The world's most complicated wristwatch has 834 parts, takes five months to assemble, and sells for $1.5 million, according to watchmaker Vacheron Constantin. Those numbers aren't too far off the mark when considering what it takes to put together the world's least complicated trade show - and to have it run like an expensive timepiece.

As it constitutes its largest segment, health care is critical to the overall health of the convention industry. And the stakes continue to go up as the issues surrounding the health care exhibition industry grow more complex. In 2008, the Healthcare Convention and Exhibitors Association (HCEA) turned its attention to one cog in the wheel of this industry - globalization - and conducted a special three-part market research report on this one area.

Understanding Global Changes
HCEA began by reaching out to some of the largest medical conventions in the world and getting their perspective on international trends. To do that, HCEA surveyed 52 leading organizations from the HCEA 100 Index of Healthcare Conventions. Combined, these 52 conventions report 652,210 total attendees, of which 439,068 are medical professionals, physicians, and nurses. These conventions are typically held in the United States, and the majority attracts attendees from around the globe.

It's important to note that globalization impacts conventions in diverse ways, depending on the medical specialty of the organization and location of the event. Certain events may naturally attract more attendees from around the world because they are the world leader in that particular therapeutic area, and in the case of the conventions participating in this research, the range of non-U.S. attendees reported in 2007 went from 54 percent to less than five percent.

Understanding global changes is critically important for leading health care convention organizers who may attract a sizable percentage of their attendees from around the world. Changes in health care marketing laws in Europe and in countries around the globe can impact the number of attendees at events, subsequently impacting convention revenue.

When asked to provide the percent of international attendance over the last 10 years, organizers reported 29 percent in 2007, 19.9 percent five years ago, and 23.6 percent 10 years ago, on average.

While the decline and rise in international attendance over the last 10 years may be attributable to many factors, chief among them is the impact of Sept. 11 on travel and the general slowdown in the U.S. and world economies. Other considerations could be the impact of biennial or quadrennial world congress events, which may draw certain international medical professionals cyclically.

Where Do They Come From?
While 29 percent of attendees, on average, are reported to be non-U.S.-based in 2007 at these surveyed health care conventions, 73 percent of all attendees hail from North America, followed by Europe with 14 percent. Asian attendees account for 6 percent, followed by South America with 4 percent, Australia with 2 percent, and Africa comprising 1 percent.

By country, Canada leads the way in non-U.S. attendees, followed by Japan, Germany, Sweden, and France. On average, these top five countries account for nearly 15 percent of non-U.S. attendees at the conventions participating in this report. These countries also represent four of the 10 largest economies in the world.

So, where do convention organizers see future attendee growth coming from over the next five years? China leads the way in expected growth followed by a tie between Canada and Japan. The United Kingdom and South Korea round out the top five growth countries, according the report respondents.

Global Observations
HCEA surveyed convention organizers' level of concern in terms of non-U.S. attendees on a scale of one to 10, where 10 represented extreme concern and one represented very little concern.

With regard to tightening travel restrictions hampering future attendance by non-U.S. attendees, 48 percent of respondents said they were highly concerned, rating their level of concern between eight and 10. Similarly, when asked whether increasingly restrictive European health care marketing laws would impact attendance at these U.S. events, 44 percent of respondents said this was a concern registering six or higher on a scale of one to 10. Nearly 20 percent rate this at eight or higher.

Other impacts to future international attendance at global U.S. meetings may be influenced by increased competition from growing health care conventions outside the United States. However, because only 24 percent of respondents rated it a six or higher, it appears that competition abroad is not a significant concern to all convention organizers.

What may be the most forward-looking observation by these medical convention organizers is where they see the future growth of practitioners in their medical specialty. Thirty-eight percent of respondents say that the number of medical professionals in their industry is growing faster outside the United States, while 29 percent say they are growing faster inside the United States. Only 33 percent say that growth in the number of medical professionals in their industry is the same in both the United States and abroad.

Benchmarking this particular aspect of industry change can be critically important to convention organizers because it may be a leading indicator of how attendance, or the potential for attendance, can change with overall industry trends.

Other concerns highlighted by organizers were the global economy, exchange rate challenges, and something that is fairly unique to the health care industry - rules that prohibit certain exhibitors from speaking to certain attendees depending on the exhibitor products and country of origin of the attendee.

Global Exhibit Halls
The increase in international attendance at U.S. conventions is actually a regulatory challenge for many health care exhibiting companies, who must strictly follow marketing guidelines that are country specific, whether exhibiting domestically or abroad.

Herein lies the challenge of globalization in the health care exhibit hall and a point of contention between convention organizers and exhibitors that is unique to the health care industry. The perception that international attendance is growing has the effect of making it more difficult for certain exhibitors to reach the U.S. medical professionals with whom they can actually communicate.

Exhibitor Observations
The exhibitor perspective on globalization comprises the second focus of the HCEA report. HCEA surveyed 45 leading health care companies, of which 17 are Fortune-level companies managing some of the world's largest convention marketing programs. How large? Respondents who exhibit at more than 76 conventions annually represent more than half of the sample. In total, all exhibitors surveyed participated at approximately 5,733 conventions in 2007.

While the HCEA report contains in-depth research into many aspects of the exhibitor perspective and marketing mix, one key finding highlights how exhibitors deal with the issues of increased international attendance at leading U.S.-based shows.

When asked about planning in advance for a significant number of attendees representing other countries at a given convention, 60.7 percent of respondents said that because of regulations and/or company guidelines, "We cannot accommodate non-U.S. attendees at most U.S. conventions." Nearly 40 percent said they staff the booth with multilingual representatives, but only 14 percent include exhibit materials that are language specific and country regulation specific that can be handed out to non-U.S. attendees. Only four percent of respondents said they will bring additional exhibits that are country specific to accommodate non-U.S. attendees.

The dynamic of international attendance can actually have the effect of reducing return on investment (ROI) for exhibitors because they have less chance to interact with their key markets. As proving exhibit ROI becomes increasingly important for health care exhibit marketers, convention organizers will need to consider this factor as the exhibit hall continues to evolve into the future.

The Big Picture
The third focus of the HCEA globalization report looks at the overall number of all health care meetings reported as international. It is important to note that many U.S.-based conventions report themselves as international due to the mix of attendees they attract from around the world, in addition to international meetings held throughout the world, including in the United States.

Over the last 10 years, HCEA has collected survey information from 4,784 international meetings. Of those, 2,864 report attendance figures. When looking at the last five years of average reported professional attendance numbers, meetings reporting themselves as international have grown 22.9 percent. By comparison, U.S. meetings report average professional attendance growth over the same five-year span at 13.7 percent.

Comparing the 10-year trend line of both segments, the data illustrates many similarities, particularly that both segments reported declines moving into 2003, but since that point, both international and U.S. meetings have reported steady growth in professional attendance.

Frank R. Skinner is the manager of marketing research for HCEA. For more information on the full report's contents, or to obtain a copy of the official HCEA 2008 Special Report on Healthcare Meeting and Exhibit Marketing Globalization, contact HCEA at (404) 252-3663 or visit www.hcea.org.