Women's Health and Well-Being Definitions Evolve

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
Appendices23
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.

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 TIME
Requires preserving different type of capital:
Material Conditions
Natural capital Human capital
Economic capital Social capital
Health status
Work-life balance
Education and skills
Income and wealth
Jobs and earnings
Housing
GDP Regrettables
Social connections
Civic engagement
and governance
Environmental 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 your
daily life
(% respondents)
Feeling fine, thank you
Source: The Economist Intelligence Unit.
Good
Average
Poor
53%
Excellent
9%
30%
7%
Terrible
1%
France
Brazil
Mexico
India
Germany
please tell us how you feel in your daily
life; % 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
please tell us how you feel in your daily
life; % 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 the
future of myself and my family
Feeling emotionally secure
and balanced
Feeling a sense of
accomplishment or satisfaction
Feeling healthy and
physically fit
Feeling financially secure
Which of the following best describes your understanding of the
phrase “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 your
government (either national, regional
or local) in supporting your health and
well-being?
(% respondents)
Unimpressed
Moderately
successful
Moderately
unsuccessful
Very
unsuccessful
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 and
physically fit
Emotional security
and stability
Feeling physically
secure
Feeling a sense of
accomplishment
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 understanding
of the phrase “feeling well”, how
active are you in trying to ensure a
sense of well-being in your daily life?
(% respondents)
Actively involved
Somewhat active
Somewhat
inactive
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
Percent saying “very active” or
somewhat active
Actively involved, by country
(% respondents)
95%
86%
86%
84%
75%
Percent saying “very active” or
“somewhat active”
Actively involved, by personal wealth
(% respondents)
Always
insecure
Often
insecure
Mostly
secure
Very
secure 98%
85%
86%
65%

I am physically active
and try to keep fit
I take preventive
health measures
I avoid unhealthful
activities
What, if anything, are the main things you do to promote your
own 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 agency
currently offers, or plans to offer, to women to promote their
health 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 including
social media
Where do you get information related to your health and
well-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 three
years, to what extent do you expect to
rely on the following sources for
information, products and services to
increase your general sense of
well-being? Percent saying “will rely
heavily” or “will rely slightly”
Future sources
(% respondents)
Pharmacists
Medical doctors,
hospitals, clinics
Online
sources
Family and
friends 82%
78%
78%
65%
Do you find health and well-being
information 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-being
in 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 of
well-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 and
well-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 promote
their 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 at
women’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-oriented
programmes:

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

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=truedb=plhAN=29382652site=eho
st-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.as
px?direct=truedb=plhAN=82378377site=eh
ost-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=
truedb=plhAN=13484595site=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.

Cover image - © Petar Paunchev/Shutterstock
While every effort has been taken to verify the accuracy
of this information, The Economist Intelligence
Unit Ltd cannot accept any responsibility or liability
for reliance by any person on this report or any of
the information, opinions or conclusions set out
in this report.

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