What people really want

Marketing is not necessarily a bad thing, the NIPC conference was told. In fact, social marketing can be successfully used by health policy makers to make initiatives work. Prof Jeff French, a global expert on health communication, addressed the NIPC conference on marketing the concept of prevention; in other words, how do you sell the benefits of a healthy lifestyle to the public? Most of these initiatives are seen by the public as boring, and are often largely ignored.

Prof French’s key message was that policy-makers and opinion-leaders need to radically rethink how health and social initiatives are ‘sold’ to the public, in order to improve their chance of success. He dealt with the concept of social marketing, which he said needed to play a central role in all social policy, including health policy. Social marketing is defined as an approach used to develop activities aimed at changing people’s behaviour for the benefit of individuals and society as a whole.

The need to adopt social marketing thinking, Prof French said, is particularly important in view of the major behavioural challenges involved in implementing medical treatments and health policy.

He put the scale of the behavioural change challenge into perspective, pointing out that diabetes alone had the potential to bankrupt health services unless successful public health prevention initiatives were implemented.

He said people in the commercial sector will tell you that marketing is ultimately not about selling people things they don’t want, but about satisfying people’s needs and responding to them.

Prof French said governments don’t invest enough in evaluating whether their health or social change programmes actually work.

He outlined how social marketing thinking can be utilised effectively in healthcare and in health promotion. Social marketing principles, he said, can add real value to preventive public health interventions. Unfortunately, these are underutilised in the health sector and the relevant people have not been trained in their use.

He stressed that if people need to be persuaded to behave in a different way, some value has to be created for them in doing so.

Citizens want to become part of the solution to health and social problems, and those in positions to influence need to recognise this. “It is not up to us to simply tell them what to do because we think they’re stupid. Our job is to help them do the things they want to do.”

Key facets of this were creating value for people, empowering them, using citizen- focused strategies, developing smart and achievable behavioural goals dictated by theory, evidence and data, and building and sustaining relationships with citizens, partners and stakeholders.

Social marketing

Explaining how social marketing works, he posed the question - why do so many people in Copenhagen use bicycles? Do they do it to save the environment or to reduce their CVD risk factors?

No, they do it because it is faster, easier, more convenient and it gives them independence. This, Prof French said, indicates that you do not encourage cycling by simply saying it’s good for the environment and your heart.

This type of marketing, he said, should therefore focus on what people want rather than what we think they need, in order to achieve health or social policy goals.

Health policy-makers therefore need to reframe what they are offering. People put more value, he said, on things they can get now, rather than some benefit they may achieve at some distant point in the future. This can be expressed in different ways. It can of be personal value to the individual, but also of social value  – people appreciating that they are helping their family or their community. It can also have environmental and economic value.

Perception

As another example of health initiatives that are seen to provide real and immediate value to participants, he spoke about a breakfast club for schoolchildren in Greenwich, near London.  It was found that many of the children were arriving at school not having eaten anything, but after setting up a breakfast club to provide them with healthy food and nourishment, it was found that nobody was participating.

Children were asked about this, and they said they felt if they attended the club, people would think their parents did not look after them properly or that they were poor.  So the club’s emphasis was changed to a music club, where children were asked to come and listen to the latest music, during which breakfast would be served. As a result, practically every child started attending the club.

In terms of health policy-makers seeking to change people’s behaviour, they need to take account of the strong competition that is out there, Prof French stressed. This included the global food and drinks industry. The emphasis should be on creating health and social initiatives that inspire, engage and enable people, rather than just dictating to them what they should be doing.

Prof French said policy-makers can take initiatives such as introducing sugar and fatty food taxes. The trouble is, unless there is popular consent on these measures, once there is a change of government, these laws can get repealed.

Simply telling people they are wrong is not the right or complete approach. Prof French quoted Stephen Denny, who said a better approach was to give people a means to do what they are already doing a little better.

Starting in the right place

Prof French said you should not start with solutions. Solutions will emerge when you analyse what people say about what will help them and what will not help them, and when you analyse what you are up against in terms of the competition for trying to change people’s behaviour.

He said people generally find official government health interventions boring and dull and these initiatives tend to have limited success.

Alternative ways of doing things include introducing cheap membership of gyms or canteens providing an express checkout for healthy products. An Icelandic children’s TV programme called Lazy Town, run in partnership with the government and private sector, has proved to be a great success in many countries in making exercise popular and more attractive to children.

Health initiatives can also use concrete incentives to get people to change their behaviour. The NHS in Dundee gave people financial incentives to quit smoking.

This, said Prof French, not only gave participants a positive incentive to change their behaviour, but also gave them a dialogue that they could use with their peers on why they were stopping smoking. In other words, people could understand why their peers were quitting when they were told that there was a cash incentive involved, rather than hearing the usual message which they might simply dismiss as people giving in to the  ‘nanny state’ telling them what to do.

Citizen focus

He said citizen focus was very important. Health policy makers do not put enough research effort into understanding the people they are seeking to help. They need to understand what people are thinking, what they think will help and not help them, what they are afraid of, what motivates them.

If this is not understood, and policy-makers do not start acting to some extent like marketers, public health interventions will not work.

He said we need to move beyond traditional targeting to more segmented interventions to different types of people.  There is no ‘one size fits all’; a mix of interventions in implementing health and social policy is needed.

In summary, Prof French said social marketing principles can be successfully applied to the implementation of health and a social policy and this is backed up by research.

Beliefs and attitudes

Social marketing can help design programmes to change people’s beliefs and attitudes; can change behaviour and sustain that change; it can improve service uptake; it can ultimately reduce demand on services; it can impact on therapeutic compliance; it can increase the uptake rates of interventions and it can build trust and engagement among the public.

Basically, he said, more effort needs to go into policy makers listening and understanding, rather than simply telling people what to do.

Future

Jenni Jones, director of prevention, training and education with Croi, closed the conference with an account of how and why the NIPC was formed and its future plans.

She stressed that the NIPC’s mission statement centred on leadership, and through education and training producing a generation of leaders to advance preventive healthcare. The mission also involves the prevention and control of cardiovascular disease for all and the promotion of healthier living.

She said at present, there was an implementation gap between best practice guidelines and taking action in preventive healthcare.

Ms Jones cited the Euroaspire findings, which showed, for example, that around one half of people who were smoking at the time of a coronary event were still smoking afterwards. However, half of these said they intended to quit in the following six months. This was also seen in terms of changing other lifestyle factors such as losing weight- there is a desire there to take action.

She said health professionals have to deal with the underlying causes of CVD in terms of behaviour, as well as managing conditions through medical therapies.

The Lancet, in 2009 she said, put it very succinctly: “To salvage the acutely ischaemic myocardium without addressing the underlying causes of the disease is futile; we need to invest in prevention.”

And it is around this goal that Croi has based its activities and under which the NIPC will operate, she said.

The Croi MyAction community prevention programme had shown it was possible to change people’s behaviour if you give them appropriate support, and Croi and the NIPC would continue to provide interventions, education, research and training to raise the standard of care and improve prevention.

For further updates on NIPC activities see www.nipc.ie