the next threeyears, to what extent do you expect torely on the following sources forinformation, products and services toincrease your general sense ofwell-being? Percent saying “will relyheavily” or “will rely slightly”

Future sources


(% respondents)

Pharmacists

Medical doctors,hospitals, clinics

Onlinesources

Family andfriends 82%

78%

78%

65%

Do you find health and well-beinginformation readily available?

Information flood

(% respondents)

85%Yes

15%No




build equity in potential future sales of its own cleaning products. But where consumers look for universal basics such as aspirin,it can be burdensome for manufacturers to have to register such products separately in many countries, says Ms O’Hayer. She calls for an international system to recognise such “well known molecules” through a single filing system or recognition of safety data and studies performed in other countries. Many countries rely on private healthcare and spending in reality, but have yet to streamline the use and availability even of common over-the-counter medicines. Motivated, perhaps, by self-interest, some of the big drug companies are trying to change that.

The rich countries of Europe are not yet at a point where people go to pharmacies because they cannot find a doctor. However, in certain poorer countries, including in Latin America, this is a common occurrence, and some commercial firms are taking the initiative to close the gap by offering products, such as vital-signs monitoring devices, which allow people to monitor their own health and fitness. People will use such products and technologies, just as they will continue to ask family and friends about their ailments. The Internet will help them, but will not replace those traditional information sources.



Conclusion

Management matters

Women define their well-being according to their immediate situation, generally emphasising physical health but also areas of wider concern ranging from family life to work-life balance and stress management. On paper, at least, policy-makers are in broad agreement, focusing on physical health treatment and information campaigns, as well as on some areas such as mental health and protection for vulnerable women not necessarily mentioned by women in a more secure position.

However, on both sides there is a hint of complacency. Women rate their own health and well-being highly and say they manage it actively. Public officials, for their part, are confident that women’s well-being has improved, and indeed that their budgets will increase despite continued austerity in the European countries surveyed. In fact, such confidence is only really justified for a fairly small group of affluent, well-educated women. Whether they are part of the emerging middle classes in developing countries like India and Mexico, or are professional women in developed European states, such women can be seen taking an active interest in their well-being, exercising, eating well and working to balance family and work life. A more in-depth analysis,

however, shows little evidence that women’s well-being is improving, or that most women are taking more active control of their well-being.

The levels of concern vary according to country and income, but the evidence abounds nonetheless. For example, many of India’s basic health and well-being indicators—from life expectancy and child mortality rates to the prevalence of child marriage—are on a par with the levels prevalent in Sub-Saharan African states, especially outside of the big cities. Mexican and German obesity levels remain very high, with little sign that they are coming down. Even in relatively healthy France, concerns over some other areas, such as the pay gap between men and women and the risk of consequent female poverty, have mounted since the 2008 financial crisis.

Tellingly, the actions being taken to quell these problems often come from central government, for example Mexico’s tax on sugary drinks and India’s drive to improve access to basic medical services. Beyond a narrow elite, there is little sign that women themselves are becoming more active in managing their health and well-being, or that policy-makers are looking much beyond traditional public education and provision. As health systems around the world become more stretched, that will need to change.



Appendices

Appendix 1 – Female consumers survey

1 (Excellent)

2 (Good)

3 (Average)

4 (Poor)

5 (Terrible)

9

53

30

7

1

(% respondents)On a scale of 1 to 5, with 1 meaning “excellent” and 5 meaning “terrible”, please tell us how you currently feel in your daily life

Feeling healthy and physically fit

Feeling a sense of accomplishment or satisfaction in life

Feeling emotionally secure and balanced

Feeling optimistic about the future of myself and my family


Feeling connected to others

Feeling physically secure

Feeling secure in my current job

Feeling optimistic about the future of my community or country

Other, please specify

64

45

39

23

21

16

11

4

4

0

(% respondents)Which of the following best describes your understanding of the phrase “feeling well”? Please select up to three



Very active

Somewhat active

Somewhat inactive

Very inactive

32

53

14

1

(% respondents)

Keeping in mind your understanding of the phrase “feeling well”, how active are you in trying to ensure a sense of well-beingin your daily life?

I avoid unhealthful activities such as smoking, drinking to excess, eating unhealthy foods, and using narcotics

I take preventive-health measures such as screening, medical check-ups, etc

I am physically active and try to keep physically fit (for example, through exercise)

I ensure I get enough sleep

I avoid stressful situations as much as possible, and try to remain emotionally balanced

I focus on building and maintaining good family relationships

I focus on building and maintaining good friendships

I inform myself about health matters and follow medical advice

I am involved with others in community activities


None, I do not take any measures to ensure a sense of well-being in my daily life

48

38

35

31

26

25

17

16

7

1

3

(% respondents)What, if anything, are the main things you do to promote your own sense of well-being? Please select the top three

Insufficient sleep or rest

Insufficient exercise

Emotional pressures

Poor diet/poor nutrition

Family problems

Work-related stress

Social pressures

Isolation from others

Poor living conditions (eg, housing, water quality, air quality)

Troubles in my relations with others

Difficult access to medical care


None, I do not face any barriers to improving my health and well-being

38

37

33

32

20

18

12

8

6

5

4

4

9

(% respondents)In your view, what are the main barriers to improving your health and well-being? Please select the top three



Yes

No

34

66

(% respondents)

Do you take part in any programmes – for example health- or sports- or community-related – aimed at boosting your sense ofwell-being?

Hobbies and cultural activities in the community

Other health- or fitness-related programmes offered by government, schools, hospitals, private companies and other organisations

Nutrition programmes

Community activities

Psychological support groups or individual/family counseling programmes

Support programmes for women/girls in difficulty (eg, battered women, pregnant teenagers, drug-dependent women)

Programmes for pregnant women and/or for new mothers


48

47

39

34

18

12

9

7

(% respondents)Please select the three items below that best describe the nature of these programmes:

Very unsuccessful

Moderately successful

Moderately unsuccessful

Very unsuccessful

Don’t know

6

38

27

25

4

(% respondents)How would you rate the success of your government (either national, regional or local) in supporting your health and well-being?

Yes

No

70

30

(% respondents)Do you actively search for information on health and well-being?

Inform myself about healthy living, preventive measures and general well-being

Diagnose or treat an illness


75

23

2

(% respondents)Is your information search mainly to:



Yes

No

85

15

(% respondents)Do you find health and well-being information readily available?

Online sources including social media

Medical doctors, hospitals, clinics

Family and friends

Pharmacists in my community

Other healthcare providers

Manufacturers of health-related products

Government agencies/programmes

Health helplines

Other retailers in my community


None of the above; I do not look for such information

66

54

41

15

14

7

4

3

1

5

4

(% respondents)Where do you get information related to your health and well-being? Please select the top three

Will rely heavily Will rely slightly Will not use at all Not sure

Medical doctors, hospitals, clinics

Other healthcare providers

Pharmacists in my community

Other retailers in my community

Manufacturers of health-related products

Online sources including social media

Family and friends

Government agencies/programmes

Health helplines

13104533

222239

152149

16

16

243929

242936

8

10

11124038

8104537

23343112

24412511

(% respondents)

Looking ahead over the next three years, to what extent to you expect to rely on the following sources for information,products or services to increase your sense of general well-being?



Excellent

Good

Poor

Very poor

13

73

13

1

(% respondents)How would you describe your current physical health?

Very secure

Mostly secure

Often insecure

Always insecure

9

55

29

7

(% respondents)How would you describe your current financial situation?

Married (or in a partnership) with children

Married (or in a partnership) with no children

Single/divorced with children

Single/divorced with no children

36

17

14

33

(% respondents)How would you describe your current personal situation?

1

2

3

4

5

More than 5

39

40

17

2

1

1

(% respondents)How many children? Please specify



Appendix 2 – Public officials survey

Yes

No

100

0

(% respondents)Does your department or agency offer or support health and well-being programmes aimed at women?

Yes

No

100

0

(% respondents)

Do you have responsibility for, or knowledge of, your department’s programmes aimed at supporting women’s health andwell-being?

India

Germany

Brazil

Mexico

France

21

20

20

20

19

(% respondents)In which country are you located?

Male

Female

60

40

(% respondents)What is your gender?

Feeling healthy and physically fit

Feeling emotionally secure and balanced

Feeling physically secure

Feeling connected to others


Feeling a sense of accomplishment or satisfaction in life

Feeling secure in one’s current job

Feeling optimistic about the future of oneself and one’s family

Feeling optimistic about the future of one’s community or country


74

51

50

43

31

26

15

3

2

0

(% respondents) In your view, what are the most important subjective measures of well-being? Please select up to three



Yes

No

100

0

(% respondents)In your view, do subjective feelings of well-being, such as a sense of satisfaction in life, improve physical health and longevity?

It has improved significantly

It has improved slightly

It has not changed at all

It has worsened slightly

It has worsened considerably

6

81

13

0

0

(% respondents)In your view, how has women’s overall well-being changed in your country in the past three years?

Public information campaigns on good nutrition and other health practices (eg, avoiding smoking or drinking to excess, getting sufficient sleep)

Active promotion of preventive-health measures such as screening, medical checkups, etc

Public information and programmes aimed at avoiding excessive stress, maintaining emotional balance

General high quality of life

Good health-related infrastructure (water and air quality, access to medical care)

Extensive information and opportunities for promoting physical fitness

Public programmes aimed at fostering strong family relationships

Public programmes aimed at fostering good community relations


None of these factors promoting well-being are present in my country

53

47

44

43

43

40

10

5

0

0

(% respondents)

What do you see as the main factors supporting or promoting women’s health and well-being in your country?Please select up to three



Inadequate public information on good health practices (eg, related to nutrition, fitness, avoiding smoking, etc)

Inadequate funding for programmes to promote mental health, emotional balance

Poor diet/poor nutritional practices

Poor living conditions (eg, quality of housing, water, air)

Inadequate funding for programmes to promote engagement in the community

Insufficient opportunities for exercise and physical fitness

Work-related stress

Insufficient medical-care resources (clinics, hospitals, healthcare professionals)

A culture contributing to emotional stress

High incidence of isolation of individuals


None of these barriers to well-being are present in my country

57

44

37

37

35

33

29

13

4

2

0

0

(% respondents)What do you see as the main barriers or threats to women’s health and well-being in your country? Please select up to three

Very successful

Moderately successful

Moderately unsuccessful

Very unsuccessful

Too early to tell

6

84

5

1

4

(% respondents) How would you rate your department’s or agency’s success in promoting women’s health and well-being?

Illness prevention (eg, screening for specific diseases, self-examination, vaccination, physical check-ups)

Health-related education, public information campaigns

Community-building activities aimed at women

Individual or group-based emotional support/psychotherapy

Physical fitness/sports

Support for battered or homeless women

Child-care or financial support for women with young children


73

54

52

50

42

11

1

0

(% respondents)

What is the focus of programmes that your department or agency currently offers, or plans to offer, to women to promotetheir health and sense of well-being? Please select up to three



We expect our budget for such programmes to increase by more than 20% in real terms

We expect our budget for such programmes to increase by up to 20% in real terms

We expect our budget for such programmes to stay about the same in real terms

We expect our budget for such programmes to decrease by up to 20% in real terms

We expect our budget for such programmes to decrease by more than 20% in real terms

Don’t know

6

68

17

3

0

6

(% respondents)

To what extent, if at all, will your department or agency change its budget over the next three years for programmes aimed atwomen’s health and well-being?

Age 15-20

Age 21-30

Age 31-45

Age 46-60

Age 61 and above


6

75

55

28

0

2

(% respondents)

Please select the age group to which your department or agency aims the majority of its women-oriented programmes.Select up to two

Teenagers and young women

Women in remote rural areas

Women in other distressed situations (eg in abusive relationships, homeless, drug dependent, isolated)

Women in poverty

All women and girls in the community, without differentiation

Women with health problems

Pregnant girls and women

Women with poor fitness but otherwise healthy

Women with emotional difficulties


47

46

46

38

36

27

26

7

3

0

(% respondents)

Please select the three most important population segments to which your department or agency aims its women-orientedprogrammes:



Yes

No

49

51

(% respondents)Does your department set targets and/or measure progress for promoting women’s health and well-being?

Measures of physical health in the target population (eg, rise/decline in disease rates)

Measures of physical fitness in the target population

Measures of community involvement or social connectedness in the target population

Number of women enrolled in programmes to promote health and/or well-being

Measures of emotional balance/happiness in the target population

Measures of financial independence in the target population

Other targets/measures, please specify

59

18

8

6

4

4

0

(% respondents)Which of the following best describes the nature of those targets and/or measures of progress?

Less than $10m

$10m to $100m

$100m to $500m

$500m to 1bn

$1bn to $5bn

Greater than $5bn

Don’t know

55

32

3

0

0

1

9

(% respondents)What is your organisation’s approximate annual budget/expenditure for women-related programmes?

Education/Training

Health

Economic development

Social services

Treasury/Finance

Housing/Urban development

Labour/Work and pensions

Culture/Media/Sport

Foreign aid agency


49

19

13

6

6

4

3

0

0

0

(% respondents)Which of the following most closely resembles the government department you work for?



Director of agency/ministry, or equivalent

Deputy director of agency/ministry, or equivalent

Financial chief/Treasurer/Comptroller, or equivalent

Senior manager or head of department, or equivalent

Manager

Project officer/Programme manager


3

1

4

13

70

3

6

(% respondents)Which of the following would best describe your title?

Local government

Regional government

Federal or central government

Independent executive agency

Non-government or community-based organisation

International/multilateral organization

50

41

5

2

2

0

(% respondents)Which of the following best describes the organisation you work for?

Federal

Regional

City/town

Neighbourhood


1

31

25

42

1

(% respondents)At what level of administration do you work?



Appendix 3 – Bibliography – Definitions and measurement of female well-being

The impacts of the crisis of gender equality and well-being in the Mediterranean EU countries, UN Interregional Crime and Justice Research Institute

Positive affect and psychosocial processes related to health, By Steptoe, Andrew; O’Donnell, Katie; Marmot, Michael; Wardle, Jane.

British Journal of Psychology. May 2008, Vol. 99 Issue 2, p211-227.

Abstract: Positive affect is associated with longevity and favourable physiological function. Positive affect was associated with greater social connectedness, emotional and practical support, optimism and adaptive coping responses, and lower depression, independently of age, gender, household income, paid employment, smoking status and negative affect. Negative affect was independently associated with negative relationships, greater exposure to chronic stress, depressed mood, pessimism and avoidant coping. Positive affect may be beneficial for health outcomes in part because it is a component of a profile of protective psychosocial characteristics.

Parenthood, Marital Status, and Well-Being in Later Life: Evidence from SHARE,

By Hank, Karsten; Wagner, Michael.

Social Indicators Research. Nov 2013, Vol. 114 Issue 2, p639-653.

Abstract: Childless individuals do not generally fare worse than parents in terms of their economic, psychological, or social well-being. Although there is some indication for a “protective effect” of marriage, having a partner does not per se contribute to

greater psychological well-being: only those reporting satisfaction with the extent of reciprocity in their relationship report lower numbers of depression symptoms than their unmarried counterparts.

[Commentary on] Integrating Social Epidemiology Into Public Health Research and Practice for Maternal Depression, By Smith, Megan V.; Lincoln, Alisa K.

American Journal of Public Health. June 2011, Vol. 101 Issue 6, p990-994.

Abstract: One method to improve current public health approaches to maternal depression is through the incorporation of a perspective focusing on community, cohesion, group membership, and connectedness—a concept often described as social capital. We describe the relevance of this ecosocial perspective for mental health promotion programmes for mothers.

Understanding Women’s Health Promotion and the Rural Church, By Plunkett, Robyn; Leipert, Beverly; Olson, Joanne K.; Ray, Susan L.

Qualitative Health Research. Dec 2014, Vol. 24 Issue 12, p1,721-1,731.

Abstract: The Church supported the physical, intellectual, emotional, and spiritual health of rural women, facilitated social connectedness, and provided healthful opportunities to give and to receive. Implications included reframing religious places as health-promoting and socially inclusive places for rural women.

Women’s Well-Being: Ranking America’s Top 25 Metro Areas, By “Measure of America, a project of the Social Science Research Council, USA, April 2012, http://www.measureofamerica.org/womens_wellbeing/

Abstract: On the whole, women living in major metropolitan areas are doing better



than the typical American woman. However, not all urban and suburban women have the same choices and opportunities; the study shows how basic indicators in health, education, and income intersect with other important factors, among them race, ethnicity, age, the opportunities of the marketplace, and marital status, to form a more complete picture of the critical factors that shape the ability of different groups of women to live freely chosen lives of value.

State of Global Well-Being, Results of the Gallup-Healthways Global Well-Being Index 2013, http://info.healthways.com/hs-fs/hub/162029/file-1634508606-df/WBI2013/Gallup-Healthways_State_of_Global_Well-Being_vFINAL.pdf

Abstract: The Gallup and Healthways Global Well-Being Index uses a holistic definition of well-being and self-reported data from individuals across the globe to create a unique view of societies’ progress on the elements that matter most to well-being. The inaugural “State of Global Well-Being” report contains: country and regional rankings; well-being profiles of countries across the globe; industry perspectives on well-being improvement; and recommendations for well-being improvement. Globally, greater well-being correlates with outcomes indicative of stability and resilience—for example, healthcare utilisation, intention to migrate, trust in elections and local institutions, daily stress, food/shelter security, volunteerism and willingness to help strangers.

Measuring National Well-being: European Comparisons, 2014, By Chris Randall and Ann Corp, UK Office of National Statistics, http://www.ons.gov.uk/ons/dcp171766_363811.pdf

Abstract: The Measuring National Well-being programme began in November 2010 with the aim to “develop and publish an accepted and trusted set of National Statistics that

help people to understand and monitor well-being”. The Office for National Statistics (ONS) publishes 41 measures of national well-being, organised by ten “domains” including topics such as Health, What we do, and Where we live. The measures include both objective data (for example, the unemployment rate) and subjective data (such as the percentage of people who felt safe walking alone after dark).

Guidelines on measuring subjective well-being, OECD, 2013, http://www.oecd.org/statistics/guidelines-on-measuring-subjective-well-being.htm

Abstract: These Guidelines represent the first attempt to provide international recommendations on collecting, publishing and analysing subjective well-being data. They provide guidance on collecting information on people’s evaluations and experiences of life, as well as on collecting “eudaimonic” measures (which focus on meaning and self-realisation as underpinning psychological well-being). The Guidelines also outline why measures of subjective well-being are relevant for monitoring and policy making, and why national statistical agencies have a critical role to play in enhancing the usefulness of existing measures.

Gender and Well-Being around the World, By Carol Graham and Soumya Chattopadhyay, Global Economy and Development Program, The Brookings Institution, USA

http://www.brookings.edu/~/media/research/files/papers/2012/8/08-gender-well-being-graham/08-gender-and-well-being-graham.pdf

Abstract: We explore gender differences in reported well-being around the world, both across and within countries—comparing age, income, and education cohorts. We find that women have higher levels of well-being than men, with a few exceptions in low-income countries. We also find differences

http://www.ons.gov.uk/ons/publications/rss.xml?edition=tcm:77-357984

http://www.ons.gov.uk/ons/dcp171766_363811.pdf

http://www.ons.gov.uk/ons/dcp171766_363811.pdf

http://www.oecd.org/statistics/guidelines-on-measuring-subjective-well-being.htm





in the standard relationships between key variables—such as marriage and well-being—when differential gender rights are accounted for. We conclude that differences in well-being across genders are affected by the same empirical and methodological factors that drive the paradoxes underlying income and well-being debates, with norms and expectations playing an important mediating role.

Predicting Well-being, By Jenny Chanfreau, Cheryl Lloyd, Christos Byron, et al, at NatCen Social Research; prepared for the UK Department of Health

Abstract: This report contributes to an emerging evidence base on what predicts well-being. Among the findings: Levels of well-being vary over the course of life, dipping in the mid-teenage years, at midlife, and again among the very old. Older women emerge as a priority group due to their very low levels of well-being. Social relationships are key. This is evident in two ways. First, people with greater well-being have more positive relationships. Second, people with higher levels of well-being tend to have parents, partners, and children who also have better well-being. Well-being is part of the public health agenda. Good self-reported health is one of the strongest predictors of high well-being, and health behaviours matter to general health.

Are we architects of our own happiness? The importance of family background for well-being, By Daniel D. Schnitzlein and Christoph Wunder, October 11th 2014, Based on data from Das Sozio-Oekonomische Panel (SOEP), SOEP papers on Multidisciplinary Panel Data Research at DIW Berlin Germany, http://ssrn.com/abstract=2529978

Abstract: This paper analyses whether individuals have equal opportunity to achieve happiness (or well-being). We estimate

sibling correlations and inter-generational correlations in self-reported life satisfaction, satisfaction with household income, job satisfaction, and satisfaction with health. We find high sibling correlations for all measures of well-being. The results suggest that family background explains, on average, between 30% and 60% of the inequality in permanent well-being. The influence is smaller when the siblings’ psychological and geographical distance from their parental home is larger. Results from inter-generational correlations suggest that parental characteristics are considerably less important than family and community factors.

Happy People Live Longer: Subjective Well-Being Contributes to Health and Longevity, By Ed Diener, University of Illinois and the Gallup Organization, US; and Micaela Y. Chan, University of Texas at Dallas, USA; Applied Psychology: Health and Well-Being, 2011, Vol. 3, p1-43.

Abstract: Seven types of evidence are reviewed that indicate that high subjective well-being (such as life satisfaction, absence of negative emotions, optimism, and positive emotions) causes better health and longevity. For example, prospective longitudinal studies of normal populations provide evidence that various types of subjective well-being such as positive affect predict health and longevity, controlling for health and socioeconomic status at baseline. Combined with experimental human and animal research, as well as naturalistic studies of changes of subjective well-being and physiological processes over time, the results show that a compelling case can be made that subjective well-being influences health and longevity in healthy populations.



Appendix 4 – Bibliography – Studies on how women obtain information on health and well-being

Constructing “sense” from evolving health information: A qualitative investigation of information seeking and sense making across sources, By Genuis, Shelagh K. Journal of the American Society for Information Science & Technology, Volume 63, Issue 8, p1,553-1,566.

Abstract: The study shows that participants accessed and valued a wide range of information sources, moved fluidly between formal and informal sources, and that trust was strengthened through interaction and referral between sources. Participants were motivated to seek information to prepare for formal encounters with health professionals, evaluate and/or supplement information already gathered, establish that they were “normal”, understand and address the physical embodiment of their experiences, and prepare for future information needs.

Understanding middle-aged women’s health information seeking on the web: a theoretical approach, By Yoo, Eun-Young and Robbins, Louise S.

Journal of the American Society for Information Science & Technology, Volume 59, Issue 4, p577-590. http://search.ebscohost.com/login.aspx?direct=true&db=plh&AN=29382652&site=ehost-live

Abstract: The survey of middle-aged women who participated in the study revealed that confidence in using the Internet, and gratification motivation, influence rates of Internet usage for health information by middle-aged women.

The Separate Spheres of Online Health: Gender, Parenting, and Online Health Information

Searching in the Information Age, By Stern, Michael J., Cotten, Shelia R. and Drentea, Patricia; http://search.ebscohost.com/login.aspx?direct=true&db=plh&AN=82378377&site=ehost-live

Journal of Family Issues, Volume: 33, Issue 10 (October 2012), p1,324-1,350.

Abstract: Parenting and gender have separate but significant influences on the following: online searching behaviour, whether the information is used, and feelings about the information obtained. The authors found that although female parents are more likely than male parents to put the health information they have found online into use, parenting and sex have more independent than combined effects. This is particularly the case regarding whether respondents search for information for themselves or others, their feelings about the information found, and the process of finding online health information.

Toward Wellness: Women Seeking Health Information, By Warner, Dorothy and Procaccino, J. Drew, Journal of the American Society for Information Science & Technology, Volume 55, Issue 8, p709-730.

http://search.ebscohost.com/login.aspx?direct=true&db=plh&AN=13484595&site=ehost-live

Abstract: Two-thirds of respondents reported seeking information on their own either before, instead of, or unrelated to a visit to a doctor. Response to 16 reasons for seeking health information appeared to indicate an interest in being a more active participant in the information-seeking process, demonstrated by a desire to seek information beyond the medical professional. Preliminary statistical evidence revealed a relation between age and the number of times the Internet had been used to look for health information, the highest frequency of usage falling generally in the 35-64 age range.









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