It is no secret that the greatest wealth one can have is their health. Synovate's latest survey on attitudes towards over the counter medications suggests that many of us are more than aware of this. In fact, most people claim to have taken some action in the last 12 months to improve their health. What are they doing, and what part does over the counter medicine play in their self treatment? Synovate sought to find out.

Health - the whole package

"Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity." - World Health Organization, 1948

Synovate surveyed almost 12,000 people from across 17 countries - Australia, Belgium, Chile, France, Germany, Hong Kong, Hungary, Indonesia, Korea, Netherlands, Serbia, Singapore, Spain, Taiwan, UAE, UK, USA - to understand attitudes towards and confidence in purchasing medication over the counter, the belief in the effectiveness of stores' own labels versus branded medications, as well as the influence of doctors and pharmacists.

Overall, the majority of respondents (60%) feel in good health, with 13% going as far as to say that they are in excellent health. Respondents from the UAE led the pack, with 84% considering themselves in good (49%) or excellent (35%) health, closely followed by Indonesia (82%).

According to Per-Henrik Karlsson, Business Development Director for Synovate CEEME (Central / Eastern Europe and Middle East), being health-conscious is relatively new for many of the local and expatriate populations in the UAE.

"This means many people are less aware of what is healthy and unhealthy, so their standards may not be up to the same level as other countries. However, the UAE is considered to have excellent healthcare - the majority of locals and expats have private medical coverage and medical facilities are of the highest quality. This could contribute to people feeling they're in excellent or good health," Karlsson said.

However, not all markets shared this healthy outlook. In particular, Korea and Taiwan have a different view, with only 37% and 39% respectively claiming to be in good or excellent health.

Explains Frank Jellinek, Client Relationship Manager for Synovate Korea:

"Koreans are perfectionists when it comes to health and appearance. Whereas the older generation believes that 'health comes from within', the post-Korea War generation sees this slightly differently, and is investing heavily in beauty and health treatments. It could be said therefore, that the majority of Koreans are not happy with their state of health as they know they could be even healthier and so go 'full-out' to achieve this! This also explains the enormous variety of health products, natural or otherwise, that can be purchased in stores, by home visit and online."

Taking health into hand

Whatever individual evaluation and perception of one's health, it appears that respondents in all markets have a shared desire to improve their health, with 87% claiming to have taken action over the last 12 months to improve it. The top activities cited were eating more fruit and vegetables (61%), taking regular exercise (37%), taking vitamin supplements (35%), and trying to lose weight (33%).

Respondents from Hungary (83%), Serbia (76%) and Chile (73%) were the highest advocates of eating more fruit and vegetables, a trend capitalised on by food brands, says Rafael Cespedes, Managing Director of Synovate in Chile.

"There is a greater concern in Chile about eating healthily. This has been adopted by brands in their communications around products that are focussed on increasing consumption of fruits and vegetables."

For Australians, the most popular course of action to improve health is to try to lose weight (61% versus a global average of 33%). Fittingly, of those surveyed, Australia is also the biggest purchaser of weight loss products - 11% against a global average of just 4% (closely followed by Spain with 10%). This is a huge opportunity for brands, says Mike Cassidy, Managing Director for Synovate Australia.

"Australia is fast becoming one of the most obese nations in the world, so marketing weight loss plans and products presents a huge opportunity for brands. The Australian government does a very good job of highlighting the risks associated with being overweight, which is why nearly two thirds of us are trying to beat the battle of the bulge."

Dosing up

So, what is at the top of our medication shopping lists?

Cough / cold medication (40%) and pain relievers (38%) are the top two medications bought over the counter by people globally in the last six months. As this survey was conducted during what could be considered 'flu season' for many markets, it is perhaps of little surprise. However, at the market level, there are some clear leaders in the purchase of these medications.

For pain relief, UAE residents are the top purchasers, with 72% having bought painkillers in the past six months. The UK (62%) and Australia (61%) are also big purchasers. A case of prevention is better than a cure? Apparently so, according to Karlsson:

"Most people in the UAE tend to carry around OTC painkillers and take them for even slight headaches, any signs of cold or flu, or other minor ailments. Headaches are common - most likely a result of a very hot climate outside combined with very cold air conditioning inside!"

At the other end of the scale is Taiwan at only 10%, followed by Hong Kong (15%), and Chile (17%).

Jenny Chang, Managing Director of Synovate Taiwan, attributes this to an affordable and accessible healthcare system in Taiwan: "Compared to other countries, clinics and hospitals in Taiwan are generally more easily accessible and patients would rather seek a physician's professional advice, even for minor symptoms they are experiencing. Besides, prescribed medications such as pain relievers or cough / cold medicines are mostly covered in the BNHI (Bureau of National Health Insurance) reimbursement scheme, which make them highly affordable to patients and may sometimes be even cheaper than OTC drugs.

"In addition, Taiwan has so many traditional Chinese clinics also covered in the BNHI that people will go there for natural fixes, like naprapathy." (Bodywork that manipulates the spine and connective tissue).

Indonesians (58%) are the top buyers of cough and cold medicines, closely followed by Koreans (56%).

As Robby Susatyo, Managing Director of Synovate Indonesia, explains, usage of over the counter cough and cold medicines is high because of a combination of factors:

"The weather here changes drastically - the sun shines in the morning and it rains the following hour. Before long, the sun is out again. This climate inconsistency increases susceptibility to feeling under the weather. Jakarta is also one of the most populated cities in the world (ranked #3) so colds spread quickly. There is very limited medical insurance coverage so almost everyone pays for their own medication. As doctor's fees are expensive, people tend to buy over the counter to self medicate. In addition, the advertising for over the counter products is very heavy. So much so, that even people who are not ill are motivated to buy."

For Koreans, it is more a matter of caution, explains Jellinek:

"Koreans are very cautious when it comes to disease, wearing masks at the onset of a cold, or when a nation-wide flu wave approaches.

This cautiousness is reflected in the administration of medicines that often come in much higher dosage than in Western countries.

However, Koreans are also known to be great advocates of traditional herbal medicine as well. A wide array of natural 'fixes' are available that offer an alternative to Western medicine, which is often frowned upon."

Battle of the brands: More than just a label?

Branded versus stores' own label? This debate spans industries, not just the over the counter drug market. Not surprisingly, opinions are divided. Overall, 42% of respondents do not perceive stores' own label over the counter products to be as effective as branded products (Spain at 71%, UK and US both 65%).

Conversely, nearly a third of people globally (27%) do consider stores' own labels to be just as effective (UAE with 52%, Chile 49%, Singapore 45%). The UK had the lowest percentage (6%) of respondents agreeing with this view, something Bob Douglas, Global Head of Synovate Healthcare, attributes to perceptions of quality.

"UK consumers may well perceive the brand as a badge which represents quality. The perception of quality is reinforced by both the premium price over generics and the fact that generics sometimes do not have UK packaging or instructions, thereby suggesting 'cheaper' and inferior imported goods."

Perhaps it is not surprising then that 44% of respondents prefer to use / give their families recognised brands. Again, the UAE leads the pack at 86%, followed by Chile at 79% (62% strongly agreed), and Singapore (71%).

"This is due to the mix of nationalities in the UAE - people look for brands they are using back home," says Karlsson. "International brands are more trusted than local brands. People in the UAE take healthcare very seriously and they prefer to go for recognised brands which they trust."

However, a small number of markets disagree that they would prefer to use / give their families recognised brands (28% overall), in particular 70% in Hungary disagree, followed by the USA and France, 49% and 48% respectively.

But what about the pharmacists' view when it comes to branded products? Contrary to the consumer view in France, pharmacists consider brands to play an important role, says Marc Papanicola, Managing Director of Synovate France.

"Pharmacists feel that it is easier to recommend a well known drug than an unknown one. Patients like to buy medication they have heard of through an advertising campaign or because people around them have already used it. This reassures them about the efficacy. Therefore, the awareness of a brand among patients is really important for pharmacists. Last but not least, pharmacists, of course, look at their margin: they don't have the same margin with all brands. They will therefore recommend brands which are financially favourable for them, depending on what has originally been negotiated with the pharmaceutical company."

In good hands?

When it comes to our health, we usually seek only what we believe to be the best advice. Does this only come from our doctors, however? Are there other sources of information that we can effectively rely on?

Synovate asked respondents which sources of health information they used. Overall, the three most popular are:

1. GP / Family Doctor / Physician / Public health doctor (69%) - The Netherlands led here with 88%, followed by Australia (86%) and Belgium (85%). The lowest were Korea 34%, Hong Kong 39%, USA 62%


2. Specialist Doctor / General health specialist (34%) - Taiwan took the lead with 75%, followed by Korea (61%) and Germany (55%). The lowest were Hong Kong 7%, Indonesia 12%, UK 17%


3. Pharmacist / Chemist (29%) Australia is highest with 70%, Belgium 58%, and Germany 52%. The lowest were Hong Kong 6%, Indonesia 7%, Serbia 8%.

Explains Bob Douglas, Global Head of Synovate Healthcare: "To some extent this will reflect the Healthcare structures in individual countries and ease of access. For example, in Holland and the UK, the GP is the gatekeeper to Healthcare. Holland showed the highest percent (88%) going to see a GP for health related advice and the UK was one of the lowest in terms of those seeking advice from a specialist.

"The role of the pharmacist in providing advice on healthcare is extremely varied. In Australia 70% claim to seek advice from a pharmacist whilst in Hong Kong the figure is a mere 6%. The role of the pharmacist is set to change radically in terms of diagnosis and treating, and this data suggests that acceptance and uptake of this type of initiative will be received very differently in different countries."

Overall, 46% worry about taking any medicines that haven't been prescribed by a doctor. At market level, the UAE felt most strongly (64%), followed by Singapore (63%) and Hong Kong (61%).

Similarly, 42% of people globally disagree that they would prefer to obtain their medications over the counter, rather than through their doctor. This was led by Serbia and Taiwan, both with 71%.

Forty percent of people globally say they worry that OTC sales assistants are not experienced enough to recommend products and 43% do not trust the advice of pharmacists, particularly in Hungary (89%), Belgium (85%) and France (81%). So it seems, overall, that our trust and therefore our preference for treatment, lies with our doctors.

However, there are some markets that have more trust in the pharmacist's advice, including UAE (70%), Germany (67%) and Hong Kong and Serbia, both with 66%.

"These results confirm the strong position pharmacies have in these countries, not only as sales channels but as consultants too," said Thomas Schafer, Associate Director for Synovate in Germany.

What about online health information? With the huge rise in online communities, it would seem that health would surely be a popular topic.

Chat sites were the fourth most popular source of health information, with 20% of respondents selecting them. Perhaps even more interesting is the split between regions, with Asian markets Taiwan (48%) and Korea (36%) being much higher than European markets such as Spain (2%), France and the UK (both 4%). Is this a clear demonstration of the difference in attitudes towards health sites and their influence on everyday life in these markets? This is something that brands in these markets might benefit from being aware of.

Commented Douglas: "Overall, we see clearly the significance of the internet as a source of healthcare information not only in terms of published information but also through the use of social networking sites. These results underlie the importance of social networking which has major implications for communication strategies. It is not surprising to see some of the Asian markets taking a lead, as they tend to embrace technology more readily than the more conservative Western countries."

OTC meds: As essential as packing your toothbrush?

When travelling for business or pleasure, there are a number of items always on our packing checklists. What about over the counter medications? Synovate asked respondents which over the counter medications they take with them when travelling, and the top three were:

1. Pain relievers (51%) - UAE residents again rank number one (75%), closely followed by The Netherlands with 73%.
2. Gastrointestinal products (37%) - Belgium was the highest here with 66%, followed by Korea with 53%.
3. First aid products (35%) - Chile led the pack here with 70%, double the global average, followed by Korea with 62%.

"Because most people in the UAE carry around OTC pain killers on a daily basis, it's not surprising that they also take those medications with them on holiday. One of the major things that the Arab and Asian populations in the UAE consider when going on holiday abroad is what the healthcare system and hospitals are like in the country they are travelling to. Medical issues are extremely top of mind," said Karlsson.

Sleep tight?

While physically it might be easy to jump from time zone to time zone, our bodies, and most notably our sleep patterns, take a little longer to adjust. It would make sense then that some, particularly those travelling on business with a limited amount of time in particular market, may consider sleeping pills an integral part of their travel regime so that they can schedule their sleep to be in line with local time.

It all sounds practical enough, yet the subject of sleeping pills generates very distinct views between markets. It seems there is no middle ground, only strong levels of comfort versus discomfort with the use of sleeping pills when travelling.

A significant 95% of Hungarians strongly agree that they are happy to take sleeping pills when travelling as do 72% of Belgians and 67% of Spaniards.

In contrast, 83% of Serbians strongly disagree that they are happy to take sleeping pills, followed by Germany (73%) and Taiwan (70%).

Commented Germany's Schaefer: "Sleeping pills have a bad reputation in Germany. There is a general tendency not use medicines if there is a way to avoid them. Sleeping pills are not considered essential or curative here so take-up is affected by this view."

Buying abroad: a foreign experience?

So, are our attitudes towards buying over the counter at home mirrored by our behaviour aboard? It would seem not. While 35% of people globally strongly or somewhat agree that they are comfortable buying OTC medicines abroad, half of Chileans and Germans are uncomfortable buying OTC medications abroad.

"The data indicates that the majority in markets with high trust in pharmacist's advice at home are uncomfortable buying over the counter medications abroad, with the UAE as an exception. Whereas the majority in countries with a high mistrust are fine buying OTC medicines abroad," observes Germany's Schafer.

"It appears that this attitude depends directly on the quality assigned to pharmacist's advice. Travellers might fear that they do not get the consultancy abroad they are used to at home. As soon as they do not expect good advice anyway, they feel comfortable to buy anywhere."

Added Chile's Cespedes: "There is some ambiguity between attitudes and actual behaviour of Chileans when it comes to over the counter drugs. Three quarters have bought OTC medicines in the last six months yet 60% say they are concerned about taking medications not prescribed by a physician. In this scenario, it is no wonder they do not feel comfortable buying medicines abroad. This attitude can also be influenced by the fact that the majority of trips abroad made by Chileans are in other South American countries, countries that are considered less reliable than Chile on health issues."

At the other end of the spectrum, those most comfortable buying OTC medicines abroad are Spaniards (58% strongly or somewhat agree that they're comfortable doing this) and, to some extent, Americans (40% strongly or somewhat agree). Indeed, 70% of Spaniards and Americans and 56% of Brits would even ask others to buy over the counter medicines for them when abroad. Now that's an interesting souvenir to bring home.