Healthcare is an important issue in the upcoming U.S. presidential election as heart disease, cancer, respiratory infections and HIV/AIDS - the leading causes of death in the world - combine with the aging world population to accelerate demand for healthcare services. A closer look at the iShares S&P Global Healthcare Fund (AMEX:IXJ) gives investors a roadmap to building a portfolio of global healthcare providers. (Read how ETFs can help you as an investor at Five Ways To Find A Winning ETF.)

Just How Global Is IXJ?
The IXJ fund allocates 36% of its assets to foreign healthcare-related stocks including Swiss drug maker Novartis AG (NYSE:NVS) and French drug maker Sanofi-Aventis (NYSE:SNY). Similar healthcare funds with no exposure to foreign-based healthcare providers include the SPDR S&P Pharmaceuticals Fund (AMEX:XPH) and the Pharmaceutical HOLDRs Fund (AMEX:PPH). As of October 29, the IXJ fund fell the least among those mentioned since the beginning of the year. IXJ fell 22.78% while the XPH and PPH funds lost 24.37% and 24.60% over the same time frame.

Why Invest Globally?
A global approach to investing in healthcare factors in the growing health needs of domestic baby boomers along with healthcare demands of the larger world around us. Globally, the World Health Organization predicts higher levels of cancer and heart disease as populations in middle- and low-income countries age over the next 25 years. (Learn how to diversify your portfolio by reading Going International.)

Domestic Reasoning
Domestic demand will be strong as well. The American Hospital Association estimates that by 2030, many baby boomers will be managing more than one health issue such as diabetes, arthritis and obesity.

Fund Leadership
Top IXJ fund holdings, including Johnson & Johnson (NYSE:JNJ), Novartis and Pfizer (NYSE:PFE), are likely to be leaders in treating domestic and international patients.

Johnson & Johnson's dominant position in consumer products like Band-Aid brand bandages, Tylenol medications and Johnson's baby products suggests consumers will continue to turn to its products for their basic healthcare needs. In the third quarter, sales of J&J's consumer products division rose 13.1% to $4.1 billion despite the tough economic environment in the U.S. and abroad.

Pfizer remained the world leader in revenue from its cholesterol drug Lipitor with $13.7 billion in sales last year, although challenges from generic competitors are looming in the future.

Novartis, last year alone, had three drugs with more than $1 billion each in revenues. These included $5 billion in sales of the hypertension drug Diovan, $3.1 billion from its leukemia drug Gleevec and $1.3 billion from its cancer drug Zometa.

Final Thoughts
Investing in international markets over the past year has been challenging. Funds like the iShares MSCI EAFE Index (AMEX:EFA) have fallen 44.59% since the beginning of the year. J&J attributed 50% of its revenue in Q3 from international sales, suggesting that investing in foreign-based healthcare providers is as important as investing in healthcare providers with a global reach.

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