1

Global Health SurveyEXPERIENCE & PERCEPTION IN 28 COUNTRIESInternational Research Institutes www.irisnetwork.org

2

3

International Research InstituteS

INRA(1950’s)

IRIS(1986)

Split in the 1980s

5-6 members (Demoscopie (Fra), RSL (UK), NSS (NL), Demoscope (SUI), Data (Esp)

B&A joined 1997

FDS (now SPA Future Thinking) 2005

33 members in 2012

4

International Research Institutes

• A voluntary trade association (non-ownership)

• Representing and consisting of quality, multi-disciplinary Independent Agencies.

• Thought leadership, sharing experiences, working groups.

• A network with trusted, local expertise overseas.

• Meet personally every six months and virtually much more often.

5Our Study

6

IRIS International Health Survey

• First fielded in 2004….21 countries, slightly smaller-scale.

• Fielded again Autumn 2011:

– 28 countries

– 22,000 interviews

– Mix of methodologies

– Romania/Canada/Ireland-lead but planned by a group of fifteen.

BASE Method Total

TOTAL 21988Finland Online 500France CATI 959

Germany Online 1087Greece CATI & Online 1002

Hungary CATI 500Ireland Face-to-Face 1000

Italy Telepanel 2030Lithuania Face-to-Face 1005

Netherlands Online 1062Poland Online 812

Romania Face-to-Face 1100Russia CATI 520

Slovenia Online 501Turkey CATI 417

UK Online 1000Ukraine Face-to-Face 600

Sample Sizes X Country

BASE Method Total

TOTAL 21988

USA Online 1014Canada Online 1006

Chile Online 640Colombia Online 506

China Online & Face-to-Face 1000

India Face-to-Face 1056Indonesia Face-to-Face 500

Malaysia Online & Face-to-Face 427

Thailand Online 540Pakistan Face-to-Face 300

Egypt CATI 500

Australia Online 910

BASE Method All respondents

TOTAL 22364

India Face-to-Face 1056

China Online & Face-to-Face 1000

Asia + Africa CATI, Online & Face-to-Face 2270

Australia Online 910

East / Central Europe CATI, Online & Face-to-Face 4956

Western Europe CATI, Online & Face-to-Face 9007

Americas Online 3166

Sample Sizes X Region

9

Scope

• Perceived Health

• Contributors to Health

• Assessment of Local Systems

• Funding Preference

• Interaction with HCPs

• Opinion of Family Physician

• How we gather information or health

• Personal input desired on health treatment

• Pervasiveness of suicide and related mental conditions

10

System Failings

11

System Attitudes

• Broad view persists of crisis in healthcare systems.

• The general view is that management failings are the primary detractor moreso than underfunding.

• The European perspective is predominantly negative, even in ‘good’ systems: government or national handing invariably criticised.

• Healthcare as a sector clearly needs “better press”.

National Health System: Good Shape or Crisis

All Countries

Turkey

Finland

UK

Netherlands

Lithuania

France

Italy

Slovenia

Germany

Ireland

Hungary

Russia

Greece

Poland

Ukraine

Romania

33

68.585131894484

55.8

41.5699743799313

41.5349160376251

38.8059701492537

33.5415088271213

26.3873084647056

24.4013976286867

24.1108114272084

23.208883478029

18.9486812931646

16.5036604346406

12.4750499001996

11.8226600985222

8.77942478372566

6.36363636363636

3

12.2302158273381

2.8

1.36187123054457

5.60823740585097

0.199004975124379

3.79049131748338

2.22839180948735

0.604701373065815

1.76711932352374

2.33914228204746

0.135329054943597

0.50919432008147

0.998003992015968

0.0909090909090913

Very good shapeExcellent

Canada

Chile

USA

Colombia

Indonesia

Malaysia

India

Thailand

China

Pakistan

Egypt

Australia

51

24

18

8

81

66

66

62

51

23

7

48

3

0

1

0

20

8

14

6

4

3

5

Regional Healthcare System Evaluation

66

51

50

48

22

30

28

14

4

8

5

1

2

1

India

China

Asia + Africa

Australia

East / Central Europe

Western Europe

Americas

Very good shapeExcellent

All Countries

Turkey

Finland

Netherlands

UK

Hungary

Russia

France

Ireland

Slovenia

Lithuania

Italy

Greece

Germany

Poland

Ukraine

Romania

34

77.4580335731415

41.2

40.5581262935897

37.0474385105806

34.7185442957291

32.4174240531866

32.0164019560845

32.004733477558

24.374381062899

23.2835820895522

20.3882796331727

19.4610778443113

16.6172818816535

16.0098522167488

10.8233181443109

5.18181818181818

6

46.7625899280576

1.8

4.11457204654563

3.28747943233855

3.54824164058612

3.60471148857675

4.9780708708587

4.58556624419881

1.39197140151811

0.796019900497513

1.19843437715211

4.69061876247505

1.85529781496152

1.84729064039409

1.47174551962327

0.636363636363638

Somewhat approveStrongly approve

Approval of National Healthcare System Management

Canada

Chile

USA

Colombia

Indonesia

India

Malaysia

China

Thailand

Pakistan

Egypt

Australia

42

30

29

19

83

78

72

54

53

25

17

39

2

2

4

1

31

27

20

3

6

0

4

6

All Countries

Slovenia

Germany

Greece

Poland

Russia

Ireland

Lithuania

France

Netherlands

Romania

UK

Turkey

Ukraine

Italy

Finland

Hungary

63

86.9080893449865

84.2956590650471

79.1417165668663

74.2610837438426

67.1214188267392

64.4276040993688

60.7960199004975

59.0260921656071

57.9088583816875

57.6363636363636

57.1357309860779

50.3597122302159

49.5275656603674

46.645050906532

37

37.4241297941968

30

10

9.92985020601246

18.9620758483033

23.6453201970443

26.9123609323059

27.798700673251

37.8109452736318

33.8749950603492

42.0911416183123

42.3636363636362

37.2294540012978

24.4604316546762

41.4806492197418

35.1401429449845

47.4

51.8714070597911

Source of Problems in the Healthcare System

Colombia

Chile

USA

Canada

China

Indonesia

Thailand

India

Pakistan

Malaysia

Egypt

Australia

95

72

72

62

79

68

66

64

62

43

69

42

5

27

10

30

16

32

34

27

35

42

29

46

Inefficient management Not enough funding

All Countries

Turkey

Netherlands

Lithuania

Romania

UK

Greece

Finland

Hungary

Poland

Slovenia

Italy

Russia

Ireland

France

Ukraine

Germany

67

83.6930455635492

83.0893187855694

82.8855721393032

81.8181818181815

81.7675186298565

81.0379241516966

78

74.9397280255296

73.7684729064036

72.7042050816687

68.7221486085391

67.6075552908175

64.7820169182124

53.4775642603303

52.8982685386435

46.4106469439165

25

11.9904076738609

16.9106812144306

14.4278606965174

18

9.16853373240478

15.5688622754491

11.6

13.9400110596445

20.8128078817734

20.8865085474448

9.49911280099047

26.4800261322367

18.4649544683726

38.255844037757

40.6510103753466

43.8113745471978

Governments, through taxation Private individuals

Funding Preference: Health Expenses of Individuals

Canada

Columbia

Chile

USA

Malaysia

Indonesia

Pakistan

Thailand

India

China

Egypt

Australia

77

76

75

35

72

67

60

52

51

42

68

65

13

16

19

46

21

33

35

48

46

58

29

23

17

Health Contributors

18

Global Behavioural & Attitudinal Differences

• Interesting differences across continents in relation to tobacco, alcohol, diet and other perceived contributors.

• European and American obsessiveness or fastidiousness.

• Asian ignorance in relation to some key contributors.

• Key implications for public health initiatives.

92

89

88

88

88

87

86

84

84

78

77

52

56

49

51

44

54

47

43

43

54

44

Level of physical exercise

Contaminants that affect one’s water and food supply

Insufficient or poor quality sleep

The diet one chooses on a regular basis

Family’s health history or genetics

Stress and anxiety

Air pollution

Use of prescribed medications

Outlook on life

Use of tobacco

The amount of alcohol consumed on a regular basis

Somewhat importantVery important

Factors Contributing to Health

Global India China Asia + Africa Australia

East /Central Europe

Western Europe Americas

TOTAL 22490 1056 1000 2266 910 4956 9137 3165

Contaminants that affect one’s water and food supply 56% 40% 54% 63% 41% 61% 55% 58%

Stress and anxiety 54% 16% 46% 37% 52% 59% 56% 69%

Use of tobacco 54% 9% 40% 31% 60% 54% 60% 71%

Level of physical exercise 52% 54% 39% 62% 46% 52% 47% 61%

The diet one chooses on a regular basis 51% 67% 53% 56% 56% 47% 47% 60%

Insufficient or poor quality sleep 49% 36% 52% 51% 47% 52% 46% 56%

Air pollution 47% 40% 40% 58% 27% 53% 44% 48%

Family’s health history or genetics 44% 38% 44% 42% 38% 46% 42% 51%

The amount of alcohol consumed on a regular basis 44% 9% 28% 26% 47% 47% 49% 53%

Use of prescribed medications 43% 60% 22% 54% 34% 42% 40% 48%

Outlook on life 43% 43% 30% 44% 42% 42% 39% 57%

Very Important Contributors to Health by Region

Tobacco as a Health Contributor x Region

94

86

86

80

76

47

17

71

60

40

54

60

31

9

Americas

Western Europe

China

East / Central Europe

Australia

Asia + Africa

India

Somewhat importantVery important

Alcohol Consumption as a Health Contributor

93

85

81

80

79

44

16

53

49

28

47

47

26

9

Americas

Western Europe

China

Australia

East / Central Europe

Asia + Africa

India

Somewhat importantVery important

23

Good Doctor/Bad System?

24

A Health Paradox

• A relatively poor perspective of the health system is accepted.

• In contrast, the family physician is very positively perceived.

• Suggests a common hardware/software conundrum, or perhaps an explicable manager/carer issue.

• Is the public simplistic in its analysis? Should the system be more obviously managed by HCPs rather than bureaucrats.

Family GP in public system

Pharmacists

Specialists in the public system

Physicians in the private health system

Nurse

Physiotherapists

Dietician/Nutritionist

Psychologist

Social worker

59

45

43

24

19

13

7

7

4

65

36

18

13

15

10

3

2

2

68

38

33

9

39

16

6

5

5

UKIrelandGlobal

Usage of Key HCPs for Health Related Services in Past Year

All Countries

Netherlands

France

Ireland

Hungary

UK

Turkey

Lithuania

Romania

Germany

Slovenia

Greece

Italy

Poland

Finland

Ukraine

Russia

84

95.336270757785994.555087141643293.672127358706291.858562740554489.35977855011

2188.435374149659687.79527559055187.18905472636

8283.457965533242281.44156447600

4577.840909090909177.360031214626676.065573770491574.829931972788765.05176814277

0457.3100456113028

34

56.076550750582645.37027483418

4165.164537842295347.45020679393

6846.235734809259856.46258503401

369.4488188976377940.67164179104

4726.451623293181621.96372291198

5831.818181818181820.40655526828

0110.163934426229520.40816326530

619.0127201211510512.98920903326

29China was not included in this question

Satisfied at allVery satisfied

Satisfaction with the Family Physician

Canada

USA

Chile

Colombia

India

Indonesia

Malaysia

Pakistan

Thailand

Egypt

Australia

93

91

48

42

93

89

82

81

80

58

92

46

54

7

2

53

38

19

43

15

10

48

27

Search & Information Behaviour

28

Finding out about Health

• Primary information sources are predictable HCPs, but extent of consultation with less generalist physicians varies very widely.

• Variation in online usage is enormous: British internet use highly developed while Irish levels are much lower.

• Sites such as Wikipedia have enormous cachet.

Consulted In Past Year On Health Issues That Concern You MostUsed To Get Information On Health Issues That Concern You Most

Own family GP in public system

Specialists

Family & friends

Pharmacists

Other GPs/physicians

Others with the condition

Non-doctor healthcare professionals

Social networking contacts

Spiritual/religious

Patient advocacy groups

57

38

35

30

19

12

9

6

3

3

61

12

23

29

7

4

3

3

1

2

67

28

28

23

5

12

8

4

1

0

Websites

TV/radio programme

Magazines or newspaper

Pamphlets in GP clinics

Books

Blogs/chatrooms

(Any) social media

Pamphlets mailed to you

Telephone information lines

Smartphone apps

DVD/CDs

51

26

24

21

19

8

7

6

3

2

2

37

11

12

12

13

1

4

4

2

1

*

71

13

14

25

14

3

4

5

5

*

1

UKIrelandGlobal

Consulted in past year Used as way to get information

The internet is a significant secondary source but much higher in some countries (Germany & UK 71%, USA 79%, China 69%)

China (12%)

Web-sites

TV or radio

Magazines or newspapers

Brochures from

physicians’ offices or

clinics Books

Blogs and/or chat rooms on

the internet

Social media

(Facebook, Twitter etc)

Global 51 26 24 21 19 8 7

India 7 51 33 7 21 1 2

China 69 61 47 23 53 23 25

Asia + Africa 40 46 38 23 23 9 18

Australia 70 14 14 28 18 8 5

East / Central Europe 47 28 26 21 18 10 5

Western Europe 48 18 18 19 14 6 4

Americas 77 18 20 27 21 8 5

Secondary Sources by Region

31

The Assertive Patient

32

Input to Treatment

• Indicated as one of the significant coming trends.

• Desired control of own treatment more in evidence where there are better treatment choices or options (Netherlands).

• Evidently a middle aged, mid/upper class, affluent, better educated phenomenon.

All Countries

Hungary

Slovenia

Germany

France

Poland

Greece

Finland

UK

Ireland

Ukraine

Netherlands

Italy

Russia

Turkey

Lithuania

Romania

11

8.58774288662363

7.15057875646391

7.2232584674573

6.25082633602106

8.00492610837437

4.59081836327345

1.8

8.99057554148066

10.0272086791417

6.14949108199321

23.1396643671221

7.68860256538758

16.4325653786291

5.515587529976

14.228855721393

8.0909090909091

51

79.0989535141751

75.0256337315117

74.6122922596271

68.7792196230923

63.5467980295567

62.7744510978043

62.2

61.1302056823595

53.7432229365714

52.8909240385456

50.8027460003629

49.3869112351513

47.5760428876122

39.568345323741

30.2487562189054

27.6363636363636

35

11.0665014929996

17.1825232661667

17.2717964629633

24.3357951299785

26.4778325123152

31.1377245508982

33.4

28.1811134627632

34.8749817746491

36.904779825397

26.0575896325148

27.937431805296

32.1272793651403

53.4772182254197

52.6368159203981

64.272727272727

Patient Input into Treatment Decisions

You decide Work with physician Physician makes decision

USA

Canada

Chile

Colombia

Thailand

Malaysia

China

Pakistan

Indonesia

India

Egypt

Australia

5

7

10

11

11

25

24

24

22

30

7

10

82

75

37

36

50

45

31

24

20

9

30

56

12

16

54

50

39

27

45

48

58

61

61

25

34

Actual & Perceived Health

35

Actual/Perceived Health Patterns

• Many feel that they are in good general health: perceived health measures are strong.

• Claimed incidences of long term serious conditions vary very substantially.

• Inter-relationship of perceived and actual health data illustrates some broad relationships but equally some more perplexing conundrums.

• We can categorise a First World Paradox of high incidence/high health but equally the probability of poorer detection (Ireland).

All Countries

Ireland

Germany

Netherlands

Slovenia

Romania

France

Greece

UK

Lithuania

Italy

Finland

Hungary

Poland

Turkey

Ukraine

Russia

70

84.286933766644682.37996307728

7473.352595542092172.40144062269772.18181818181

8272.179792695246472.155688622754169.26844206730

9468.756218905472662.95904780516

8262.8

57.043871759811956.403940886699556.3549160671461

53.6747473823352.57575466441

23

14

33.04125601771898.817257239330

0511.889832095782312.293024459360317.45454545454

5514.938807503053514.570858283433111.62370800719

0920.09950248756216.392829371076

87810.93855044105

155.9113300492610815.10791366906

4711.92285615897145.270641584843

31

GoodExcellent

Perceived Personal Health Assessment

USA

Colombia

Canada

Chile

Pakistan

Indonesia

India

Malaysia

Thailand

China

Egypt

Australia

85

84

76

57

87

85

73

70

63

60

66

65

19

17

15

3

38

23

15

9

13

9

12

13

Top 5 Chronic Conditions by Region

16

14

11

11

10

8

5

8

10

9

5

4

5

6

4

4

5

2

2

1

5

5

6

3

4

4

3

4

5

7

2

3

2

1

Western Europe

Americas

Australia

East /Central Europe

China

Asia + Africa

India

High blood pressure High cholesterol Heart condition Diabetes Asthma

All Countries

Hungary

Germany

Finland

France

Turkey

Netherlands

Italy

Poland

UK

Russia

Slovenia

Romania

Greece

Lithuania

Ireland

Ukraine

13

27.2401504595011

25.5942719053246

19.8

19.3142362510952

17.7458033573141

17.7392004711123

14.723833656805

14.6551724137931

11.5743623097075

11.3483081298157

11.1917987548184

10.4545454545455

7.58483033932134

7.56218905472637

5.03673301864309

4.31472255752963

7

6.45276861982408

9.9004908622008

13.2

9.23513090235043

10.0719424460432

11.8128608991692

7.66758547191573

8.00492610837437

7.6153743116159

2.67278980842764

5.90319637112988

2.52280524813582

0.153975668719675

5

10.9471220445315

6.70483535916024

5.8

9.48684539477796

6.95443645083933

8.2321138804775

4.77320770577417

6.65024630541872

5.5315412178914

8.87727456142035

3.20597691792508

4.72727272727273

3.39321357285429

3.681592039801

3.61963719873256

4.70781922943757

5

7.04066485850994

7.86425556661857

7.2

6.11230777603111

7.67386091127098

8.77944818219711

4.62484411059205

4.43349753694581

4.80337995502764

3.00328574448053

2.82998811057932

3.90909090909091

2.69461077844312

1.39303482587065

2.14446900546143

1.32904251772057

4

2.80348313821416

6.04542519264239

8.2

7.17109129280745

4.07673860911271

7.54255867225525

2.41691382807736

3.32512315270936

4.25342678307524

3.41308629089476

1

1.89620758483034

0.796019900497513

1.808312943685

1.25063985000853

Chronic Conditions by Country (Top 5)

Canada

USA

Chile

Colombia

Thailand

China

Pakistan

India

Malaysia

Indonesia

Egypt

Australia

20

16

10

5

19

10

9

5

4

3

6

11

15

13

4

3

13

4

1

0

3

2

1

9

6

4

3

0

5

2

1

1

1

1

1

4

8

6

4

1

9

4

2

3

3

1

4

6

10

3

3

1

4

3

1

4

1

1

7

High blood pressure High cholesterol Heart condition Diabetes Asthma

HIGHER INCIDENCE /POORER SELF PERCEPTION

HIGHER INCIDENCE /BETTER SELF PERCEPTION

LOWER INCIDENCE /POORER SELF PERCEPTION

LOWER INCIDENCE /BETTER SELF PERCEPTION

GLOBAL AVERAGE

33%

70%

HungaryFinland

China

TurkeyPolandRussia

Chile

ThailandAustralia

ItalyUK

GreeceUkraine

Egypt

CanadaFrance

Nederlands

USA

Germany

Slovenia

Romania

MalaysiaIndia

ColombiaIreland

PakistanIndonesia

Lithuania

PERSONAL HEALTH PERCEPTION

Actual & Perceived Health Contrast

ANY SERIOUS ILLNESS

INCIDENCE

40

Key Thoughts

41

Key Thoughts

• Global variation in need but with much basic commonality.

• Study helps to better illustrate global threats posed by local ignorance and the need for better regulation.

• Transformative effect of online.

• The rise of the assertive patient.

• Differences in detection rates and in HCP use.

• Need for better PR for health systems.

Larry RyanCouncil Member, IRISDirector, B&Awww.banda.ie