Is the Health and Wellness Industry 'Recession Proof'? A Zpryme Market Research and Insights Perspective 2008

Is the Health & Wellness Industry ‗Recession Proof‘?

An examination of leading economic indicators that provide a
preeminent reflection of the health and wellness industries historical
significance in the U.S. economy and the health and wellness
industries stability in times of recession.

Copyright © 2008 Zpryme Research & Consulting, LLC All rights reserved.

Abstract:
An examination of leading economic indicators that provide a
preeminent reflection of the health and wellness industries historical
significance in the U.S. economy and the health and wellness industries
stability in times of recession for 2008.

FOR MORE INFORMATION March 2008
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Published March 2008

Table of Contents
The link between the Retail Industry, Health Care Industry and the Health and Wellness Industry ............... 3

Health Care‘s Consistent Contribution to GDP ............................................................................................... 4

Health Care Employment Exceeds Retail Employment in December 2007 .................................................... 5

Health Care Spending and Spending on Prescription and non-Prescription Drugs ........................................ 5

Health & Wellness Employment Growth ........................................................................................................ 6

Health Care‘s Impact on the Retail Industry – Statistical Model .................................................................... 7

Health Care Drivers: State Level Analysis...................................................................................................... 8

Retail Drivers: Metropolitan Statistical Area (M.S.A.) Analysis ...................................................................... 8

Health Care‘s Impact on Change Retail Economic Activity: State Level Analysis ............................................ 9

Health Care‘s Impact on Change Retail Economic Activity: M.S.A. Analysis ................................................. 10

Modeling Considerations ............................................................................................................................. 11

Conclusions ................................................................................................................................................... 12

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Is the Health and Wellness Industry ‘Recession Proof’?
Finding stability in unstable times, the state of the current U.S. economy is unpredictable to say the least.
However, while most U.S. industries have burrowed their own holes in an effort to sit out prior and
subsequent economic storms, the health and wellness industry has instead taken these dejected points in
time as a mechanism for opportunity. The principle of this analysis is to consider and analyze the
proposed question ―Is the Health and Wellness Industry Recession Proof?‖

The above question is examined using the comprehensive analysis described below.

1) Examine the History of the health care industry
2) Examine the relationship between the health care and health and wellness industry
3) Examine the relationship between the retail industry and the health and wellness industry
4) Examine the projected employment of health and wellness positions
5) Econometric analysis of the drivers of the health care and retail across states and major cities
6) Econometric analysis of the impact of the health care industry on the retail industry

Generally, the health and wellness industry is comprised of providers of preventive, remedial, and
therapeutic products and services focused on the healthy balance of mind, body and/or spirit that results
in an overall feeling of well-being.

For this analysis, the health and wellness industry would not be recession proof if the health and wellness
industry experienced zero or negative growth when the overall U.S. economy experiences a recession as
defined by the Federal Reserve. Generally, a U.S. recession is a period of general economic decline;
specifically, a decline in GDP for two or more consecutive quarters. Thus, if the health and wellness industry
experienced two consecutive quarters of decline because the broader general economy was also
declining, then it would not be considered recession proof.

Generally, the health and wellness industry comprises of providers of preventive, remedial, and
therapeutic products and services for an individual‘s healthy balance of the mind, body and/or spirit that
results in an overall feeling of well-being.

For this analysis, the health and wellness industry would not be recession proof if the health and wellness
industry experienced zero or negative growth when the overall U.S. economy experiences a recession as
defined by the Federal Reserve. Generally, a U.S. recession is a period of general economic decline;
specifically, a decline in GDP for two or more consecutive quarters. Thus, if the health and wellness industry
experienced two consecutive quarters of decline because the broader general economy was also
declining, then it would not be considered recession proof.




The link between the Retail Industry, Health Care Industry and the Health and Wellness Industry

Critical to this analysis is the assertion that the health and wellness industry is strongly related to the
performance and growth of the health care industry. However, this assertion is based on basic economic
principles that can be commonly observed in the daily market place. In making this connection, we can
further gain insight into the behavior of the health and wellness industry by observing the historical
performance of the health care industry in periods overall U.S. economic hardship.

We could probably go on for 100 pages about why there is a high correlation between these industries,
but for the purposes of this analysis, we will only touch on this topic briefly before going into further
analysis.

Since 2001, the health and wellness Industry has increased its share of its total contribution to the U.S.
Retail Industry, growing from 8.0% of the retail industry in 2001 to 10.7% of retail industry by 2006.
Additionally, the health and wellness industry has grown at a much faster rate than the retail industry
showing impressive year-over-year growth in 2005 and 2006.

Table 1. Health and Wellness Industry, Retail, and Health Care Market in the U.S. 2001 - 2006

Industry 2001 2002 2003 2004 2005 2006
Health & Wellness $55.0 $59.0 $63.2 $68.0 $79.0 $91.0
Retail $691.6 $719.6 $751.5 $776.9 $812.7 $848.0
Health Care $654.2 $706.3 $757.2 $808.0 $847.6 $901.4
Health & Wellness as a % of the Retail Industry 8.0% 8.2% 8.4% 8.8% 9.7% 10.7%
Annual Growth
Health & Wellness 7.3% 7.1% 7.6% 16.2% 15.2%
Retail 4.0% 4.4% 3.4% 4.6% 4.3%
Health Care 8.0% 7.2% 6.7% 4.9% 6.3%
Source: Natural Marketing Institute and the U.S. Bureau of Economic Analysis

In fact, Table 1 shows that the health and wellness industries annual growth from 2001 to 2004 seemed to
be more closely related to the growth of the U.S. health care industry. This should come as no surprise
since the fundamental drivers of both the health care industry and health and wellness industry are closely
related. Both industries are largely driven by the aging U.S. population which is riddled with many well
document health problems such as obesity, diabetes, heart disease and asthma, etc.

The data in Table 1 clearly support the statements above, and help further explain the aggressive growth
in the health and wellness industry. The consumer logic is very similar to dental hygiene, where consumers
who purchase toothpaste are more likely to purchase mouthwash. Thus, these two goods are
complimentary because an increase in the demand for toothpaste will lead to an increase in mouthwash
sales.




TOP DRIVERS: Healthcare’s Impact on the Retail Industry DRIVER EXPLANATION

Health-care designs and competitors are gaining
ground, with low-cost walk-in health-care centers
for common ailments — at one end of the
Government Policy, Legislation and Regulation continuum, and highly personalized ―concierge
care‖ at the other. Another example without the
FDA approval, a prescription drug would never
enter a pharmacy.
Consumers acquire prescription drugs with their
Complimentary Goods physician‘s authorization. The same consumer
may also obtain vitamins and herbal supplements
as a preventive measure for their wellbeing.
The healthcare industry has created and filled
more high-skilled careers than any other industry.
Healthcare Creates High-Skilled Jobs This in effect has created a large pool of
consumers that have access to an ever increasing
pocket of discretionary income – the majority in
which is spent on retail products and services.

A strong health care sector directly impacts the retail sector by creating high skilled jobs, and by driving
complementary good sales at the retail level (as described above). As the health care sector expands, this
will create more of the high paying jobs, and thus create more consumers who have higher discretionary
incomes. In the end, all activities of economic stimulus in the economy as it relate to the health and wellness
industry is driven by government policy, legislation and regulation.

Health Care’s Consistent Contribution to GDP

The U.S. Gross Domestic Product (GDP) has a large impact on each person within the U.S. economy; in
consequence the gross domestic product is the most commonly economic indicator used to measure the
economic growth of the U.S.

An investigation of the contributions to percent change in real gross domestic product by the health care
and retail industry revealed that even during U.S. economic hardship the health care industry continued to
sustain growth, while the retail sector experienced mild forms of decline. The U.S. retail industry is
correlated with the health and wellness industry as the health and wellness industry has a substantial stake
in retail products and services.




Health Care Employment Exceeds Retail Employment in December 2007

18,000
Another variable fostering
Chart 1. Retail and Health Care Employment, 1970 - 2007
Source: Bureau of Labor Statistics this growth in the health care
16,000 sector, and as of this past
14,000 December 2007, the health
12,000 care industry has even
eclipsed the dominant retail
10,000
industry in total number of
8,000 employees with more than 15
6,000 Retail million active health related
careers.
4,000 Health
Care
2,000
0
1970
1972
1973
1975
1976
1978
1979
1981
1982
1984
1985
1987
1989
1990
1992
1993
1995
1996
1998
1999
2001
2002
2004
2005
2006
2007
1971

1974

1977

1980

1983

1986
1988

1991

1994

1997

2000

2003
Health Care Spending and Spending on Prescription and non-Prescription Drugs

$3,000 In the U.S. the average
Chart 2. Average U.S. Consumer Expenditures on Health Care and
expenditures on health care
Prescription and Non-Prescription
Source: Bureau of Labor Statistics Consumer Expenditures Survey and on prescription and non-
$2,500
Health Care Expenditures prescription drugs has
experienced aggressive
$2,000 Presecription and Non-Prescription Drug growth from 1984 to 2006.
Expeditures

$1,500 Average annual health care
expenditures increased by
$1,000
163.7% from 2000 to 2006,
reaching $2,766 in 2006.

$500
Prescription and non-
prescription drugs
$0 expenditures increased by
207.8% from 2000 to 2006,
1985
1986
1987
1988

1990
1991

1993
1994
1995
1996

1998
1999

2001
2002
2003
2004

2006
1984

1989

1992

1997

2000

2005

reaching $514 in 2006.

Health care is becoming more expensive for people. Broken down by age groups: 25-34, 35-44, 45-54
are under the cumulative growth rate for income per unit while, the other age groups: under 25, 55-64,
65-74, and 75 and over, experienced cumulative growth rates higher than income per unit. Health care
spending for those over 75 increased the greatest, while those under 25 experienced growths in their
health care spending that exceeded the income per unit growth rate. Income per unit increases and




decreases over time do not seem to have an effect on spending. Those under 25 seem to experience the
highest fluctuations in spending increases/ decreases, which can likely be attributed to smaller rates of
people seeking health care, less preventative medicine, as well as enjoying lower health maintenance costs
compared to the older groups. The 65-74 year old age group has the highest current level of health care
expenditure. This can be attributed to higher health care costs, increased medical procedures and
medications, etc. at this age.

For the past 23 years, prescription and non prescription drug expenditures have risen from $167 of the
total $1,049 spent on health care per person in 1984, to $514 of the $2,766 spent on health care per
person in 2007. The average drug expenditure rate in relation to total expenditures on health care is
17.82%, ranging from a low of 15.9% in 1984 to a high of 20.7% in 2002. These rates vary greater
than those of the amount of income per unit spent on health care. This means that the costs of drugs are
growing at a higher rate than both the income per unit as well as the total health care expenditure. The
cumulative growth rate for drug expenditures across all age groups in relation to overall health care is
117.8% for the 23 years. Age groups under 25, 25-34. , 35-44 are clearly below this rate, while those
in the age group of 45-54 are close to the same rate. The cumulative growth rate for those in age groups
55-64, 65-74, and 75 and above is higher than the overall rate. The correlation between decreases in
total health care spending and drug expenditures is clear. As the spending on health care decreases, so
will the spending on drugs. This is a logical result as medications are a portion of health care, and are
dependent on its spending. In recent years, there has been a decrease in proportions of health care
spending on prescription and non prescription drugs which could be explained by the use of alternative
methods of treatment, holistic approaches gaining popularity as well as an increase of individuals across
all age groups living a healthier life style.

Health & Wellness Employment Growth

An analysis of data pertaining to employment growth per industry has exposed insightful suggestions of
the financial viability contiguous to the health care industry. Extending from 1996 thru 2006, the health
care had realized an average occupational growth rate of 2.5% per year- which is nothing less than
impressive, ranking it 3nd overall when compared to all other industries. Furthermore, an economic
investigation of the forecasted data based on a methodology derived from the U.S. Bureau of Labor
Statistics, reveals that an equivalent trend will persist into 2016. Further analysis demonstrated that the
prediction models offered support for future growth of the health care industry occupations from 2008 -
2016 - preserving their position in close proximity to the top when growth rates are compared to all other
high growth industries. Historical data has also revealed that even in slow economic times, more
specifically, existing Federal Reserve confirmed recessions in our nation‘s past; the health care industry still
continued to provide stable employment and new innovations in occupational efficiency. This evidence was
cross referenced and obtained in a breakdown of all occupational segments of the health care industry.

Another central finding was considered; upon studying the historical data of the occupational growth of the
top 6 segments of the health care industry leads one to believe this industry is as close to recession proof
as any one industry could be. The health care occupations that are the least susceptible to recession are:
Home Health Aides, Medical Assistants, Mental Health and Substance Abuse Social Workers, Physical
Therapists, Health Care Support, and Health Educators. All 6 of these ―sub-industries‖ have experienced




substantial rates of occupational growth in the past decade, and are predicted to sustain these high levels
of growth from 2008 - 2016. For example, home health aides are expected to grow by 48.73% in the
next ten years, while medical assistant positions are expected to grow by 35.42%; followed by Mental
Health and Substance Abuse Social Workers, Physical Therapists, Health Care Support Occupations, and
Health Educators- growing at 29.91%, 27.06%, 26.78%, and 26.19% respectively.

A clear distinction in positive growth was drawn when the health care industry was compared to that of all
other industries - the dissimilarity in industry growth further corroborates that the health care industry is
inelastic to times of recession. From 2008 thru 2016 the Health Care Industry is forecasted to have an
average occupational growth rate of 2.45% per year. When compared to the occupational growth rates
of all other industries, the health care industry ranks in 1st place. This is remarkable considering the health
care industry occupational growth rate ranked 3rd when compared to all others from 1996-2006.
Moreover, this mark in increase has occurred during the presence of a recession, while all but a few
industries have substantial drops in employment and intensified levels of layoffs. For example, the retail
industry average occupational growth rate is expected to fall from 0.8 % per year during 1996-2006 to
0.4% from 2008 - 2016. The average growth rate (per year) of occupations for every industry during the
period 1996-2006 was 1.16% and plunged to 1.05% with the health care industry removed from the
calculation – another optimistic indication of the economic strength of the health care industry.

Each individual segment of the health care industry is showing inherited signs of exceptionally strong future
occupational growth rates. Ranked 2nd and 3rd among the 30 industries with the largest growing
occupational opportunities are; Personal Home Care and Health Aid Markets- which have forecasted
improvements in absolute employment growth of 50.6% and 48.7%- for 2008-2016. These are behind
only the Network systems and data communications analysts market. These same segments also maintain
the same standings when ranked among the top 30 Fastest Growing Occupations/Industries from 2008 to
2016. As a result, the health care industry could quite possibly show no signs of recession symptoms and
continue to provide new opportunities for new occupations, stable employment opportunities, and a
consistent environment for investing and generating unwavering cash flows - even when recession rears its
ugly head.

Health Care’s Impact on the Retail Industry – Statistical Model

This analysis has established the following thus far:

1. In the U.S. the average expenditures on health care and on prescription and non-prescription
drugs has experienced aggressive growth from 1984 to 2006
2. From 1970 to 2006, the health care industry has always made a positive contribution to GDP.
3. For the first time in U.S. history, in December of 2007, the health care industry employed more
persons in the U.S. than the retail industry.

Our final analysis tries to tie all these findings together by examining the impact the health care industry
has on the retail sector.




Health Care Drivers: State Level Analysis

State level data was used in this analysis because the data included all 50 states and the District of
Columbia whereas the Metropolitan Statistical Area, MSA data was only available for 136 MSA‘s
meaning that just under half of the population would not be accounted for in the MSA analysis. Eight cross
sectional models were used to examine how age, education, per-capita income, and total employment
impact the level of health care economic activity (output in millions of dollars) at the state level for every
year from 1999 to 2006.

Table 2. Key Driver Statistical Analysis by Year and State, 1999 - 2006

Economic Driver 1999 2000 2001 2002 2003 2004 2005 2006
Size of Population Age 18 to 24
+ + + + + + + +
- - - - - - - -
+ + + + + + + +
Size of Population Age70+
- - - - - - - +
Total Population with a BA Degree or
Higher + + + + + + + +
Total Persons Employed
- - - - - - - -
Per Capita Income in 1999
+ + + + + + + +
Source: U.S. Census Bureau 2000 Census and the U.S. Bureau of Economic Analysis

Note: Shaded blue cells in table 2 represent that the variable was statistically significant at the .05 level of probability. A ―+‖
indicates the variable made a positive contribution to the level of health care economic activity while a ―-― means the variable
made a negative contribution to the level of health care economic activity.

Key Findings:

1. Educational level of the 18 to 24, 25 to 39, and 40 to 69 age groups significantly and positively
contributed to the amount of health care economic activity from 1999 to 2004.
2. Educational level of the 25 to 39 and 40 to 69 age groups all significantly and positively
contributed to the amount of health care economic activity from 2005 to 2006.

Interpretation: On average, states with large populations of people 18 to 24, 25 to 39, and 40 to 69 are
expected to have higher health care output. Additionally, education is important because possibly, being
educated raised the state level of employment, and thus access to general health care.

Retail Drivers: Metropolitan Statistical Area (M.S.A.) Analysis

MSA level data was used in this analysis because the data compared 252 MSA‘s, and thus allowed for
much more variation to be considered in the analysis, and account for a good majority of the U.S.
population. Five cross sectional models were used to examine how age, education, household income, and
total employment impact the level of retail economic activity (output in millions of dollars) at the MSA level
for every year from 2001 to 2005.




Table 3. Key Driver Statistical Analysis by Year and MSA/Market, 2001 - 2005

Economic Driver 2001 2002 2003 2004 2005
Size of Population Age 18 to 24 - - - - -
Size of Population Age 25 to 39 + + + + +
Size of Population Age 40 to 69 - - - - -
Size of Population Age70+ + + + + +
Total Households Making $75,000 to $124,999 + + + + +
Total Households Making $125,000+ - - - - -
Total Population with a BA Degree or Higher + + + + +
Total Persons Employed - - - - -

Note: Shaded blue cells in table 3 represent that the variable was statistically significant at the .05 level of probability. A ―+‖
indicates the variable made a positive contribution to the level of retail economic activity while a ―-― means the variable made a
negative contribution to the level of retail economic activity.

Key Findings:

1. Educational level of the 25 to 39 and 70+ age groups all significantly and positively contributed
to the amount of retail economic activity from 2001 to 2005. The age group 70+ was not
significant in 2002.
2. From 2001 to 2005, the age group 18 to 24 made a significant and negative contribution to the
level of retail economic activity.

Interpretation: On average, MSA’s/markets with large populations of people 18 to 24 relative to other age
groups, are expected to have lower overall retail sales. This is likely explained by the fact that this age group
is likely to spend less at the retail level because their overall incomes are lower compared to their peers who
are older and have more work experience. Additionally, education is important because it raised the level of
income, and thus their discretionary income.

Health Care’s Impact on Change Retail Economic Activity: State Level Analysis

State level data was used in this analysis to capture the entire U.S. population, and to identify if the
outcomes are consistent with the results of the MSA level model discussed below. Seven cross sectional
models were used to examine how health care output (% change from previous year), age, education,
income, and total employment, impacted the change in the level of retail economic activity (output in
millions of dollars) at the MSA level for every year from 1999 to 2006.

Key Findings:

1. Across states, holding all the variables mentioned above equal, an annual percentage increase in
the health care industry had a positive and significant impact on the annual percentage increase




on the retail industry in 2002, 2004, and 2005. These findings are consistent with the MSA level
analysis below.
2. The change from 1999 to 2000 showed a negative and significant impact, but this was the only
year that such an instance was observed.

Interpretation: On average, growth in the health care industry contributes to economic growth in the retail
industry. States with growing health care industries are more likely to experience growth in their respective
retail sectors.

Chart 1. State Level Analysis of Health Care Impact on Percent Change in Retail Economic Activity

Interpretation: Results reported as average percent change in retail annual growth given a 1% increase/growth in
the health care market. For example, from 01 to 02, in a given market, if health care output grew by 1%, we would
expect a 0.36% increase in the retail economic output for that respective market. That is only the contribution of the
health care industry. Other factors taken in aggregate would be used to predict the total growth, but this analysis is
focused on the contribution to retail growth attributed to the health care sector.
1.00%
0.80%
0.80% 0.66%
0.60%
0.36%
0.40%
0.22%
0.20% 0.13%
0.07%
0.00%
-0.20%
-0.40%
-0.60% -0.47%
99 to 00 Pct 00 to 01 Pct 01 to 02 Pct 02 to 03 Pct 03 to 04 Pct 04 to 05 Pct 05 to 06 Pct
Change* Change Change* Change Change* Change* Change


*Indicates that health care variable was significant in impacting the percent change in retail economic activity. Significant variables are
also shaded in red with a black outline.

Health Care’s Impact on Change Retail Economic Activity: M.S.A. Analysis

MSA level data was used in this analysis because the data comprised 136 MSA‘s that had both retail and
health care data available from 2001 to 2005. Four cross sectional models were used to examine how
health care output (% change from previous year), age, education, income, and total employment
impacted the change in the level of retail economic activity (output in millions of dollars) at the MSA level
for every year from 2001 to 2005.




Key Findings:

1. Across markets (MSA‘s), holding all the variables mentioned above equal, an annual percentage
increase in the health care industry had a positive and significant impact on the annual percentage
increase on the retail industry in 2002, 2004, and 2005.
2. The MSA level findings show that the impact of the health care industry on the retail industry is a
bit smaller when compared to the state level analysis.

Interpretation: On average, growth in the health care industry can contributes to economic growth in the
retail industry. Markets or MSA’s with expanding health care industries are more likely to experience
growth in their respective retail sectors.

Chart 2. MSA/Market Analysis of Health Care Impact on Percent Change in Retail Economic Activity

Interpretation: Results reported as average percent change in retail annual growth (percent change) given a 1%
increase/growth in the health care market. For example, from 2001to 2002, in a given market, if health care output
grew by 1%, we would expect a 0.20% increase in the retail economic output for that respective market. That is only
the contribution of the health care industry and other factors, taken in aggregate, would need to be used to predict
the total growth. This analysis is focused on the contribution to retail growth attributed to the health care sector.
0.40% 0.38%
0.35%
0.30% 0.28%
0.25% 0.20%
0.20%
0.15%
0.10%
0.05%
0.00%
-0.05%
-0.10% -0.08%
01 to 02 Pct Change 02 to 03 Pct Change 03 to 04 Pct Change 04 to 05 Pct Change


*Indicates that health care variable was significant in impacting the percent change in retail economic activity. Significant variables are
also shaded in red with a black outline.

Modeling Considerations

In a perfect world, we would have historical employment and sales data from the health and wellness
industry to investigate, but that data is not available to the public, and we suspect that private
corporations would not release the data even if they had it.

In this report, we have made the case that the health and wellness and health care industries are in fact
highly correlated, and this analysis does a good job of capturing the health and wellness industry‘s
recession resiliency.




Conclusions

There exists substantial economic and statistical evidence to support the claim that the health and wellness
industry is ‗recession proof‘. As long as the health care sector in the U.S. continues its current course, then so
will the demand for health and wellness complimentary products.

There is much more to be addressed regarding this subject, and this analysis is a starting point rather than
an ending point in regards to this dynamic topic. Today‘s markets are assiduous, and globally integrated
and thus careful attention should be warranted when implementing strategies based on the historical
performance of an industry.

We recommend a constant monitoring and evaluation system to each respective agent in the health and
wellness industry that can be used to gauge current market performance. Many times, decision and policy
makers act upon their gut feeling or years of industry experience, however, without accurate information,
such a decision can be very unsafe. Now, if this same decision is combined with timely and accurate
information on market performance, then the more likely the profit maximizing (or cost minimizing) course
of action will be taken.

It is our sincere belief that inaction is much more likely to cause a decline in any market player‘s or
industry‘s performance rather than the overall general economy. In time of general economic decline, a
solution could be simply broadening one‘s product line, diversifying one‘s customer base, or entering
global markets that have a rising middle-class with a stable upper-class as a buffer, to absorb growth until
the market in question returns to a period of economic growth.

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Is the Health and Wellness Industry 'Recession Proof'? A Zpryme Market Research and Insights Perspective 2008

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