EACA - Speeches & Presentations - The Social marketing Approach: Influence of ...

The Social marketing Approach: Influence of Social Marketing in Public Health

Good afternoon

It wasn't so long ago that any suggestion that social marketing could play an important part in health promotion and other major social movements and activities (environment or energy conservation) would be rejected because of the negative connotations linked to the word marketing. One reason for this attitude was simply that the concept was new, and, like any innovative idea, it was first greeted with scepticism.

Campaigns for social change are not a new phenomenon. They have been waged from time immemorial. In Ancient Greece and Rome, campaigns were launched to free slaves. In England during the Industrial Revolution, campaigns were mounted to abolish debtor prisons, grant voting rights to women, and abolish child labour. Notable social reform campaigns in nineteenth-century America included the abolition, temperance, prohibition and suffrage movements as well as a consumer movement to have governments regulate the quality of foods and drugs.

In modern times, campaigns have been launched in areas as health promotion (anti-smoking, safety, drug abuse, drink/driving, AIDS, nutrition or physical fitness); environment (safer water, cleaner air, preservation of national parks and forests); education (literacy, school attendance, encouragement of students to take math and sciences) and in the economy (to boost job skills and training, attract foreign investors or revitalise older cities).

Some of these campaigns have been successful, while others have failed. People involved in social change campaigns have gradually come to realize that an approach focused entirely on alerting the public to the dangers of certain health related behaviours or of polluting the environment is often inadequate in fostering changes in attitudes, opinions and, above all, behaviours.

The effectiveness of such programmes in a variety of economic, political, and cultural environments has led to an active debate over what exactly constitutes social marketing and what the role of programmes should be vis a vis the public health system.

Communications is a core determinant of health. What we consume and how we live are influenced and determined by our attitudes, the information we possess, the sources of our knowledge, and the wider social, economic and political contexts within which we live. Advertising and marketing are capable of affecting us in both positive and negative ways. The globalisation of markets and market-driven consumption patterns have created global appetites that are of increasing importance for public health. Whether it is tobacco, soft drinks and alcohol or high fat foods and unhealthy lifestyles, marketing plays a critical role in influencing people's health.

In many developing countries, public sector health systems are unable to ensure that products and services reach a large part of the population and in particular, those at the low end of the cash economy.

In many cases, there is no supporting literature, nor an adequately trained staff to explain the correct use of health products. This is especially true for HIV/AIDS, where staff need to have a thorough understanding of the means of transmission and its prevention. In many countries, cultural norms, geography, and low literacy levels compound the problems.

Outside the public health system, many essential health products can be purchased in commercial outlets. While the commercial sector is a significant distribution resource because it ensures that products are widely distributed and available, these products are usually affordable to only the richest one per cent of the population and are often sold with little or no promotion. There exists, therefore, a need for a regular supply of high quality health products, which are both accessible and affordable to lower income people. This need is compounded by a lack of information and education surrounding the products, their correct use. Even where information, education and communication programmes are being implemented, an inaccessible and infrequent source of supply often negates the impact of the messages disseminated by these campaigns.

In social marketing, the goal is to improve a particular condition of public health or safety, but marketing is the operative word. We need not forget that social marketing works best when the media of choice is combined with community activity. Using traditional commercial marketing techniques, social marketing makes needed products available and affordable to low-income people, while encouraging the adoption of healthier behaviour.

Many of these programmes operate in countries in economic, political and social transition, such as Cambodia, Mozambique, or Zaire. Their ability to operate effectively in a variety of different environments is a key strength of the social marketing approach.

Social marketing: A threat to the commercial sector?

Social marketing programmes have often been accused of competing unfairly with the existing commercial sector. They are among the most cost-effective of health interventions. They recover a large percentage of operating costs and make programmes as cost efficient as possible through various mechanisms. Even with highly subsidized products, a proportion of the distribution cost is met by the consumer and not the donor or the public health system. Sales revenues are reinvested in the programme and foster the development of long-term institutional and management capacity.

Such initiatives are not an alternative to donor funding. In order to continue reaching low-income populations, social marketing programmes will continue to need donor support.

Social marketing has been shown to be an effective and cost-efficient approach in addressing the health needs of low-income populations throughout the world. For example, condom social marketing programmes have made condoms accessible, affordable and acceptable in many of the world's poorest countries. Innovative communications campaigns have disseminated prevention and behaviour change messages to thousands of individuals and their communities.

Developing Social Marketing Campaigns

Social campaigns form an integral part of the environment in industrial and developing countries. They are often prompted by the perception that some situation represents a social problem and merits social action. Examples include the fact that some people are unaware of some services that may improve their lives (such as treatment for TB), that some social systems are unjust (child labour, for instance), that some individuals are engaged in behaviours associated with a high level of risk (such as using illegal drugs), or that some governments are unresponsive to the needs of certain groups (such as street children or minorities).

Although many chronic conditions exist, only some are granted "problem" status. In public health, this designation depends largely on medical, economic, and political issues as well as the possibility of mobilizing resources for any initiative.

Some social campaigns are designed merely to help bring problem areas into the open and draw attention to their roots, which can often be a taboo subject. Although sharpening society's awareness of a problem is indeed necessary, it is by no means sufficient to bring about changes in societal attitudes and behaviour, as these are shaped by habits, interests, feelings and beliefs, among other factors. That is why social campaigns conceived simply to educate or admonish often turn out to be relatively ineffective.

When developing a social marketing campaign the main topics to consider, and questions to ask are.

Communication Objective: What are you trying to do?
Target Audience: Who are you trying to reach?
Current Attitudes: What does your target audience currently believe to be true, regarding your issue?
Desired Attitudes: What do you want them to believe differently?
Desired Action: What do you want the audience to DO as a result of your message?
Primary Selling Proposition: What's in it for them?
Support: What research, proof, other successes or evidence exists to support your message?
Personality: What kind of tone do you want to utilize? Humor? Suspenseful? Everybody's On Board? Educational? Somber? Non-condescending?
Success Indicators: How will you know you have succeeded?
Distribution channels: making the "product" available

Mass media are undoubtedly the most important means for creating awareness of social products as well as for distributing non-tangible products. Their effectiveness varies greatly. In urban areas, depending on the target group, television, cinema, and radio as well as magazines, newspapers, posters, and other print media can be effective. In rural areas, often only radio plus traditional "media" such as folk theatre, puppet shows and song and dance performances are appropriate.

As a rule, the communication channels selected should be ones the target audience comes into contact with on a regular basis as well as perceives as being credible, since familiarity with a medium and with the performers makes it easier to get the message accepted. Projects that use media with entertainment value (movies, soap operas, radio plays, music, theatre, comics and so on) are particularly successful. Members of the target group can identify with the heroine/hero or with a well-known idol and this has a motivating effect in the desired direction of change.

Notwithstanding the great importance and obvious success of mass media in social marketing, interpersonal contacts and the services associated with them remain indispensable. Mass media can arouse interest, but personal consultation, motivation by promoters, or a doctor's concern, make all the difference between merely knowing about something, having a positive attitude toward it and actually adopting the new behaviour. Personal communication reinforces every other channel and it takes on primary importance wherever modern mass media fail to penetrate or are underused.

It is essential that the target groups should feel they are being personally addressed and taken seriously, with due respect to their human dignity and their private sphere. Hence great importance is attached to the selection of promoters, multipliers and advisors as well as to their training.

Tangible products (as condoms for family planning), which may form part of a social marketing campaign for public health, can be provided through various channels. The decision on the marketing channels to be selected depends on many factors such as the nature of the product, costs, the size and location of the target population and its consumption habits.

The product itself and the commitment of the distributing agents to promoting it and advising about its use play an important role. Drugs, for example, must be dispensed responsibly by medical personnel. In the end, the credibility and success of a campaign depends largely on the regular availability of the products and uncomplicated access to them.

A few tips on how to make things better

Raise awareness - High public awareness can bring support for prevention and help change social norms related to public health issues.
Increase knowledge - Communications can provide facts and help dispel myths and misconceptions.
Influence attitudes and norms
Show benefit of behaviour change
Reinforce knowledge, attitudes, and behaviour
Suggest/prompt an action
Increase demand for services - By making people more aware of the problems and possible solutions, communications can increase public demand and support for prevention and other services.
Refute myths and misconceptions - What communications cannot do, in most people, is bring about a long-term change in behaviour. Additional prevention strategies are needed to do this.

How Social Marketing Works

The key to a successful social marketing campaign is learning what will work with the target population. This is more effective than simply telling people what they "should do." The program's or campaign's ultimate outcome should be to establish social norms that promote and sustain healthy, safe behaviours. Effective channels of communications should be chosen including television, radio, newspapers and other print media, and bulletin boards throughout the community such as those found in churches, neighbourhood centres and other places where people congregate.

A message should appeal to a variety of emotions and perceptions such as logic and reason, self-esteem, fear and patriotism. Appeals to fear have been most effective when anxiety can easily be reduced and when delivered by a highly credible source such as priests or doctors.. If the message explains how to reduce the fear, it will give a sense of control back to the audience.

An holistic public health approach to prevention should be used. The public health model stresses that problems arise through the interaction of a host(s), agent, and environment. Prevention programs that focus totally on the host may overlook the influences in the environment or community that promote substance abuse.

AIDS: A Successful story

Condom social marketing (CSM) emerged as an effective tool in combating the spread of HIV/AIDS in the mid-1980s. In 1996, social marketing programmes distributed more than 783 million condoms in over 50 countries and conducted targeted communications campaigns in countries as economically and culturally diverse as Malawi and Bolivia.

In response to the HIV/AIDS epidemic, social marketing programmes have made condoms accessible, affordable and acceptable to low-income populations and high-risk groups in many of the world's developing countries. Social marketing has become increasingly popular among governments and donors as a way of addressing serious health issues in developing countries. In several of these countries, this approach has been expanded to incorporate other essential health products and has become an important component of efforts to improve national health.

Social marketing programmes have successfully addressed many of the issues of demand and supply. In the case of condoms in particular, social marketing has acted as a normalizer of the product. Thanks to social marketing programmes, now in many countries there is a de-stigmatization or normalization of condoms and their use in populations in general and especially amongst those at high risk of HIV infection. Condoms are sold in other types of shops, their brand name is known and accompanied by a recognizable logotype, and medical providers and others talk about them in the media and educate people about their benefits.

In addition to using the traditional wholesale and retail network, the social marketing programmes also focused on developing non-traditional outlets and informal distribution systems. Other innovative distribution systems have been used, including working with local NGOs and training community-based sales agents in order to penetrate many rural areas and continue sales even during periods of economic disruption. For example in Haiti, the social marketing programme has recruited and trained outreach workers from its partner NGOs to act as wholesale distributors and retail sales agents.
Making products available is just one part of the social marketing equation. Encouraging their use represents the other. A strong communications component is essential to the success of a social marketing programme.

Local culture and traditions are widely used to influence people's behaviors. For example, in Cambodia puppet shows, one of the oldest traditional art forms of Cambodian culture, are used to get the message through. In Uganda, the social marketing programme developed a talk show in collaboration with a local radio station designed to provide information on STDs and reproductive health in general. In Cote d'Ivoire the social marketing project has developed a popular twelve-part television soap opera.

Research and Evaluation

A valuable element of a successful social marketing programme is a strong research and evaluation component. Research plays a significant role in the development of the brand, its positioning and promotion. It informs the development of the messages and identifies misconceptions and societal or cultural prejudices towards behavioral change. The results allow the project to assess the effectiveness of existing behaviour change interventions and to influence the direction and content of future communications. Evaluation criteria need to be developed for social marketing since they are not yet well established or defined.

Social marketing programmes also conduct research to assess whether services or products are available when and where consumers need them and whether social marketing programmes are reaching their targeted consumers.

The relative newness of many social marketing programmes also makes it difficult to evaluate their impact, as changes are often achieved over the period of several years. As social marketing projects mature and the nature of the epidemic changes, better criteria will be needed to be developed to measure the impact of the Social Marketing programmes and their effect on behaviour.

Conclusions

The rapid growth of social marketing programmes has led to a natural donor-driven debate regarding their cost and long term sustainability. Concerns have been raised regarding the possible adverse impact of social marketing programmes on the commercial sector and their role vis a vis the public health sector. By subsidizing high quality products, it is argued that such programmes sabotage the emerging commercial sector.

If we are consciously seeking to include more people with disabilities in our advertising, there are some observations we can offer that might help the process.

It should be said though that social marketing programmes do not compete with the public health system. On the contrary, such programmes complement and support existing services. By making products available and affordable outside the health system, social marketing programmes alleviate the pressure on existing services, allowing the health system to use scarce resources more effectively. They are developed in close collaboration with host country governments and reflect current priorities and needs.

Communications campaigns are designed to support existing interventions, and many of the materials developed by social marketing programmes can be used in clinics, schools, and throughout the public health system. Social marketing programmes do not operate in a vacuum; government support is a key component of a successful programme. The purpose of such health projects is to provide essential services and materials to countries whose governments have neither the resources nor the infrastructure to deliver them. Many governments have recognised the valuable role social marketing programmes can play in different areas of public health and have extended financial and political support to the activity.

The beneficiaries of these projects are often among the poorest people in the world. While there is an increasing awareness of the need to develop institutional capacity and improve cost effectiveness, these projects will continue to require some level of subsidy, until such products and services can be made available and affordable to those who need them most, either by the government or existing commercial infrastructure.

Social marketing programmes also play an important role in countries where governments are dysfunctional or undergoing a period of economic and political transition.

Communications campaigns work better when expectations are more realistic for their outcomes, when useful strategies are borrowed from social learning and social marketing, and when entertainment strategies from mass communications have been incorporated. Customs, norms, values, and leadership patterns must be considered in formulating social change strategies targeted on society as a whole or on a single community.

To conclude, it is the link between distribution and communications that makes social marketing such an effective intervention. Social marketing programmes borrow from many traditional commercial marketing techniques in developing their communications campaigns. Programmes use a variety of traditional and mass media to promote the brand, both among retailers and consumers. While much of this activity is focused on raising demand for the product, the need to communicate prevention messages is incorporated in brand promotion. The health of the community, not necessarily that of the individual, is the main concern.