Selling health: social marketing approaches are increasingly used in health promotion, but what does it involve and how can community practitioners use it?
Subject: Obesity in children (Prevention)
Health promotion (Methods)
Wellness programs (Service introduction)
Authors: Foxton, Julie
Thurtle, Val
Ames, Mavis
Pub Date: 02/01/2009
Publication: Name: Community Practitioner Publisher: Ten Alps Publishing Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2009 Ten Alps Publishing ISSN: 1462-2815
Issue: Date: Feb, 2009 Source Volume: 82 Source Issue: 2
Topic: Event Code: 366 Services introduction Advertising Code: 57 New Products/Services Computer Subject: Company service introduction
Organization: Government Agency: United Kingdom. Department of Health
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 192802941
Full Text: Obesity rates are rising at an alarming rate, particularly in children (1) and the Department of Health (DH) is using social marketing to help achieve its aim to reduce the proportion of overweight and obese children to 2000 levels by 2010. (2)

Social marketing is a relatively new approach with increasing importance and significance to health. This article looks at its history, what it involves and the theories that underpin it.

Commercial origins

Many readers will have been influenced this morning by marketing, and the breakfast table shows the results of marketing strategies translated into purchases such as cereals, tea and coffee.

Those with jobs involving health promotion and client-centred care may think they will never have to actually advertise their products and services to clients, but we need to 'stop, look and listen', as things are changing fast.

Change has been faster in the 20th Century than in any other period. (3) The public has greater access to numerous channels of information, allowing them to question what healthcare professionals tell them, and many companies use marketing tactics that involve 'data, statistics' and 'science'. (4) This access to information has been coupled with changes in government policy, such as in Choosing health, (5) which talks about the 'power of social marketing' and 'marketing tools applied to social good used to build public awareness and change behaviour' (p21).

This emphasis on marketing has driven a new way forward for the NHS and led to the formation of the National Social Marketing Centre, (6) a partnership between the DH and National Consumer Council. Such interest and activity in social marketing has been noted in New Zealand, Australia, North America and Scotland, where the Institute of Social Marketing (7) has existed for over 25 years.

Theoretical basis

Social marketing is marketing with a 'social rather than a financial goal' (p43), (8) involving programmes that are planned, researched and implemented to enable a targeted population to make changes that benefit themselves and society.

Social marketing uses a range of models and several different tools, many of which will be familiar to healthcare professionals--such as the Stages of Change theory (9)--but also social cognitive theory, which incorporates a wider social context of the immediate environment coupled with the individual's personal characteristics. (8) The exchange theory is also key, refering to a process in which both 'consumer' and 'supplier' believe they are benefiting--a 'win-win' situation. (8)

Old-style health messages appear to have been largely unsuccessful, and the chief medical officer's report on exercise (10) noted that only 30% of men and fewer women took regular exercise considered to beneficial to health. The principles of social marketing are to put the client at the heart of the process by producing what they want rather than something that needs advertising in order to be sold--'producing what you can sell rather than selling what you produce'. (8) In health campaigns, this means asking what clients will find most useful, being aware of what they do in their everyday lives and why they do it. This is 'customer insight', and helps to develop a true picture of an individual and their place in society by describing their purchasing habits, leisure and work activities. This then helps in developing the materials and delivering the messages to the client. It usually involves 'segmenting' the audience according to specific characteristics..

Audience segmentation

One major aspect of Healthy weight, healthy lives (2) is the targeting of overweight children. To this end, the DH spent two years researching the segmentation of this target audience, so that definite 'segments' could be identified easily.

Cluster segmentation moves beyond simple demography and epidemiology, looking at the behavioural and psychographic make-up of clients within an area. Knowing which clusters are in a target area will help to identify 'at-risk' families and set realistic goals. Appropriate materials can then be developed for the appropriate segment, and key messages can be developed around the same theme but targeting different groups.

[ILLUSTRATION OMITTED]

The social marketer has to be aware that there is constant competition for the time and attention of their audience, including other so-called 'health' messages such as 'low fat' on a high-carbohydrate product.

In social marketing, once the initiative is launched, it is constantly monitored and evaluated, feeding back into market and consumer research the whole time. This allows lessons to be learnt for future reference and further campaigns.

Common concerns

There can be unease about the ethics of using a commercially-focused approach for these purposes. (11) Many of the most successful companies that have used these kinds of marketing for commercial advantage, such as Tesco and McDonalds, can be criticised for controlling a lion's share of the market. There are also concerns about confidentiality and protecting people's privacy when information is gathered about them in order to target them more effectively.

Another concern can be cost. The DH has so far spent two years researching and segmenting target groups for its Change4Life campaign, (12) designed to be readily identified and adopted by the public and healthcare professionals. This brand can be tailored locally for specific purposes, such as 'Fit4Life' for physical activity or 'Food4Life' for healthy eating. This has a financial implication, and while research shows that this approach can be very successful, (13) there is little to support the idea that this type of campaign will benefit those who need it the most. (14)

Relevance for practitioners

Social marketing is set to become part of the care delivery in the NHS, which now encourages both professionals and patients to take part in the decision-making process. (15) Howkins and Thornton (16) suggest that the future of the NHS is based on partnership working, collaborative working and the joint working of healthcare professionals, their clients and others in the delivery of care. This ethos has been reinforced further by the recent Darzi Review, (17) which suggests that change will require leadership that is 'clinically driven and locally led' (p4). The review's primary and community care vision (18) talks of strengthening clinical leadership to help promote healthy lifestyles and improve health and wellbeing.

Healthcare professionals are in an ideal position to help reinforce media messages through brief counselling sessions. They are also in a good position to promote an alternative channel through which health messages can be relayed, and are a trusted source of information. (4)

There are many examples of social marketing tools that have been developed to promote health in the UK, and one successful initiative in Portsmouth is described (see Box 1).

Conclusions

Social marketing is a relatively new concept for many heathcare professionals. However, it is simply a more sophisticated way of getting health messages understood and acted upon, which is an integral part of health visitor, school nurse and other community practitioner roles.

This article has looked at the theories that underpin social marketing and the basic ways in which it works. Throughout this, it has been demonstrated how keen the DH are for healthcare professionals to embrace this method as a tool in changing perceptions and behaviour in order to tackle obesity and other health issues.

Further information

For more details and examples of social marketing approaches, please see:

* National Social Marketing Centre: www.nsms.org.uk

* The DH's Change4Life programme: www.change4life.com

References

(1) World Health Organization. Childhood overweight and obesity. Geneva: World Health Organization, 2008. Available at: www.who.int/dietphysicalactivity/ childhood/en (accessed 17 December 2008).

(2) Department of Health. Healthy weight, healthy lives. London: Stationery Office, 2008.

(3) Kaminski J. Leadership and change management: navigating the turbulent frontier. Nursing Informatics, 2000. Available at: www.nursing-informatics.com/ changemant.html (accessed 17 December 2008).

(4) Evans, WD. How social marketing works in health care. BMJ, 2006; 332(7551): 1207-10.

(5) Department of Health. Choosing health. London: Stationery Office, 2004.

(6) National Social Marketing Centre. NSMC: about us. London: National Social Marketing Centre, 2007. Available at: www.nsms.org.uk/public/ default.aspx?PageID=6 (accessed 17 December 2008).

(7) Institute of Social Marketing. About ISM. Stirling: University of Stirling, 2008. Available at: www.ism.stir.ac.uk/about.htm (accessed 17 December 2008)

(8) Hastings G. Social marketing: why should the devil have all the best tunes? London: Elsevier, 2007.

(9) Mason P. Helping individuals to change behaviour. In: Ewles L (Ed.). Key topics in public health. London: Elsevier, 2005.

(10) Department of Health. At least five times a week: evidence on the impact of physical activity and its relationship to health. London: Stationery Office, 2004.

(11) Boynton PM. Selling health the Tesco way: every little helps? BMJ, 2007; 335(7623): 778.

(12) Department of Health: Change4Life: eat well, move more, live longer. London: Department of Health, 2008. Available at: www.dh.gov.uk/en/News/Currentcampaigns/ Change4Life/index.htm (accessed 17 December 2008).

(13) Hastings G, McDermott L. Putting social marketing into practice. BMJ, 2006; 332(7551):1210-2.

(14) Grilli R, Ramsay C, Minozzi S. Mass media interventions: effects on health services utilisation. Cochrane Database Systematic Review, 2002; (1): CD000389.

(15) Ewens A. The nature and purpose of leadership. In: Howkins E, Thornton C (Eds.). Managing and leading innovation in health care. London: Bailliere Tindall, 2002.

(16) Howkins E, Thornton C. Creativity in health care. In: Howkins E, Thornton C (Eds.). Managing and leading innovation in health care. London: Bailliere Tindall, 2002.

(17) Department of Health. Our NHS, our future, Next Stage Review: leading local change. London: Stationery Office, 2008.

(18) Department of Health. Our vision for primary and community care: NHS Next Stage Review. London: Stationery Office, 2008.

Julie Foxton

Physical activity co-ordinator for the early years, South East Public Health Group

Val Thurtle

Lecturer in primary care and public health, University of Reading

Mavis Ames

Team leader, Portsmouth City Council Health Improvement and Development Service
Box 1: Portsmouth City Council's Harvey Project

The Harvey Project was the brainchild of Portsmouth's Food and Health
group (a multi-agency partnership) and promotes healthy eating, good
oral health and physical health.

'Harvey' was created primarily as a promotional tool to engage with
children and their families, to provide clear and consistent messages
on healthy eating across the city and to address concerns expressed by
head teachers and school nurses regarding the poor nutritional content
of packed lunches. The tool was also developed to tackle a lack of
appropriate resources and health inequalities across the city. Harvey
was chosen by primary school children from a range of characters. He
was named 'Healthy Harvey' by local children, and a competition was
held to identify key slogans to attach to him. Winning slogans were
'Have a hoot with fruit', 'Twice a day keeps decay away' and 'Be a
sort, do lots of sport'.

A range of resources have been developed under the Harvey branding,
with input from a range of professionals. These include teaching
packs, leaflets and promotional materials. A costume has also been
made, so that a life-size Harvey can make appearances to celebrate
work around the three key themes within the city. This has been
extremely positive and children get very excited about his visits.
Parents and professionals have also fed back about the importance
of having confidence that the information they receive is from a
reputable source. They have confidence that the Harvey-branded
sources have been approved by local professionals, and that they
provide clear and consistent information.
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