On Social Marketing and Social Change

Revising HIV Prevalence Figures and Lowering Them: Better Research is Needed

Mead Over at the Center for Global Development looks at the downward revision of HIV prevalence figures by the UN. After dissecting the reasons for the flip, which he largely attributes to more accurate data from India, he goes on to add:

So the scandal here is not about exaggeration of the total number of HIV infections. It's about the failure of international donors over a period of 20 years to conduct enough research on HIV prevention. The world seems to be split between two types of people. On the one hand are those who think the benefits and cost-effectiveness of HIV interventions are so obvious that it would be unethical to divert money from implementation to research. In this well populated category we can place the $250+ million Gates-funded Avahan prevention program in India, which favored rapid start-up of implementation over building in data collection that would have permitted a rigorous evaluation so that those in India and elsewhere could learn how well it was working. On the other hand are people who think HIV prevention is hopeless because "people can’t change their sexual behavior" and who are only willing to consider medical interventions like treatment or a vaccine while opposing HIV prevention research. Where are the donors in the middle, who believe that HIV prevention may be cost-effective, but recognize the gaps in knowledge and are willing to invest to find out exactly how cost-effective they can make it?

You can read more about the need to support HIV prevention research, and act on your beliefs, by going to The Sydney Declaration: Good Research Drives Good Policy and Programming - A Call to Scale Up Research  issued by the International AIDS Society in July 2007:

Ten per cent of all resources dedicated to HIV programming should be used for research towards optimizing interventions utilized and health outcomes achieved.

Yet, as I have noted here before, simply conducting more research programs that focus on changing the behavior of individuals and are not designed from the beginning to achieve scale, are not our answer either.

Mobile Health Applications:SMS

The Wall Street Journal features the use of SMS for providing basic health information. Besides the pin-up project, SexInfo, the report describes several applications for appointment reminders and other treatment adherence behaviors. Other projects include psychological support for people with bulimia in Germany, adjunctive therapy for people who are quitting smoking in New Zealand, diabetes management in Scotland and a clinical trial in Africa to improve tuberculosis treatment in rural villages.

For more on mobile applications for health - and ones that are pushing the envelope. And ways to be thinking about going mobile for change.

UN Revises Global HIV Prevalence Estimates

A story long in the making went public today: The UN has revised its estimates for HIV prevalence around the world.

From the full report [pdf file]:

In 2007, advances in the methodology of estimations of HIV epidemics applied to an expanded range of country data have resulted in substantial changes in estimates of numbers of persons living with HIV worldwide. However the qualitative interpretation of the severity and implications of the pandemic has altered little. The estimated number of persons living with HIV worldwide in 2007 was 33.2 million [30.6-36.1 million], a reduction of 16% compared with the estimate published in 2006 (39.5 million [34.7-47.1 million]). The single biggest reason for this reduction was the intensive exercise to assess India’s HIV epidemic, which resulted in a major revision of that country’s estimates. Important revisions of estimates elsewhere, particularly in sub-Saharan Africa, also contributed. Of the total difference in the estimates published in 2006 and 2007, 70% are due to changes in six countries: Angola, India, Kenya, Mozambique, Nigeria, and Zimbabwe. In both Kenya and Zimbabwe, there is increasing evidence that a proportion of the declines is due to a reduction of the number of new infections which is in part due to a reduction in risky behaviours.

Because estimates of new HIV infections and HIV-associated deaths are derived through mathematical models applied to HIV prevalence estimates, new estimates of HIV incidence and mortality in 2007 also differ substantially from earlier assessments. It is emphasized that these differences between estimates published in 2006 and those published in 2007 result largely from refinements in methodology, rather than trends in the pandemic itself...

Global HIV prevalence—the percentage of the world’s adult population living with HIV—has been estimated to be level since 2001. Downward trends in HIV prevalence are occurring in a number of countries, where prevention efforts aimed at reducing new HIV infections since 2000 and 2001 are showing results. In most of sub-Saharan Africa, national HIV prevalence has either stabilized or is showing signs of a decline. Côte d’Ivoire, Kenya and Zimbabwe have all seen declines in national prevalence, continuing earlier trends. In South-East Asia, the epidemics in Cambodia, Myanmar and Thailand all show declines in HIV prevalence.

Conversation with Greg Cowal

At our last Conversations on Social Marketing session Greg Cowal spoke about his company’s [GSP] efforts to assist Proctor and Gamble in reaching ‘the next billion’ – mostly poor women living in developing countries. In Mexico, where he is implementing the Golden Stores project, 620,000 changarros or ‘Mom & Pop’ grocery stores account for 65% of all purchases of fast moving consumer goods (FMCG).  The Wall Street Journal has described these ‘high frequency’ stores where the average customer shops at least 4-5 times a week as: Crammed with food and a hodgepodge of household items, these retailers serve as the pantries of the world’s poorest consumers for whom money and space are tight. P&G saw the need to penetrate this market segment with its products in a consistent way.

The project is part ethnographic research where the project staff live with these retail owners in their own homes for a month or more to get a deep understanding of their lives and how running a retail operation works (or doesn’t) for them. Next comes a store detailing and merchandising program that identifies highly visible shelf space and turns it into a P&G showcase of their brands. It is a staff intensive program that is largely managed through cell phones and GPS systems. Regular follow-up by staff and retailer education and support programs centered on running a more successful business round out their activities. It is a clear demonstration of how successfully marketing FMCG to consumers can ultimately depend on how well your brands are marketed to the retail owners (people critical to success) and at the point-of-purchase.

Some of the insights Greg and his team have taken away from the experience so far include:

These shops are family owned and most members participate in one way or another – the opposite to this is where one member wants or needs to have an extra income.

They are not good at managing their income or budgets.

They live on a day to day basis.

A changarros' life span is 3 to 5 years.

The owners are not good at changes or modernization.

They do not trust or use banks.

The idea of someone coming into their store and changing their layout was - and still is - a work in progress.

In the end, what has been our major success has been the SERVICE provided to them.

Stoppping the Nonsense

A meditation for a Sunday morning - or whenever you are seeing this.

An [sic] lot of nonsense has been written about social marketing, that it's a waste of money, but we've shown the way it can be done effectively...Changing people's behaviour is the hardest thing to do, but government has a responsibility to set out an example and inform people. Unless you get your branding right, you're going to fail because no-one's going to understand you. - Roger Williams, head of marketing at the Scottish government.

And for more food for thought on social marketing.

Internet Addiction

Up to 30 percent of South Koreans under 18, or about 2.4 million people, are at risk of Internet addiction... They spend at least two hours a day online, usually playing games or chatting. Of those, up to a quarter million probably show signs of actual addiction, like an inability to stop themselves from using computers, rising levels of tolerance that drive them to seek ever longer sessions online, and withdrawal symptoms like anger and craving when prevented from logging on.

To address the problem, the government has built a network of 140 Internet-addiction counseling centers, in addition to treatment programs at almost 100 hospitals and, most recently, the Internet Rescue camp, which started this summer. Researchers have developed a checklist for diagnosing the addiction and determining its severity, the K-Scale. - NYT, Sunday, 18 Nov.

You can check your level of Internet Addiction here.

Some more background. Moral: Be aware of unintended effects.

m-Government: The Next Frontier in Public Service Delivery

An interesting follow-up to a post earlier this week about mobile networks in developing countries. I just received a notice about a World Bank sponsored conference of the delivery of public services through mobile phones on November 29th. From the announcement:

According to the ITU, the total number of mobile users worldwide as of late 2006 was about 2.7 billion and the number of internet users was just above 1.1 billion. This means that there is at least 23.6% of world population (and at least 22.2% of developing countries population but in reality more) who already have mobile phones but are not yet using the Internet.

Questions to be explored at the seminar may include:

• Does this provide a strong case for leveraging the mobile channel to dramatically improve access to public services, including electronic government services to those who can afford to use a personal or shared mobile phone (e.g. Village Phone)? Does this create an opportunity to connect in the near future the next two billion people to some of the benefits of e-government, e-health, e-education, e-banking and e-commerce?  Should the governments and development community take this opportunity to drastically improve access to information and services much more seriously?
• Can Mobile Government transform the lives of common people in developing countries? What are best examples of such impact? What are the types of services which can be easily provided on mobile phones/devices ("quick wins") and what the more strategic high-impact services ("killer applications")?
• What are the key constraints to making this vision a reality? What are the critical success factors and lessons learned?
• How should governments and donors change the way they do business to take full advantage of mobile technologies?
• What is the role of the private sector? Are there successful business models (e.g. PPP) for private sector companies to support value-added m-government services?

It sounds like a fascinating few hours that may be well worth your time in person or via webcast. R. Chandrashekar, Additional Secretary (e-Gov) for the Government of India will be a keynoter explaining how up to 50-60% of government services in India can be delivered via mobile channel.

I have to be out of town that day but will appreciate getting a report from anyone who can attend and will share it here.

Just when you thought it may be safe to forget about mobile again.

The Price of Social Marketing: More Social Marketers' Thoughts

The article about social marketing in last week's Boston Globe and my post in response to it have generated an unprecedented conversation among social marketers and others including a note at the Chronicle of Philanthropy. The social marketing list serve had a number of contributions on the subject as well. So to get these voices 'on the record,' I asked several of them if they would agree to my posting excerpts from their comments. The response was immediate - literally overnight - and positive. So here they come. Hopefully, they will give you more to think about when it comes to your own work.

The Boston Globe article still is quite interesting beyond the idealism presented, because it questions the presuppositions of social marketing and its opponents (that have to be tested to then develop feasible strategies). I always wondered whether they are right but cannot judge that myself (except that if you want market structures to develop e.g. distribution of condoms, then you have to start it at one point, and better early to minimize the inhibition of  entrepreneurship. That seems at least on that general level clear beyond reasonable doubt). - Mathis Danelzik

[In response to a question of when was social marketing ever defined as selling products] ...it illustrates how isolated our international and domestic social marketing programs have become. The first large-scale social marketing programs were international - the early diarrheal disease work in El Salvador by Manoff - AED's work in Honduras and The Gambia and then Egypt and very soon after the social marketing of contraceptives by PSI, the Futures Group, AED and others. Tens of millions of dollars have been invested in designing, conducting, and evaluating these social marketing efforts. 

From the very beginning they were product oriented and not message oriented. That is the solution to a problem was found in social marketing of new products and services. Give-a-ways were never part of these early social marketing efforts. Products - condoms and contraceptives, ORS packets, etc, were physical products - with real costs, distribution channels, and promotion efforts.  Price was discovered early on to ADD VALUE to products and some of the most interesting pricing studies among the poor have been done by these programs going back 30 years. But they are all but unknown by most "public health" social marketers in the US. - Bill Smith

The issue I would have with these studies is that the relevant behavior should not be how many people GET drugs or condoms or bed nets. It is: how many were used! The argument for charging (usually very low) prices and not giving things away is that they will be used because the target market has invested in them.

Public programs and Bill Gates can give away a lot of products but if they just sit there and not get used, it is not good social marketing. (An MBA student told me of visiting a household in Africa and finding 50 bed nets in a second floor room. When she asked about them, the person said: "Oh those are no good. They were free from the government.)

Finally, charging a price is not a requirement of social marketing. It may be the best tactic but the challenge is always: did we get the behavior we wanted.  - Alan Andreasen

In my own experience price is just like the other three Ps - it is driven by consumer perception. Price can add value to consumers who distrust government hand-outs - it can be a burden to people who value the product less than the price, or  a free hand-out from a trusted source can be perceived as a wonderful gift...

Marketing does not need to replace charity - but where people can pay; where people are willing to pay; and where people value products and services they pay for over free ones, then marketing has help reduce the burden on charity and increase efficiencies in the social system.

The important thing about marketing is that it is a process for answering these questions for specific segments of the population, under specific conditions at specific time periods. That, in my mind, is its real  contribution to social change. The quality of pricing studies in many of the international social marketing programs have been very high. I do think it is disappointing that many of our domestic social marketing programs here in the US have not given as much attention to pricing.

As someone has said everything has a price - it may be self-respect for someone, time for someone else, or 200 dollars for someone else. The question is figuring it out. I think broad generalizations about price being good or bad are not all that helpful. - Bill Smith

What frustrates me about this argument [in the Globe article] is the lack of focus on segmentation. If we're the marketers we claim to be we know that just because some women in the US will pay $15 for shampoo doesn't mean others will - never mind whether men in India will. So because one deworming study - which didn't talk about which segment they studied - showed people used more if it was free, that means everything should be free? In social marketing if price (monetary or other) is the barrier - we aim to get rid of it (make it free, lower the price, etc).  But if for some segments price isn't the barrier, then we have a reason to consider charging.  Here we see people avoiding the free government condoms when possible as they are thought to be bad quality (same exact condoms as the subsidized ones) - but if they don't have access or money for the other brands they will occasionally use the free ones. It's about making sure the appropriate options are available to them, sometimes they need the whole range of options. (and then we move on to the rest of the marketing mix). - Risha Hess

Thanks to all of the contributors on the list serve and especially those who gave me permission to reprint their comments here. If you'd like to subscribe to the social marketing list serve, send an e-mail to: [email protected]

In the message space, put: subscribe soc-mktg <your name>

Social Networks or Mobile

I was invited out to lunch last week where the question quickly turned to what type of strategic direction an organization should take in the new media space. Knowing better than to presume, I asked what they meant by new media and it turned out to be social networking sites and/or the b'sphere. Well, there is certainly lots of action in those places and, for public health, some interesting opportunities. Though I think the Second Life phenomenon, despite the spin, has slowed to a crawl and is on the verge of becoming the fad it always was. My advice to them, and since it only cost them lunch is free to you too, is to think mobile. There are any number of reasons for my position here, and here's a recent presentation on marketing with the connected consumer that outlines some of them. A news article I read today, however, shows how far reaching the mobile trend will go as the CTO of Verizon says that their whole 4G strategy is built around the idea of mobile platforms performing social networking functions: What we see is the typical person today at Facebook or YouTube, or any social networking site, being the major wireless user of the future... 4G isn't going to be about more voice (services) or more text messaging...It's going to be about interactive applications - customers that are far more comfortable with and demanding of interactive applications, people who believe interactivity is a right.

So if you are thinking ahead, and I realized again today that many people don't look past next month or where the next Benjamins are coming from, social networking behaviors are not going to go away - they will shift to the seventh media of mobile phones.

For the readers who say to themselves "I work with the poor and vulnerable, the Internet and mobile won't affect my work" - consider this recent announcement:

"The World Bank is now doubling its commitment in Africa's broadband infrastructure development in the next five years by investing $1 billion in broadband infrastructure development," said World Bank director of operations, Hartwig Schafer. He added that the aim of the funds is to make sure that the continent catches up with the rest of the world in broadband connectivity...Celtel International, Africa's second largest mobile service provider, received a $320 million loan for expansion in five countries on the continent, including Madagascar, Uganda, Sierre Leone, and Malawi. Celtel has a presence in 14 African countries.

Then there's a recent market report from the World Resources Institute [pdf file] that concludes:

Mobile phones already have an enormous lead over computers in developing countries. Moreover, phones are relatively easy to master, generally require no sophisticated technical support, and, as voice-based devices, pose no literacy barrier. Phones are less expensive than computers - basic GSM models designed for developing countries are approaching US$30 - and service is often offered through prepaid business models that are more affordable for BOP consumers...Equally important is the potential for low-cost fixed wireless networks in rural areas, bringing Internet access - and Voice-over-Internet telephony - to phones and other devices in areas too sparsely populated to support conventional cellular networks. Adding a WiFi chip to a mobile phone to allow access to such rural networks will cost only a few dollars.

The combination of powerful phones, inexpensive networks, and voice-accessible Internet applications - for obtaining market prices, health information, or government services - may open up the Internet to large numbers of new users. [Ed Note: had to underline that!].

Regardless of where you are reading this (and God forbid someone's doing it on their cell phone, though if you are check the Plusmo feed I have) - you can sit and wait for it and try to catch up..or you can lead.

Conversation with Doug Evans

Doug Evans, who worked with me at Prospect Associates and AIR, is a leader in conducting research on the use of brands as a strategy in public health programs. Not logos and slogans, but for behavior change. The quest began with his pioneering work for the American Legacy Foundation and the truth campaign, and will come together with a number of like-minded professionals in a book on Brands and Public Health in the Spring 2008. Doug’s presentation at Conversations of Social Marketing covered a lot of ground – theoretical, practical and empirical here are some of the highlights from his talk.

Overview and Critical Takeaway Points

• Brands in the commercial and public health sectors add value to the relationships between products and consumers.
• Public health brands can be differentiated from commercial brands by their purposes (changing health behavior), value exchange between brand and consumer, and outcomes (health behavior change).
• Brands can apply “upstream” – such as to organizations and government policies – and “downstream” to individual behavior.
• Branding is a global social marketing strategy that has demonstrated  evidence of effectiveness across cultures, country settings and topics.
• More research is needed on how public health brands work, and more brands should be developed in the public health sector.

He talked about how brands work in both the commercials and public health context. In particular he pointed the persuasive mechanisms that great brands employ including tapping into the audience’s aspiration to an appealing external ideal; modeling a socially desirable good; being associated with this idealized imagery and then delivering on this promise.

What is public health branding? He described it as associations that enhance value of health behaviors for an audience (better life as a nonsmoking, physically active, condom user); that is, public health brands are about healthy lifestyles. 

How to measure brand equity in public health is an issue he and his colleagues have spent much time exploring; their data have led to the development of the Public Health Brand Equity Scale.

How can the effectiveness of brands be evaluated?

• Was the audience exposed to message?
• What were audience message reactions (message perceived as credible, likeable?)
• What associations were formed by target audience with brand?
• Is brand exposure associated with positive reactions and associations?
• Are reactions and associations related to intended behavior change?

Doug also presented some of the evidence supporting the use of brand strategies in public health including:

• Overall, social marketing has been found to be effective, but with small effect sizes in the 5–9% range (Snyder et al. 2002).
• There is limited evidence on targeted message strategies, including branded campaigns.
• Most effective branded campaigns are found in tobacco, nutrition/physical activity, HIV/STDs (Evans, et al. forthcoming).

Some of the results he cited included those of Farrelly et al. (2005) who showed that the truth campaign was associated with 22% of observed decline in youth smoking prevalence from 1999 to 2002. Siegel & Biener (2000) found that  12–13 year olds in Massachusetts exposed at baseline were less likely to progress to established smoking; no effect was found for 14–15 year olds or with exposure to radio or outdoor ads. Sly et al. (2002) documented that teens with anti-tobacco industry attitudes promoted by Florida TRUTH were 4 times less likely to initiate smoking & 13 times less likely to become established smokers.

He closed by offering some suggestions for future research efforts in this area:

1. To what extent, and under what conditions, do public health brand equity effects increase over time?
2. How does the relationship between PH brands and audience change over time?
3. Can public health brands withstand fluctuating media buys, low exposure?
4. What effects do changes in social norms and other moderators such as the media and marketing environment have on brand equity and its mediating effects?
5. How can social marketers improve the effectiveness of brands in maintaining health behavior change over time?

Marketing and Development

The use of social marketing in international development, especially for health improvement, gets a critical look in today's Boston Globe (A handout, not a hand up).

In public health, many aid groups have embraced a strategy of stimulating demand for goods such as condoms, anti-malaria bed nets, and water-purification systems through education and advertising, and then selling them at very low prices through health clinics, kiosks, and itinerant vendors. One goal of this strategy, called "social marketing," is to create homegrown distribution networks that wouldn't exist if the products were simply given away. But another has been to persuade people to value products that are good for them, and for several decades it's been the conventional wisdom that unless people spend money on something they will be unlikely to value it - or use it. Give things away and they will be taken for granted, it's thought...

But in the last couple of years there has been a sharp backlash against this philosophy that has pushed its practitioners off-balance and led economists to take sides. Some officials with the World Health Organization have started to speak out against the practice. High-profile development scholars, including the Columbia University economist Jeffrey Sachs, have joined a chorus of criticism, and several economic studies have chipped away at the rationale behind social marketing.

The focus of the piece is on two recent studies that question the relative value of social marketing to free distribution methods. And while the balanced part of the piece does include some proponents calling for complementarity in strategies, the media advocate in me realizes that when your opponent gets the first and last word in, the reporter's mind was made up.

What puzzles me is that the reporters and commentators on this issue leave unexamined comments by the 'free distribution' advocates such as this:  Kremer argues that the logic of "free = life" has been so amply demonstrated that it should be extended to every basic health good, including condoms. Start adding up the costs for subsidizing health-related products such as food, condoms, bednets, soap, clean cooking fuels, AZT, ACT, clean water supplies, vitamin supplements, oral rehydration salts and therapies, treatments for tuberculosis and pneumonia, reproductive health products and services, tobacco cessation programs, obesity prevention programs, treatments for mental illnesses, and ... [add your own favorites here] and I wonder where all the resources will come from, and what the trade-offs would be. Yet, while the article is framed by the idea of trying to achieve sustainability in development programs (more on social marketing approaches to sustainability) these questions remain curiously unaddressed and unexplored. We should be talking about realities, not ideologies, and seeking practical and sustainable approaches to improving the health and social conditions of poor and vulnerable peoples.

I do hope that this conversation leads to more research on which to establish an evidence base that addresses the question: Which distribution and pricing strategies, promoted for which products and services, under what conditions, work for specific groups of people? And if you like, don't call it marketing.

Kvetching about Social Marketing

It is rare to see a news article about social marketing (as opposed to the few that cover social marketing programs). And speaking from recent experience, even rarer when the reporter actually talks to social marketers and not economists. So I was very interested to see how interviews I and a few other social marketers turned out in the Washington Business Journal.

The first challenge was finding a copy of the paper; which I never did. Going online, the WBJ only shows the first graphs and then asks for a $98 annual subscription fee to continue (well, not THAT interested!). Then I found that the article has been syndicated in the South Florida Business Journal, and, you guessed it, they offered free access. [That's a bitch. I go back tonight to make the link for you and they have shut off access to it too. Fortunately I printed it off yesterday. SO you'll have to trust me on the rest from here.]

I started reading the article...profile of the Save the Crabs, Then Eat 'Em program in the first three graphs. And then the kvetching began - by the other social marketers! I should have suspected as much from the headline: Selling bitter medicine.

The problem that social marketing has is that our behavior and products are always the crummier ones...

It's a lot easier to describe what an iPhone does than it is to describe why you should tolerate other groups...You're dealing with intangibles.

Given the challenges, there are teeny budgets. Gillette gets a billion dollars to present a new razor and somebody has to prevent AIDS with a budget of $500,000.

Sandwiched between the program and these quotes was my rhapsodizing on the potential of new media and mobile technologies for reaching new audiences and facilitating behavior change; but nothing new there.

The brand manager, public relations counsel and/or CEO of Social Marketing Inc would apoplectic (or at least dyspeptic) over some of these comments. Let alone what the customers and shareholders (should) be thinking: you get a chance to tell our story and this is what comes out?

What about the behavior changes that do occur? And most commercial marketers I know who have migrated to social marketing have done so because they think these are the most important and inspiring behaviors and products to work on.

Beyond confusing product attributes and product benefits - and trying to compare the two, don't tell most commercial marketers that they have the easier job - especially when their competitors are really out to eat their lunch! When you deal with brands, it's always about intangibles - and getting that right is something most companies don't do easily either.

Marketing success is not a linear relationship to marketing expenditures. And that goes for social marketing projects too. Just check out the annual marketing budgets of some of the top 10 brands - Heinz ketchup clocks in at $413,800! Nope. The key to success is the amount of cognitive effort that goes into any good (social) marketing program - that includes research, strategy, creative and execution.

We all can appreciate the frustrations and concerns that drive this type of talking. And it's been a conversation that's been going on among social marketers for quite a long time now. When talking with the public however, get over it!

I can't believe the time has come to have to suggest that we need to issue some talking points for spokespeople on what to say about social marketing. Here's my starting suggestion:

Principles #1, #2 & #3: Focus on the benefits.

I'd like to hear what some of your talking points are.

With friends like this...

Two Calls for Abstracts: Two Social Marketing Conferences

I have two calls for abstracts sitting in my inbox for social marketing conferences in 2008 - one ever reliable and one claiming the 'world' title.

The 18th Annual Social Marketing in Public Health Conference, to be held 18-21 June 2008 in Clearwater Beach, FL, invites abstract submissions to be considered for oral presentations. The deadline for submissions is 4 January 2008. The content should demonstrate the application of social marketing to health behavior change and improvement of public health and community health practice. Abstracts may describe contributions to theory, completed work involving social marketing, or work in progress that will be substantially completed by June 2008. Information for abstract submission.

The 1st World Social Marketing Conference, to be convened in Brighton, UK  29-30 September 2008, has issued its call for abstracts for the academic program.

We encourage submissions from all disciplines, from all parts of the world, on all topics related to social marketing.  We are interested in empirical or theoretical contributions to social marketing, whether quantitative or qualitative.  We do discourage case study submissions; because the conference has a practitioner track, we would encourage case studies to be submitted in that track.

Participants have two options for submission: Complete paper submissions and working paper submissions.  All submissions will be evaluated in a blind peer review process.  Accepted complete paper submissions will be scheduled for oral presentations.  Accepted working paper submissions will be scheduled for poster sessions.

More information about the conference is available at the National Social Marketing Centre. The submission deadline is 29 February 2008. The abstract guidelines [pdf file].

Conversation with Richard Pollard

I was delighted to have Richard Pollard accept an invitation to join our conversations on social marketing this past week. I had met him in the past few months and quickly found not only a fount of colorful stories from the earliest days of social marketing, but one of the most innovative thinkers in focusing on the role of social marketing in the health marketplace.

Today, Richard may be best known for his contributions to the development of the Total Market Approach (TMA; pdf file) which has spawned some corollary movements including Making Markets Work for the Poor [pdf file]. TMA isn't something you'll find in any of the social marketing texts, and indeed, it seems to be known and discussed by only a few in the international development field, including at Global Health Policy and private sector development staff at The World Bank. However, he clearly showed its evolutionary arc from the first social marketing projects of the 1970s, and their even earlier progenitors - social responsibility campaigns in India in the 1960s. Part history lesson, and part glimpse into the future, Richard provided an impressive and thorough introduction to some ideas you will be hearing more about in the years to come.

The presentation began with the recognition that behavior change programs that require a product or service to ensure compliance must ensure these services are available, accessible and affordable. BUT… there are often inadequate public sector resources to achieve equitable coverage and sustain it; donor fatigue at continuing to put funds into the same programs for years if not decades; and the unmet needs of substantial segments of the population even after implementation occurs that are often related to access issues and existing realities.

One of the more important slides Richard showed was a chart depicting the relative share of pocketbook that people spend in countries such as Kenya, Cambodia, Egypt, India and China. In all instances, more than 50% of people's health expenditures are in the private sector and in no case did health expenditures in the public sector reach 40%. His point is that there is already a fragmented marketplace for health products and services that is by it's very nature inequitable (it favors people who can afford to pay for products and services even in societies that are, in theory and by design, suppose to provide public services to everyone). The development of the TMA approach is, in part, an attempt to correct some of these marketplace inequities and develop more sustainable long-term solutions to health problems.

Richard defined TMA as one in which all sectors (public, private and NGO or donor-financed social marketing) are integrated within one “market” that is segmented by willingness to pay. The objective is to open up the market to the commercial sector through better targeting of public and NGO/social marketing subsidies to the poorest of the poor and allowing the commercial sector to develop products and services to other groups more able and willing to pay [Ed Note: see for example The Next 4 Billion]. The overriding issue confronting TMA approaches is to ensure total market growth and rural/ low-income access that gains more users and, therefore, increased volume through rural wholesalers and community-based distribution. A TMA approach must also insure that commercial interests are not squeezed out of the market (whether it be for condoms, oral contraceptives or LLINs) by free or very low cost public or subsidized social marketing supply to those who can afford mass market prices and are willing to pay. Finally, there must be in place a fair regulatory and policy playing field.

He identified the roles of social marketing organizations (SMOs) in TMA as:

• Assisting all sectors to move to a TMA over time.
• Selling commodities to achieve a behavioral result
• Helping the public sector achieve better targeting of subsidies, and implementing cost recovery as appropriate.
• Regarding their own brands as a strategy to open up markets for future commercial sector.
• Supporting national, integrated demand generation activities across all sectors.
• Motivating the commercial sector to re-price brands and modulating product price subsidies where required (LLINs or ACT).
• Developing community-based initiatives linking communciations with the provision of commodities.
• Pursuing public-sector and NGO-sector outreach.
• Exploring and implementing micro-credit and other BOTP approaches.
• Creating adequate demand on rural kiosks/ shops.

TMA will only work well when driven by consumer demand and choice. He pointed out that consumers are more than willing to pay whatever they can afford. A payment adds value! There are also no quick fixes for a market. One low cost brand cannot make a market; it requires multiple brands and pricing coupled with strong demand. Finally, an equitable market is one where all sectors of  society have access to a range of brands they can afford and market subsidies/ distortions are carefully targeted. To my way of thinking, all the types of activities social marketers who understand the role of markets in health behavior change may be among the best to plan and undertake.

With his closing slide, Richard made the following points:

• Most markets are unique and are at different levels of maturity.
• Notably, public sector policies/ capacities are different; existing demand levels are different.
• The role of an SMO is to (1) identify strategies to move towards a TMA over a realistic time-frame and establish its own strategies and (2) establish market positioning of their own brands and policies within that framework for each country.
• The role of donors is to work within long-term market development scenarios.

The next time you hear someone talk about upstream approaches to public health, ask yourself if they have reached the core and identified the strength of the social marketing approach: competing in and harmonizing the marketplace of behaviors, ideas, products and services.

[Update: See also Social Marketing, Total Market Approach and the Base of the Pyramid].

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Conversation with Katya Andresen

Conversations on Social Marketing this week kicked off with a presentation from Katya Andresen on the essential elements of social marketing for nonprofit organizations and NGOs. Some of the key points she made during her presentation included her expansive view of where social marketing thinking belongs in the portfolio of an NGO. She identified the usual suspects of outreach efforts and programs. But as she goes into great depth in her book Robin Hood Marketing, she also sees fund raising, media relations, train the trainer activities and corporate partnerships as benefiting from an audience-centered approach. [Note: one of Katya's preparation rituals is to spend the time before her presentation mingling with the participants to learn about them.] Now that she has entered the b'sphere with her blog Getting to the Point, she also adds online and social media to her list of times when one must think like a marketer.

Katya noted that there are three core ideas that nonprofit marketers have to internalize to be successful social marketers:

• Knowing that mission statements aren't enough to create change or attract attention.
• Looking at the world from the point of view of our audience rather than our own.
• Understanding what compels action - that it is not information alone and that it differs for each of our priority audiences.

Her final set of ideas had to do with what she referred to as What I put in the 'to go'€ box.

A perspective and a message that answers the questions:

• Why me?
• What for?
• Why now?
• Who says?
• THEN - Make it EASY TO ACT

Many of these themes formed the basis for the conversation that followed her talk. Another theme that we kept returning to was that marketing is now all about conversations and engaging people where they are, not where we are coming from (such as reciting our mission statement and carrying on the conversation on our terms). The latter is a sure fire recipe for distress - for them and us.

A Social Marketing Manifesto

Over the past decade or more, social marketing has been put into a straitjacket. I can't put a firm date on it, but I remember becoming concerned in the early 1990s that the tyranny of focus groups had taken over how market research 'should' be conducted because that's what OMB would allow Federal agencies to do without extensive and prolonged bureaucratic reviews of research protocols (psst: now it's ethnographic research). Then there was the unexamined adoption by many people (some who should have known better) of the transtheoretical (aka stages of change) model of behavior change as 'our theory' - as it was recently referred to on the social marketing list serve - when it's least well-suited for guiding social or population change efforts. In other circles, social marketing became equated with the distribution and promotion of subsidized commodities - and sales targets reigned supreme. And the mantra of behavior change as the goal of social marketing got twisted from  its original call as a population-based methodology [pdf file] to one focused exclusively on individuals - until some of those proponents finally figured out that it is a bigger world that pros and cons and blaming the victim isn't just a slogan.

What has been loss in all of this is the soul of social marketing and its subsequent arrested development. Reductionist paradigms supported a model of rational choice where pros and cons were all that were needed to change behavior in 'contemplative' audiences through some sort of convoluted 'exchange relationship.' People were to change through social marketing programs to 'improve society;' that the community or society may be the issue apparently never occurred to some people. That communities could be the context of change, and even the drivers of change, was rarely acknowledged - even though some of the pioneers of this field developed and applied the social marketing model in community settings. And process measures, or outputs such as the number of people reached with a public service campaign, the number of brochures distributed or the number of condoms sold became the means to justify the ends of the programs - not health behavior change or health impact.

That won't change in one post, but it starts here for me. It's time for a manifesto for social marketing; not one aimed at the 'outside' world, but one aimed at the insiders. By insiders I'm not referring just to the people and organizations associated with social marketing, but the ones standing on the edges, humming the tunes, sipping the Kool-Aid but too cool to dance: the government agencies, foundations, health departments, schools of public health, NGOs and voluntary organizations that define social marketing to fit their version of reality. That find it too applied, too 'socialistic' (that 'social' word), too expensive or too...scary because it challenges too many of their core beliefs and challenges them to act, not describe and analyze. Then there are the agencies and individuals who are simply confused by the whole thing because so many different definitions of what is social marketing are out there. Inevitably there are a few who don't want to expend the cognitive effort it takes to be deliberate, systematic and strategic in their thinking and planning (my Nike planners - they just do it).

I made a comment on Monday at the Conversations session that has come back to me several times in 24 hours: in reviewing at least four new texts on social marketing over the past year or so, I haven't seen a total of 4 new ideas among them. The field has become an echo chamber. No wonder people question its relevance in this day and age! The old models of social marketing are becoming fossils. Here are six things I believe are important for a new social marketing.

Focusing on audiences, their wants and needs, aspirations, lifestyle, freedom of choice. And not just those audiences identified by our epi friends as having the greatest need, or by our pr colleagues as the low hanging fruit, but the people who are crucial to the success of our programs - the volunteers, business leaders, distributors, partner organizations, media representatives and policy makers to name a few.

Targeting aggregated behavior change – priority segments of the population, not individuals, are the focus of programs. Social marketing must be based on theoretical models that guide the selection of the most relevant determinants, priority audiences, objectives, interventions and evaluations for population-based behavior change such as theories of diffusion of innovations, social networks, community assets, political economics and social capital. My belief is that the major reason we cannot achieve public health impact for many of our interventions like HIV prevention is that we do not design interventions for scale, we design them with models of behavior change that are most effective with individuals.

Designing behaviors that fit their reality. We need to bring to behavior change the same insight, thought and rigor that designers bring to their work in developing products, services and experiences. If more social marketers thought like designers, and didn't act as technicians plugging the latest scientific finding into their 'message machine or wheel' my hunch is we'd be more successful - and sleep better. Behaviors, not just messages, need to be tailored for people's real lives - not the one we imagine or theorize they have, if we think about them at all.

Rebalancing incentives and costs for maintaining or changing behaviors. Though you might say 'gotcha! back to pros and cons' it's a bigger idea than that. Rebalancing doesn't mean convincing a person to use a new set of weights in their personal equation to calculate risks and benefits of acting in certain ways. People LEARN new behaviors and what I am mystified by is how complex theories are dragged out to explain and try to modify behaviors when simple learning principles like what gets associated with what and what gets rewarded and punished (or not) are often the elegantly simple solution.  Rebalancing also means adjusting the environment, policies and marketplace whenever possible to shift power to the individual to have freedom to choose and basic human rights. We need to start asking ourselves questions like: where do inequities in health status stem from? Is income generation a prerequisite for health improvement in impoverished communities? How do we allow markets to work for the poor and vulnerable [pdf file]?

Creating opportunities and access to try, practice and sustain behaviors. We must take distribution systems, in all their forms and expressions, as seriously - if not more so - as the messages and creative products we produce. People do not think or choose their way to new behaviors - they must have access to the information they need to make informed choices (in ways, places and times that literacy, cultural and other considerations should inherently inform: relevance should never be an after thought in social marketing). And they must have the opportunities to try new behaviors, practice them and then be able to sustain them. Behavior change is not a one-off proposition.

Communicating these behaviors, incentives and opportunities to priority audiences and letting people experience them. ALL social marketing programs are mired in the last century when it comes to models of communication. The reflexive urge to continue with top down, command and control techniques will continue for awhile (aka Source - Message - Channel - Receiver or inoculation models). However, as regular readers of this blog may have discerned, I hold out that the technological revolutions we are experiencing in communications will lead to the adoption of modern communication models to frame our thinking and activities - even if many have to change while kicking and screaming or longing for 'the good ol' days.' And then there are the questions we started asking 5 years about how do we apply what we know about positioning and brands to develop powerful and sustained behavior change programs, and not just logos and tag lines or ... mission statements.

I yield the floor...

The World's Longest Condom Chain

To complete last week's story - yes, it is officially a world record!