Achieving success in improving people’s health, positively influencing social conditions, enabling people to lift themselves out of poverty and achieving social justice and equity are some of the focus points of social marketing. Since its original formulation, countless people and organizations in the world have observed, experimented and, more importantly, applied the ideas of marketing to social issues. Their work, though poorly chronicled in the professional literature (and a weakness hindering its broader acceptance in professional communities), has been documented and put into systematic form in several major publications and books on the subject. There are also several cookbooks for practitioners to help them apply social marketing.
For the past year, I have been using variations of this graphic in presentations to visually display in one place the essential elements of social marketing. It is designed for posting on your wall, serving as your screen saver, going anywhere with you so you can quickly access the major ingredients as you engage in program design. It’s not a textbook to wade through, a cookbook to leaf through, or a workbook to apply to each program you design. Rather, it is a map – not focused on the topology of your specific problem, not highlighting the shortest or even best route to a solution, but a reminder of the space you are in as you attempt to make change happen among people in need, organizations that serve them and community leaders and policymakers who create the opportunities and allocate the resources to support these efforts. The idea is to begin at the center and then work your way out to the edges where the program elements (tactics) take shape.
What the graphic depicts is an expansion of the essential components of social marketing as I currently distill them from the research and being involved in the development of hundreds of programs and campaigns. Take a look and then I’ll briefly discuss the pieces (right click on the window for a full size pop-up, suitable for printing).
The social marketing idea consists of 4 bands that exist for each priority audience or market a program addresses. These bands are the 4 big ideas in social marketing.
They are what distinguish social marketing from strictly communication, community-based methods, education, economic and advocacy efforts aimed at social change.
The Audience Benefit
Benefits exist in the mind of the audience, consumer or user. They are not tangible things, though tangible items can sometimes capture the essence of a benefit if carefully designed. Benefits tap into the underlying motivations of groups of people (or segments); they are not health, a cleaner environment, access to services or even money. For example, in our work with state children’s health insurance programs, the audience insight into the benefit for parents to enroll in SCHIPs was not access to care; it was peace-of-mind. It was being able to allow their child to fully participate in life like other kids without the parent’s nagging concern about ‘what happens if…?” Likewise, a major barrier to these same parents enrolling in the program was, strangely enough, the concern that by their enrolling in the program they were taking the spot of someone who they believed would be more in need of it than them. I say ‘strangely’ because the program administrators had not even conceived of that possibility.
The influence of social marketing in public health circles was its focus on population-based behavior change – not increasing awareness, changing attitudes or influencing perceptions and intentions as most health campaigns did then (and even to some extent now). Squarely placing behavior change as the outcome of interest has enormous implications for program architecture and design; it also makes results and accountability more observable too.
Under the target behavior, there are 3 sets of questions program designers must address – the nature of those questions will vary depending on the theoretical or ideological perspective they bring to the task. What the social marketing approach embraces is to understand the determinants, context and consequences of current behaviors, and desired ones, from the point-of-view (POV) of the audience. The determinants can include any number of variables specified by behavioral theory and research. However, the perspective on determinants needs to broaden beyond individual ones to include the many social determinants as well, some of which may fall under the rubric of context. Context is the ‘ground’ in the gestalt sense of the word in which individual behaviors ‘figure’ against the social and physical 'ground' in which people live. Poverty, housing conditions, social capital, the quality of built and natural environments, working conditions and public policies are examples of context – a context not just to understand, but also to potentially target for change in order to bring about healthier conditions and behaviors.
Finally, the consequences of current and alternative behaviors need to be assessed - see applied behavior analysis. What intrinsic, social and other rewards, modulators and punishments exist or can be created to enable people to move to healthier and more productive lives? Economists point to monetary rewards and penalties as one of the more important policy levers in influencing behavior change. Money has the property of being whatever people want it to be (in terms of how they think about it and exchange it for favored goods and services). Yet, in daily life there are countless other sources of rewards and punishments (or at least inhibitors) for current behaviors and healthier alternatives that marketers concern themselves with in this analysis.
Products, Services and Behaviors
One of the great dividing lines between social marketing practitioners in the developing world and the developed world has been erased. That is between social marketing that focuses on product sales and the movement of commodities and social marketing that focuses on behavior change. What has become clear to both 'camps' is that products and services can be necessary, but not sufficient, conditions to improve health (e.g., condoms for HIV prevention, LLINs for malaria control). What’s crucial, and the point that the advocates of free distribution leave out and is the rallying point for all social marketers, is that people must use these products and services (e.g., family planning, testing and counseling centers, prenatal clinics) and change behaviors to impact morbidity and mortality. These are the most important things to be measuring and influencing. We are not satisfied with sales figures, visits, products distributed, exposure and other measures of process - behavioral outcomes define success. Health and social outcomes then follow.
The point that gets lost on the behavior change proponents is that behavior change is an incremental process that must start with people’s current realities and that the suggested behaviors must be relevant to their lives – not a theory or research finding. Thus, while programs may have desired behavioral outcomes, helping people get to that point may mean designing programs that focus on shaping, or targeting incremental, behaviors. For example, while consistent use of a condom in high risk situations may be an objective for an HIV prevention program, depending on the audience the incremental behavioral steps might include seeking out and getting one, negotiating with a partner to use it and correctly using it. When thinking about HIV prevention more broadly, other behavioral steps include getting tested for HIV, being faithful to a partner, abstaining from sex and getting prophylactic treatment if pregnant and HIV positive to prevent HIV transmission to the infant. The important point that social marketing brings to this discussion is that the behaviors we focus on should be ones that the people we work with agree are relevant, possible and they believe they are able to do in their daily lives (not just as part of a research protocol). If not, then we need to back up and work on earlier steps in the behavior change (or behavior chain) process.
Whether it is a behavior in the chain of behavioral steps to the ultimate target behavior, or a product or service offering that supports or enables behavior change, the ideas of branding, personality (image or tone) and positioning come into strategic play. Explicit here is the need to understand the competition, whether it is other organizations, interests and programs or competing behaviors (doing one thing versus another). Branding is not the logo, theme song and tag line of a campaign or a program. It is what the behavior and program mean to the people. An exemplar of this approach is in developing conservation programs in tropical developing countries, where Rare’s programs use a threatened species for image and communication purposes, but the brand is Pride that supports behavior and conservation objectives. It’s unusual to find such sophisticated use of brands in social marketing programs (truth is another good example) because most programs forget that they are in the psychology business, not dictation.
The Marketing Mix
What we need to be better at in social marketing is understanding that our products, services and behaviors have to be designed with specific features that appeal to our target audience. The 5 A Day program, for instance, designed behaviors to support the objective of increasing the number of servings of fruits and vegetables people eat each day by listening to and then incorporating the ideas of the priority audience – behaviors that focused on ease and convenience - rather than developing and promoting recipes (as a counter example) that had more fruits and vegetables in them. Our products and services likewise need to be thought about from a design POV – how their use and the experiences they create for the audience reinforce or inhibit healthier choices and facilitate or impede access and opportunities to engage with them.
Social marketing has taken the idea of price beyond monetary ones to include psychological, social, geographic and other rewards and punishments for everyday behaviors. An exclusive focus on just monetary costs limits social marketing programs and leads to marketing myopia just as much as a focus on psychological, social or physical barriers does. If we understand the consequences of behavior and behavior change, then we can begin to judge the salience of various levels and types of prices for current and alternative behaviors from the audience POV. We then have the chance to develop programs that realign incentives and costs for products, services and behaviors that resonate with the market and lead to better outcomes.
Access and opportunities to healthier and health-promoting products, services and behaviors is the big step between wanting to engage in a healthier lifestyle and being able to do it (placing opportunity within an arm's reach of desire). Access to products and services, in concept, is fairly straightforward – though execution and logistics in resource poor environments to make these a reality can be daunting. Equally important, especially to the behavior change minded social marketer, is creating access and opportunities to perform the healthier alternatives – or not practice the unhealthier ones. Clean indoor air laws clearly address the latter issue, while increasing the availability of fresh fruits and vegetables, having more safe places to be physically active and offering healthier options in restaurants and fast service establishments are examples of improving access and opportunities to engage in healthy behaviors.
The promotion of a target behavior is the realm of persuasive communications efforts. While much attention is given by many practitioners and people who should know better as to how to craft messages and identify channels, select credible sources, and target messages to receivers of wisdom, the S-C-M-R model is under deservedly heavy fire by theory, evidence and new technologies that are reconceptualizing the role of the audience as a producer and not just a passive recipient of health information. In social marketing, our aim needs to be higher. An under-appreciated aspect of communication theory that supports marketing, and especially the creation of markets, is agenda-setting theory: how to develop and marshal support for public policy initiatives among policymakers, the media, opinion leaders and the general public. Media advocacy and social marketing, while favoring different tactics, both focus (or should) on broader population change objectives that alter the 4P context in which behavior occurs. It’s no accident that many tobacco control policy initiatives focus on increasing the price of tobacco, restricting access and sales, removing opportunities to smoke, banning various promotions and advertising activities, and increasing access and opportunities for smoking cessation services. Too few social marketing efforts expand beyond 1P marketing efforts that favor communication tactics and vehicles – the traditional “un-4Ps of PSAs, posters, pamphlets and publicity” that now include entertainment, social and mobile media. Promotions (communications) need to work with the other 3Ps in an integrated way to increase the likelihood that a high percentage of people in our priority audience engage in healthier and socially beneficial behaviors.
A picture, and about 2,000 words, of what I see as the social marketing idea. I invite you to provide your own takeaway.