Best Practices and Prospects for Social Marketing in Public Health
Speech by
François Lagarde
Social Marketing and Communications Consultant
At the 89th Annual Conference of the
Canadian Public Health Association on
Best Practices in Public Health
Montreal, Quebec
June 8, 1998
Biography
François Lagarde, M.A., has worked as a social marketing
and communications consultant since 1991. From 1984 to 1991, Mr.
Lagarde worked for ParticipACTION where he served as vice-president
and manager of media campaigns/special projects. He is currently
a consultant to several organizations in the health, environment,
and development aid fields. Mr. Lagarde's client base is wide-ranging:
foundations, community groups, private companies, and public agencies,
including several public health organizations, as well as federal
and provincial departments of health. In addition, he is currently
working with the Academy for Educational Development, a Washington-based
organization renowned for its leadership in the development and
implementation of social change strategies. Mr. Lagarde is also
a trainer and frequent guest speaker at seminars in several Canadian
universities and organizations.
Introduction
Every day, public health professionals juggle with new information
on the population health status. Citizens, professionals and
decision-makers are constantly being encouraged to adopt certain
types of behaviour or make decisions which will help create
and maintain a health-oriented physical and social environment.
Using
their knowledge and expertise, public health professionals
produce reports and plans, which they follow up with recommendations
to a large number of individuals and organizations in the hope
that messages will be adopted.
Yet, people who attempt to convince others to change their behaviour
or decisions soon realize that conveying objective information
on the scope of issues or how to behave will only make a very limited
number of people change.
You may even have thought about your relative success in terms
of change while watching television one evening. After all, if
a car manufacturer, food company or a bank can convince consumers
to buy or use their products, why couldn't we use the same methods
in public health to convince people to adopt a certain type of
behaviour?
This is how the idea of applying commercial marketing methods
to social or public health issues originated. The idea first began
to take root in the postwar period (Rothschild, 1997). However,
the expression "social marketing" was used for the first
time in 1971 by Philip Kotler and Gerald Zaltman who defined it
as follows: "Social marketing is the design, implementation,
and control of programs calculated to influence the acceptability
of social ideas and involving considerations of product planning,
pricing, communication, distribution, and marketing research."
Over the past few decades, a growing number of organizations have
adopted this approach. The number of social marketing definitions
began to grow. One definition that I find particularly relevant
is: "Social marketing is the application of commercial marketing
technologies to the analysis, planning, execution, and evaluation
of programs designed to influence the voluntary behavior of target
audiences in order to improve their personal welfare and that of
their society." (Andreasen, 1995).
Fundamental Components
Over the past few years, academics and practitioners have tried
to identify the fundamental components of social marketing
(Lefebvre and Rochlin, 1997; Maibach et al., 1997; Middlestadt
et al.,
1996; Smith, 1998). This following list is a summary:
- Developing an audience-centered orientation, rather than one that
focuses on the message to be conveyed. This orientation is achieved
by holding formative research activities to better understand the
audience profile (needs, wants, perceptions, lifestyles, living
environment and media habits).
- Segmenting the audience or clientele. For example, it would be
wrong to say that all adolescents between the ages of 14 and 18
think and behave the same way. Segmentation based on predisposition,
motives, values and lifestyle is essential when designing and targeting
social marketing activities.
- Taking into account real and perceived barriers (which prevent
people from adopting a new behaviour) combined with a willingness
to modify programs, products, services or ideas accordingly. Of
course, this involves acting on the systems or structures which
create the barriers.
- Illustrating the benefits for individuals in the target group based
on their needs and interests, which are not necessarily the same
as those of public health professionals and experts.
- Using a variety of means to reach target audiences through the
media, face-to-face communication and events. The methods selected
should be based on an analysis of the target groups' profiles.
- Pre-testing, as well as ongoing monitoring and evaluation to modify
and improve the program. This includes documenting the impact or
outcomes.
- Seeking participation by representatives from target groups at
the design stage through research and mobilization activities.
- Forming partnerships to enhance credibility and facilitate access
to target groups. Partnerships also help mobilize the human, financial
and material resources required to implement social marketing activities.
- Creating synergy and complementarity with all other types of approaches
to social change, which may have a sustainable effect on the modification
of behaviours and health determinants.
- Making a substantial and long-term financial commitment is equally
vital to the success of these types of programs. The extent and
duration of financial commitments must be in keeping with the level
of change expected. You also need to remember that social change
does not take months, but rather years or decades.
Best Practices in Canadian Public Health
Since the title of this conference is "Best Practices in Public
Health", I thought it would be appropriate to illustrate the
ten fundamental components of social marketing using Canadian accomplishments
as examples. I would like to take this opportunity to thank leaders
in Canadian social marketing who helped me select these examples
for you: Peggy Edwards, Larry Hershfield, Jim Mintz, Lise Renaud
and Eric Young. I would also add that this list of "best practices" is
not the result of exhaustive research, nor does it necessarily
represent all initiatives worthy of the list. After all, my objective
here is to illustrate the fundamental components of social marketing.
I would also like to demonstrate how social marketing can be applied
at both the local and national levels.
ParticipACTION
ParticipACTION was established the same year the first definition
of social marketing was published. The organization is often
hailed as one of the first Canadian success stories in social
marketing. For the past quarter century, ParticipACTION has
dedicated its efforts toward the promotion of physical activity,
and its
work is recognized around the world. Peggy Edwards (1997) summarized
the reasons for the organization's success: ParticipACTION
had a great start with clear and specific objectives. Media
good
will and high-quality messages have meant that ParticipACTION
has never paid a cent for media coverage valued at an estimated
$15 million per year. ParticipACTION has also been successful
at attracting and involving corporate, not-for-profit and professional
partners. Although ParticipACTION is generally associated with
traditional advertising campaigns, the organization also explored
a number of different avenues. The CrownLife ParticipACTION
Challenge, which pitted active cities against each other, was
a classic
example of a community event that was both the message and
the medium. Using a bottom-up, light-hearted approach, ParticipACTION's
ongoing delivery is based on a loose motivational model with
examples that are easy to follow and adapt based on: awareness,
education, motivation, solutions and reinforcement.
Vitality
Vitality is a joint campaign of ParticipACTION and Health Canada.
Formative research and an in-depth analysis of the target clientele
revealed two key observations: First of all, that time is the
major obstacle which prevents people between the ages of 25 and
45 from having a healthy nutrition and engaging in regular physical
activity. Secondly, that the primary goal of this particular
population segment is to spend time with their friends and children.
Vitality launched a campaign based on the slogan: "Grab
on to the Good Times." Advertisements showed moments in
daily life where adults forgot about their concerns, and spent
some time in the company of their children or friends. The "good
times" were centered around physical activities and a healthy
nutrition.
Health Canada Segmentation and Partnerships
Since the mid-1980s, a highly dynamic team at Health Canada has
created some major social marketing campaigns under the leadership
of Jim Mintz. All campaigns have been subject to ongoing monitoring
(Health and Welfare Canada,1992).
I would say that what makes these campaigns so different is the
care with which target audiences are analyzed and the resulting
segmentation. The most noteworthy example is definitely the psychographic
segmentation of youth between the ages of 11 and 17 for the "Really
Me" anti-drug campaign and the "Break Free" campaign
urging youth to not start or to quit smoking. Health Canada defined
seven population segments based on the behaviour and attitudes
of youth to better target and prioritize groups. The advertising
agencies which worked for Health Canada were thus able to reach
the right audiences.
Over a ten-year period, Health Canada also formed partnerships
with more than 125 companies, non-profit organizations and other
government agencies. Together, the organizations contributed close
to $60 million in financial, human and material resources. This
is an impressive feat for a government organization that must balance
partners' needs with the political and administrative constraints
in a major federal government department.
Health Canada has also published numerous documents, organized
training activities and set up Web sites to help Canadian public
health professionals acquire social marketing knowledge and know-how.
The vast majority of public health professionals who adopted social
marketing methods have benefitted and continue to benefit from
Health Canada's work.
OK, I Quit!
The "OK, I Quit!" campaign was carried out in the Montreal
area, and was a scripto-visual tool to help women stop smoking.
The audience was functionally illiterate women between the ages
of 18 and 35 with less than nine years of schooling. The campaign
was designed, tested and validated through formative research conducted
with some forty people in the target population segment and an
advisory committee. The project was interesting in that it brought
to light significant differences in viewpoints between advisory
committee members and women in the target population segment. Fortunately,
the team proved extremely willing to modify the project based on
the comments of the target population segment. The number of pages
in the guide was reduced from 24 to 8, and the initial step-based
approach was eliminated. Instead, the guide provided concrete methods
to help women quit smoking. The women in the illustrations were
also modified to have a more realistic appearance. Lise Renaud,
Monique Caron-Bouchard and Gloria Sacks-Silver (1990/1991) concluded
their project report with: "We converted the guide into scripto-visual
language adapted to the needs and expectations of the target clientele.
The formative research proved to be truly useful in this instance.
Aside from producing a significant reduction in production costs,
the formative research ensured greater effectiveness for the product
and better communication with the target audience."
Strengthening the Forces
Strengthening the Forces is a health promotion campaign of the
Canadian Forces that focuses essentially on the benefits of
health and physical activity to help members of the Forces
carry out
their work. To respect the organizational culture and internal
dynamics of the armed forces, the campaign brought health to
the forefront alongside other key military values, such as
respect for the chain of command, pride, a sense of mission,
team spirit,
etc.. In short, members of the forces could not consider themselves
accomplished soldiers if they were not concerned with their
physical and mental fitness, as well as that of their subordinates.
A
social marketing strategy was primarily applied to communications
between health personnel and each member of the Canadian Forces.
The face-to-face approach was further reinforced with notices
on bulletin boards and in various publications, as well as
speeches during events. Basically, all methods recommended
as part of
the formative research were used. Motives and obstacles which
would prevent members from adopting a wide range of behaviours
were also covered. Objectives have been evaluated annually
since the campaign was launched. Updating and reminder activities
for
health personnel are carried out frequently on practically
all Canadian Forces bases.
The Fort McMurray Young Adult HIV Prevention Campaign
To increase awareness of HIV risks among young adults, the Fort
McMurray (Alberta) Young Adult Prevention Campaign launched an
innovative radio program to deliver HIV prevention messages to
a hard-to-reach target audience: young males between the ages
of 18 and 26 who may be at risk of HIV. A nine-episode radio
play called "Riff the Cat" was developed for radio,
since it is a medium known to be popular with the target group.
The campaign obtained the support of newspapers and public transit
commissions, then used posters and the Internet to turn the play
into the primary strategy for combatting apathy among young adults
toward personal risks from HIV. Campaign organizers spent an
enormous amount of time carrying out an exhaustive review of
relevant publications (Kneeshaw, 1996). They also ensured that
youth from the target group participated in the development of
the show's characters (Barrington and Kneeshaw, 1996). This project
is an excellent example of partnership at work. The media placement,
production and broadcasting of material was contributed free
of charge by public and private-sector partners. The activity
took place in early 1998, and is part of an ongoing project subject
since 1992. All activities are subject to evaluation and organizers
are always prepared to modify the program based on current evaluations.
Project on Steroids and Body Image
One of the aims of the Canadian Centre for Ethics in Sport is
to reduce the use of anabolic steroids by young men (ages 14-24)
to change their appearance. After consulting publications on
the subject and interviewing professionals, gym owners, trainers,
police officers and public health professionals, messages were
developed and pre-tested to convey straightforward information
that would not be ignored. Campaign organizers were also aware
that the muscle-building effects of steroids could not be denied.
In fact, steroids do have the desired effect in terms of muscle
development, and users are generally satisfied with results.
Therefore, campaign materials could not simply state the opposite,
and deny the efficacy of steroids. Given their motivations,
members
of the target group were more likely to react to outside or
social taboos, such as: peer censure of the activity, the risk
of HIV/AIDS,
the stigma of drug use; the visible physical and psychological
side effects of use, and the black market. The campaign also
focused on several audiences which were likely to have an influence
on youth. The groundwork helped prepare the design of the material
and publication strategies. The following campaign messages
illustrate the campaign's overall positioning: Steroids Make
You Smaller,
If You Pump This... Know This, and Rage Against Roids.
Critics of Social Marketing
In spite of its popularity, social marketing also has its critics.
Social marketing is often accused of placing undue responsibility
on individuals to solve public health problems (Maibach and Holtgrave,1995).
I would agree that if a program focuses solely on the willingness
and ability of individuals to adopt a certain type of behaviour,
it places an inordinate amount of responsibility on individuals.
Social, political or physical barriers must be taken into account.
However, social marketing cannot be criticized for this shortcoming
if it is limited exclusively to the influence exercised over individuals.
Nothing is stopping public health professionals from using social
marketing principles to modify the decisions and actions of socio-economic
and political partners. For example, I worked with a team at the
Montérégie Public Health Department to develop a
social marketing strategy that would encourage elected officials
and municipal employees to enforce municipal regulations against
smoking. From this standpoint, social marketing can be a major
asset for convincing decision-makers and individuals who are in
a position to influence overall health determinants to make significant
changes.
Social marketing is also accused as being tantamount to public
manipulation. The issue of manipulation is essentially an ethical
one, which involves every form of communication and social change.
I have seen lobbyists play around with numbers and community leaders
manipulate causes, meetings and crowds. In social marketing, our
primary goal is to establish a link between the motives of the
target group and the behaviour being advocated. False representation
is obviously just as unacceptable in social marketing as in any
other field.
I have also detected a certain fundamental contempt among critics
of social marketing for using the commercial marketing methods
of the capitalist system - a system that some people hold responsible
for our public health and environmental problems. At times, I have
also noticed some resistance on the part of public health experts
to accept formative research results which contradict some of their
own premises.
If you find the word 'marketing' hard to say, then just avoid
it. However, be sure that you take the time to know your audiences
better before actually addressing them. The very real motives and
barriers they encounter are just as important as the public health
issues and messages you seek to convey to them. There is lots of
room for humility in social marketing too. People respond when
you modify your programs based on your knowledge of their reality.
Whether you call this method marketing or not, the important thing
is to apply it.
Perspectives
A number of authors and conferences have studied the future of
social marketing as a field. Social marketing practices could
certainly benefit from a more precise definition of the field,
increased training for professionals, more sophisticated and
better adapted research techniques, more extensive and longer-term
financial resources, as well as a systematic evaluation of
practices (Maibach et al., 1997; Lefebvre, 1997). Other issues
of a different
nature, but of equal importance, also come to mind regarding
the future of social marketing in public health:
- Complementarity and synergy with other approaches to change
- Information technology
Complementarity and Synergy with Other Approaches to Change
I am all for the ecumenical approach to change strategies. Social
marketing alone is rarely sufficient to bring about change.
A variety of strategies need to be applied if change is to
occur.
Social
marketing works best when policies are modified and communities
are mobilized. The combined approach can change conditions,
as well as socio-economic and environmental systems. Ultimately,
this will have an impact on both individual behaviour and health
determinants.
Information Technology
The explosion of new information technology is more than just a
passing fad. This is a major turning point in the way we communicate
and perceive relations at the community level. Technology is
transforming the geographically-based notion of the community
to one of a community of interests. Marshall Goldsmith recently
summarized this fundamental change when he wrote: "New technologies,
new organizational forms, and the rise of the global village
will have a profound effect on our sense of community in the
years ahead. Two trends stand out: the explosion of our potential
to communicate instantaneously and massively across the globe
and, closely aligned with that, our ability to create communities
of choice." In social marketing, we will have to do more
than simply place what we have on paper on the Internet. Leaders
of social change will have to adapt to an interactive world where
social dynamics are modified by information technology. People
who are not open to dialog and willing to accept profound changes
to their practices will not succeed.
Conclusion
A number of Canadian experiences illustrate the contribution
of social marketing to the advancement of public health issues.
Canada has even played a leadership role in this regard. Despite
what some critics have said, social marketing provides a rigorous
framework for the analysis of needs, motivations and barriers
among target audiences. Social marketing will be invaluable
in
the future if we apply it toward integrated actions and approaches
to social change. We should also use it to influence decision-makers
who can have an impact on health determinants and the conditions
that will facilitate the adoption of specific types of behaviour
by the population. Social marketing will then be able to continue
to make a contribution to the public health by influencing
and mobilizing both decision-makers and the public so they
adopt
health-oriented behaviours and practices.
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Inc. for Alberta Health.
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1. Source: Various documents written by Russ Kisby of ParticipACTION
and François Lagarde.
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