On Social Marketing and Social Change

Personal Health Records for All

[Editor Note. Personal health records figure prominently in most discussions of applying health information technology to improve, among other things, people's lives and the quality of healthcare they receive. Cynthia Solomon is the President of FollowMe™, a company started in 2000 as a web-based Personal Health Record that stores personal health information for its subscribers.The FollowMe management team has been involved in ongoing national efforts to standardize the technology and to assure that privacy and safety of consumers is protected. Here she talks about the need for PHRs to be accessible for people with low literacy skills - I would add people with low health literacy skills to the list as well.]

Just as the Internet and information technology have transformed American life (or life in America) in the last 20 years, the personal health record (PHR) has the potential to transform the healthcare delivery system as we know it.

Today, the PHR is an electronic repository of an individual’s health and medical history, controlled by the patient, who can allow permission to physicians and others to access their digitized record.

While PHRs have finally caught the attention of major stakeholders including health plans, hospitals, major employers, policy makers and even search engines and software giants, as a vehicle to gather (and sometimes sell) data, manage risk, address population health, maximize revenues, sell advertising and reign in health costs; our experience over the past 8 years is that the PHR can significantly impact lives in a much more personal way.

The promise of the PHR is that it can put the patient at the center of their care as a participant not just a recipient. No where is this more important than with those people whose primary language is not English. More than 52 million people in the U.S. speak a language other than English at home. The limited English speaking (LEP) population has increased by almost 4 million in just the last five years, bringing that total to 23 million. Communication is vital to safe and quality health care, and language barriers are another risk contributing to medical errors that few doctors and health care organizations are prepared to handle. The PHR through its capacity to display information in more than one language offers an opportunity to bridge language barriers between patients and their providers. The PHR has the potential to make health care more accessible for patients who speak or understand little or no English.

In 2003, MiVIA, a pilot PHR program for migrant farm workers was launched in Sonoma, California. Today with more than 6000 users and growing; MiVIA members are raising their expectation of the PHR and requesting more tools and functions as a way to communicate with their providers and better understand their medical issues and the medical system.

Given the opportunity, resources and access, LEP populations will engage in technology. The challenge and responsibility we have is to create and develop the tools that address cultural differences in a way that is respectful and effective. This is no easy task. How do we create a technology environment that is inclusive? Who is responsible for doing this? How do we identify and measure appropriate content for these tools?

As the next generation of PHRs rolls out with decision support, condition specific management tools, surveys and risk assessments who will take responsibility for assuring equal access to the same benefits that the English tools provide?

How should we policy makers and technology solutions participate in creating the appropriate development environment for these tools? For starters I would like to recommend that

1. Drop assumptions. Just because a person is poor, mobile, uninsured , or does not speak English does not mean they have no interest in learning ways to help them access the medical system.
   
2. Don’t label – no one wants to be “labeled." We learned this the hard way with MiVIA. People don’t identify themselves as migrants or farm workers and they resent being categorized.
   
3. Respect diversity - don’t pander to it. Invite consumers /users to help identify not only the challenges they have but what they think the solution might be.

The challenge is to use the PHR to “build the bridge” not create a barrier for those millions of LEP patients.

Marketing Convenient Health Care

Two stories popped up today updating the trend in the US for convenient health care delivered through retail drug stores (a social marketing story talked about here 18 months ago). Jo Ciavaglia reports that in the past year 16 CVS MinuteClinics have been opened in Philadelphia PA area and 8 Walgreen Take Care Clinics are in Pittsburgh.

While the flack from the American Medical Association continues, major insurers in Pennsylvania are embracing the trend and covering some MinuteClinic services as in-network. The story also notes that the clinics can electronically transfer patient records to any physician in the US - yet a recent study in The New England Journal of Medicine found only 4% of US physicians have a fully functional system to manage electronic health records. Jo also notes: Earlier this month, a Wall Street Journal.com/Harris Interactive survey of 5,000 adult found most who used a pharmacy or retail chain clinics were satisfied with the quality of care, cost, and staff qualifications.

Jeffrey Krasner ledes in The Boston Globe: Some of the state's largest health insurers say they will cover visits to the retail health clinics expected to open in CVS and Walgreens drugstores later this year, making the clinics attractive options for the treatment of everyday ailments. He reports that CVS will have 28 MinuteClinics in operation in Massachusetts by the end of the year and 100 within 5 years. In Massachusetts the proposal to offer more accessible and affordable care was opposed by the Massachusetts Medical Society and Boston's Mayor Menino who "decried the notion of retailers profiting from illness" (sound familiar to those in the international social marketing world? Free insecticide-treated bednets anyone?) ... despite the medical establishment's objections, the state Public Health Council in January approved the MinuteClinic plan, saying expanding access to healthcare outweighed concerns about patients using the clinics as a substitute for an ongoing relationship with a physician.

It's also noteworthy that the insurers see these clinics as one way to address the shortage of primary care physicians in the state and that the state hospital association also supports the movement toward reducing the burden on emergency rooms and improving access to primary care.

What's notable for me as a social marketer is how the business sector in the US is following a similar model that social marketers have been using in developing countries for a decade or more and where the ideas of social franchising are gaining even more currency as a base-of-the pyramid business model. What often gets overlooked in the ideological battles - in the US and abroad - of providing market-oriented, or publicly/donor financed, or consumer-oriented health promotion, disease prevention and health care, is that people need and want access to health products and services. When the marketplace (and I include here the total market of public, private and nonprofit (NGO) sectors) is not satisfying these wants and needs, social entrepreneurs and marketers (and even some corporations willing to get out of the box of 'profit or CSR?') have the tools and abilities to make equity and access of health for all more authentic. When you start thinking about total market approaches, innovative solutions to public health challenges can emerge when the lines between sectors and what 'they are responsible for' are blurred and they instead converge on the people in need.

Children's Mental Health Services: Ringing the Alarm

The call by the opening keynote speakers for developing systems of care for children's mental health focused on the importance of social marketing and adopting a public health approach . Dr. Blau noted that people with mental illness die 25 years younger than those without one. To continue to address this disparity and the lack of mental health services for children and their families - and let's not forget the issue of the stigma of mental illness, he then went on to state that ...you have heard me say it before, and I will never stop saying it - we are all social marketers.

Dr. Satcher continued on the theme of improving services by calling for a public health approach to mental illness - referencing the Surgeon General's Report on Mental Illness that was published when he held that position. He stressed the need to:

1. Address stigma head-on

2. Balance the health care delivery system with more emphasis on disease prevention and health promotion

3.  Assure quality of care

At the end of the meeting, Greg Frankson, a social change activist and spoken word artist, was invited to the podium to recap the meeting. It was an inspiring several minutes as everyone in the hall listened intently to his three offerings. Here's one he graciously gave me permission to publish here.

Sense of Urgency by Ritallin

joy, love, health and hope
helps the kids and the youth learn to live and cope
i said joy, love, health and hope
open your hearts and your minds to expand their scope

i say – ring the alarm! ring the alarm!
gotta do what we can to reduce the harm
locksteppin’ together moving arm in arm
did you hear Dr. Blau? yo, ring the alarm
gotta work hard to deal with the twenty percenters
1 in 5 kids would benefit from mental health centers
and it presents a challenge met with a system of care
hey there – those kids need you so you best be prepared
we need a sense of urgency – let me say that again
we need a sense of urgency because it’s best to depend
that this is life and death serious for kids who died
tormented deep inside and moved to youthful suicides
when the hope is snuffed in droves our youth are leaving their schools
where do they go? what do they do? without the basest of tools
fall through the cracks by the thousands lacking means and ways
gather ‘em all and fill Yankee Stadium in less than thirty days
we know the language of stigma shot with venom and gall
but what’s galling is the seven in ten we let fall
through the cracks breaking backs of youth who should stall tall
but you know what’s really crazy? doing nothing at all
so the time to act is now – grand and small across a range
of community initiative that pushing us all to rearrange
explode the notion that these kids are nuts and strange
cuz you’re standing at the precipice of permanent change

and so joy, love, health and hope
helps the kids and the youth learn to live and cope
i said joy, love, health and hope
open your hearts and your minds to expand their scope

i say – ring the alarm! ring the alarm!
gotta do what we can to reduce the harm
locksteppin’ together moving arm in arm
did you hear Dr. Satcher? yo, ring the alarm
what’s the use of big brains if ideas get ignored?
what’s the use of science applied to no effect across the board?
if stigmatized so they can’t realize potential and goals
are we surprised if kids and youth throw in their hands and fold?
each and every minute, in it opportunity abounds
so listen up to this message and yo i hope it resounds
we need a sense of urgency – we gotta fix that truck
cuz this is an emergency – from what i’ve heard I’m struck
by the way passionate leaders frame it so you can win
cuz it’s not failure but low aim that’s the original sin
so fight the stigma and promote the virtue of sound mind
with children and youth central to the core design
set up the systems that support us all with wisdom and speed
and treat us equal based on age, gender, color and creed
for you cannot be afraid to fight your way upstream
it’s an investment to ensure the kids can hope and dream
it’s an investment granting power to each girl and boy
to have good health, exist in love and live each day with joy
these aren’t proprietary secrets that I just revealed
so let’s all take up the challenge from across the field

because joy, love, health and hope
helps the kids and the youth learn to live and cope
i said joy, love, health and hope
open your hearts and your minds to expand their scope
cuz yo – joy, love, health and hope
helps the kids and the youth learn to live and cope
i said joy, love, health and hope
open your hearts and your minds to expand their scope.

© A. Gregory Frankson, 2008. All rights reserved.

Information Rx for Healthy People in 2020

Ed Note: This is the first in a series of guest posts on issues about social marketing, health communication and health information technology to expand the conversation in the b'sphere health space around the Healthy People 2020 development process. Joshua Seidman is the President of the Center for Information Therapy. In this post, he looks forward to health information democratization.

When Healthy People 2000 was dreamed up two decades ago, the World Wide Web was not much more than a figment of someone’s imagination. When Healthy People 2010 was issued 10 years later, the Web had become a powerful avenue for democratizing access to health information. How can we possibly anticipate what the Internet will mean when we try to evaluate the nation’s health in 2020?

Although no doubt a revolutionary force, information democratization does not necessarily mean that consumers can get what they want or what they need to best manage their health. Most people still want help from health care professionals.

Susannah Fox from the Pew Internet & American Life Project reports that 80% of Internet health information seekers still turned to a professional in a time of crisis—a figure much higher than any other industry Pew Internet has studied. The Internet offers great potential, and yet, many consumers still often feel lost in a maze of health information.

Harnessing the power of information democratization requires us to identify the challenges and find appropriate solutions.

•    “Availability” does not necessarily equate with “access.” Just because the information I need exists somewhere doesn’t necessarily mean that I can find it. Navigation to information targeted to the appropriate moment in care is critically important. We need to translate widespread availability of information into true, ubiquitous, and timely access - something that’s feasible by linking data sources with high-quality health content.

•    “Data” is not the same as “information,” which is different from “knowledge,” which is not equal to “behavior.” In order to go up the chain from data all the way to the behavior change needed for positive health outcomes, we need to connect accessible data with science—such as evidence-based medicine, decision sciences, predictive modeling, and behavior change science.

•    For some people, the free access to information has led to a diagnosis of “information overdose” and a high signal-to-noise ratio. The appropriate Ix (or information therapy) means finding the right dose, frequency, and duration of information to proactively deliver, prescribe, or make available. We can do that by thinking creatively about how to target, tailor and contextualize health information for consumers’ individual learning styles, education levels, values, and preferences.

We can accomplish these three things by 2020 if we: develop clear definitions of what constitutes achievement of them; establish measurable objectives for what should be done; and align incentives to reward clinicians, systems, consumers, and others for achieving them. Those steps will allow us to create real improvement in health care delivery by translating information democratization into effective communication.

Discovering 2700 More Social Marketers

I just returned from Nashville where I sat in on some of the Training Institutes for developing local systems of care for children and adolescents with mental health needs and their families. The meeting convened over 2,700 professionals, kids and families who work within local coalitions to tackle these issues in communities across the US. For social marketers interested in issues such as reducing mental illness stigma, the work goes on in these communities on a daily basis - complete with funded staff positions entitled 'social marketing coordinators.'

I went to the opening session to meet up with Dr. David Satcher who was receiving a lifetime achievement award and listen to his address to the meeting (Dr. Satcher was the Director when we at Prospect Associates began supporting the CDC in its venture into the worlds of health communication and social marketing). He was preceded to the podium by Dr. Gary Blau who provides the leadership for this overall effort at SAMHSA. Midway through his talk, Gary asked the crowd "Who here is a social marketer?" and everyone yelled back "We are." A quick check with other people sitting at my table confirmed that yes, for over 7 years the projects funded by SAMHSA have all adopted the rhetoric (if not quite the practice as I saw it there and think about it here) of social marketing. Who knew?

And who knew that over 1,000 social marketers would enroll in the social marketing e-conference; 300 would attend the Social Marketing in Public Health conference (despite worries about the availability of travel funds for government-funded projects and state agency staff); that as of this past Friday Alan Andreasen reports there are 1,758 social marketing listserver subscribers - and then there's the over 500 loyal subscribers here! It seems time for the movement to coalesce social marketers to begin.

Stay tuned - there was one session in Clearwater Beach exploring the prospects of a society of social marketing where the discussion focused on questions of what the conceptual base for a society could be (marketing, health communication, behavioral or social sciences), the fields of practice it might include (PR and advertising people, social workers, community nurses - who IS a social marketer?), its geographic scope (US, North American, global) and the structure of the exchange between the organization and its members (service and member benefits and features). This is just the beginning of the conversation among people who gather at social marketing meetings; make a note that two more such gatherings are planned at the CDC health marketing conference in August and the world social marketing conference in Brighton England in September. To broaden our ability to participate and capture a true range and sense of the community on these and other issues, should we get some pages started for an extended conversation about a professional association of social marketers on the social marketing wiki? Or leave your comments here.

Becoming the Healthiest Nation

The Healthiest Nation Alliance was announced earlier this month. It was timed to coincide with the CDC Leaders-to-Leaders conference that I was attending [webcasts of the event are available here].

The Healthiest Nation Alliance aspires to help create an America where an integrated national system values health, prioritizes prevention, and protects from emerging threats. The Alliance exists to provide leadership and foster actions by organizations and individuals that encourage or sustain health.

Panel presentations and group breakouts covered the usual territory when it comes to health promotion and disease promotion gaggles. What was clear throughout the discussions was a shared commitment by most participants to a social determinants model to frame the issue - a model that social marketers who adhere to the individual behavior change paradigm may find perplexing in its focus on upstream determinants. One of the implications that kept being drawn as well was that such a focus leads to examining the role of interpersonal and institutional networks in amplifying the effects of these determinants and suggesting the ways in which to change them. 

One of the questions I have, and which wasn't really answered by anyone I talked with at the meeting, was how this new Alliance would intersect, compete with or otherwise relate to the Healthy People 2020 development process. Seems like we are asking a lot or organizations and people to invest time and resources in overlapping efforts.

Segmenting Black America

Among the more frustrating things of doing social marketing with the wannabes is their insistence to segment the general population by race and ethnicity - and then leave it at that! 'We have to have a program for African Americans, Hispanics, etc...!' is the rhetoric and practice. Yet, the assumption that these are homogeneous segments (OK, maybe age and gender get factored in at times) is the frustration when it comes to action: we know the assumption isn't reality, but our government surveys don't give us opportunities to understand our audiences as people rather than demographics. Consequently our programs rarely capture the insight of their daily lives unless the intrepid few have the resources to do some qualitative research.

Radio One, in conjunction with Yankelovich, has recently issued a series of reports and fact sheets that deserve wide attention among social marketers and health communicators. The Black America Today study is billed as the largest segmentation study based on a survey of 3,400 African Americans between 13 and 74 years of age. The report identifies 11 segments and the segmentation analysis identifies differences among Black America from what it means to be Black today to consumer trends, media preferences and confidence in key institutions (such as the church, government, financial services companies and the media). Here are the segments with brief descriptors (fuller reports of each one).

Connected Black Teens They are tech savvy, highly social, brand driven and fans of Black music (Hip Hop and R&B). They have a plan for their future, they want to preserve Black cultural traditions and believe that too much focus is put on the oppression of Blacks. 

Digital Networkers Over half of this web savvy, high tech, mobile segment are college or high school students who ‘network’ heavily using Facebook, MySpace, instant messaging and their cell phones. They are saving money – to buy a home or for retirement. 

Black Onliners Heavy web users, this mostly male segment is stressed by their work/life balance and the need to straddle Black and White worlds; they are focused on money as the most meaningful measure of success and are the most stressed of any segment about ‘having to fit in’. They are the most frequent users of Black websites and the most frequent online shoppers.

Stretched Black Straddlers Mostly 18-34, this online, cell phone toting segment is the most stressed by ‘straddling’ the needs of family and work. Stressed about money and a lack of time, they are heavy users of Black TV and websites and the most likely to say they have been racially discriminated against in the past three months. 

New Middle Class The best educated, most employed and wealthiest segment is mostly between the ages of 25 and 44 and is the most technologically forward segment. They are the most likely to describe themselves as Black rather than African-American and to believe that problems in the Black community can best be solved by Blacks. They are positive about the future and forward looking.

Family Struggles Mostly female and heavy TV watchers, this segment is struggling economically and is stressed trying to raise their children on a tight budget. They are the most likely of any segment to relate to the ways Blacks are portrayed on Black TV. Most of their friends and co-workers are Black.

Black is Better This confident, optimistic, fun-loving segment is very focused on family and their job. They are the most responsive to Black media and most likely to ‘buy Black’, consistent with their very strong focus on Black culture, history and solidarity. 

Sick and Stressed Mostly over the age of 35, this struggling segment is stressed about money and health, pessimistic about their personal future, and least likely to say things are getting better for them. They are the least likely to have a healthy lifestyle, to play sports or work out or have health insurance. 

Faith Fulfills This highly religious segment, who spend more time than average volunteering for religious or non-profit organizations, is most likely to trust God to take care of things. With an average age of 48, they experience low levels of stress and are the least likely to have been raised by a single parent or to worry about money a lot. 

Broadcast Blacks Highly confident, independent and positive in their attitudes, this female-skewed, older segment is the most likely to say things are getting better for them. They are heavy users of TV and radio (especially Gospel radio) and have the lowest Internet usage. They place high importance on ‘buying Black’.

Boomer Blacks This ‘oldest’ segment (average 52) is tech savvy with high ownership of computers, DVRs, home theater systems and wireless internet access – 90% are online. They are the most likely to believe that Black children should have Black role models and that it’s important to take advantage of the opportunities won by previous generations. 

Some of the overall analysis highlights find (each segment has a more complete and targeted analysis):

• 82% said they believe it is “important for parents to prepare their children for prejudice” 
• 34% agree that “too much focus is put on the oppression of Blacks”
• Among teens, 52% think there is too much focus on the oppression of Blacks
• More (48%) think that things got better since the Civil Rights struggles of the 60s—than the 1/3 say who say things aren’t better
• The majority (76%) have not been discriminated against in the past three months 
• African-Americans are more than twice as likely to really trust Black media (30%) as they are to trust mainstream media (13%)
• Education and Black media get the highest level of “trust to treat you and your family fairly” at 30%
• The health care system and financial institutions are tied as far as trust at 24% for #2
• Almost everyone—88%—has enormous respect for the opinions and desires of older family members 

Media consumption patterns overall include:

• 45 hours a week watching TV, not including time spent watching DVDs
• 84% of households have cable or satellite Media Consumption (Internet)
• Among Blacks age 13-74, 68% are online; Among Black teens, its over 90% that are online 
• Spend 31 hours a week using the Internet
• Spend 22 hours listening to AM or FM radio in a typical week 
• Nearly 9 in 10 spend more than an hour reading magazines every week 
• Spend 2 hours a week reading the newspaper Black Media Consumption
• Among all Black households, 81% watch Black TV channels weekly; 66% believe there should be more television shows that focus on Blacks 
• Of the TV watched in a typical week, 32% is spent watching channels focused on African Americans/Blacks

Now if Radio One would get involved with the public health people to help apply this segmentation analysis to health issues, we will have an even more powerful tool. But for now, it's more information than what we have had before about how people cluster in terms of their lives - not their disease status.

What China Tells Us About Obesity Prevention

Barry Popkin, in the latest issue of Health Affairs, looks at the impact of economic and other globalization trends on the prevalence of obesity in China. He notes that between 1989 and 2000 the number of overweight adult males tripled, and among adult females it doubled, in China - a rate of change that is among the most rapid in the world - and far larger than in the US.  By 2004, nearly a quarter of all Chinese adults were overweight.

His analysis of data from several sources suggests that some of this change is attributable to major dietary changes fueled by tax and import policy changes that increased cheap, plentiful edible oils and the availability and consumption of lower cost animal-source foods. He also sees a shift toward energy-dense diets.

What may be most startling to the conventional wisdom about the increase in obesity is that he does not link it to a Westernization of the food supply and eating patterns. Indeed, it is changes in food marketing that he points to. Many scholars have suggested that the consumption patterns, featuring fast food chains and soft drink consumption, that are dominant in the United States will become a global issue. However, this does not appear to be the pattern of change in China. The major changes one sees in China are in the food marketing landscape. Throughout Asia as in Latin America, the food marketing landscape is becoming dominated by supermarkets, particularly large superstores. In China, Carrefour and Wal-Mart supermarkets are not only expanding rapidly but are also being matched by domestic clones.

This observation should be a reminder to social marketers and others who are attempting to solve what they perceive to be the problems underlying the obesity epidemic - people's 'bad' behaviors and slick advertising (communication and promotion). Creating solutions to the obesity epidemic must tackle fundamental issues relating to the products (the increasing number of foods and selection), prices (affordability) and places (accessibility, opportunity). The challenge is for policy makers and public health professionals to understand that obesity prevention is a marketing issue - not a behavior change and communication one.

And that the greatest increases in obesity are among the world's poor should give many in the development world a second thought as to what the priorities must become in the years ahead.

Let's Tweet About Something Important

Republican Congressmen are aghast that their right to use social media to perform their official duties might be infringed upon. In Michael Falcone's story in The New York Times today he quotes one Congressman saying: Leadership has told me personally that they will next focus on limiting our access to text, blogs, and other social media outlets on the Internet. This threat led to a twittering backlash you can follow at Tech Daily Dose.

One conservative blog cited in the article opined: Whatever intention the Democrats have, this idea is ridiculous. Congressmen should be able to decide for themselves where and how they interact with their constituents and the American people.

A new site has gone up that pronounces Congressional rules should not prevent lawmakers from joining us in online conversations.

If we would turn some of this anger and indignation into creating solutions so that federal agencies could join the online conversations to improve public health and social welfare - something they are currently forbidden to do. Let our government tweet!

Making Citizen Empowerment a Cornerstone of National Health Policy

A report from the UK Cabinet (Excellence and fairness: Achieving world class public services) charts a new course for reform of, and to achieve excellence in, providing public services in the UK. The vision is based upon three principles: citizen empowerment, a new professionalism in the public workforce and strategic leadership from government. For me, the timing is useful as one context for shaping the US public health objectives for the next decade. For readers who aren't familiar with Healthy People, it is the US government's vehicle for developing, adopting and then acting on public health priorities for the next decade. You can go here for an overview of the Healthy People 2020 process or to the Healthy People 2010 objectives to get an idea of their scope. 

The section on citizen empowerment is useful to those of us who are social marketers and claim an audience-centric approach as one of our guiding principles (so do they!). Citizen empowerment is also a core feature for those who see social media and mobile technologies as enabling philosophies and tools. Below are some excerpts from the report that may inspire both your imagination and intention to become involved in opportunities to contribute to national policy development. I'll note here that the original document concerns ALL public services and not just health, though these are the focus of what I extracted. The promises of social marketing and applications of new media are not restricted to just health issues!

Here is the nut of their approach: The best systems in the world treat each citizen as a unique individual, with his or her own family’s distinct needs, and then tailor the service to meet these personalised requirements. No centrally driven or centrally accountable system can operate in this fine-grained way…

'The underlying quality of public services is better than ever before. The challenge now is to ensure the development of more personalised and responsive, as well as fair and equitable services. Alongside the extension of choice in health and other services, there must be a deepening of user involvement through new forms of individual and community control. The exact mechanism will vary from service to service, but the aspiration will be the same: enabling more personalised services by giving citizens the information and power to shape services around their needs and aspirations, rather than by assuming that someone in the Government knows best.' (my emphasis throughout)

Some of their recommendations to empower citizens include:

For many services, empowerment starts when people are able to make real choices about which services are best suited to them – their lifestyles and their needs. Enhancing and extending the opportunities people have to make choices empowers citizens. It also creates pressure for improvement by rewarding services that offer what people want…in a range of sectors from childcare to primary health, alternative education, probation and employment services.

The whole agenda of reform will rest on improved transparency of information about public services and their performance, as well as transparency about the standards that citizens should be able to expect. Effective empowerment rests on good information…Central government is therefore committed to ensuring that, as a matter of course, public services make non-personal information available for re-use. This will include the provision of frequent, comparative and tailored performance data about services at a local level.

In addition to encouraging collaboration between service users and professionals, networks of users can also provide personalised and ongoing support to an extent which would be impossible if provided by professionals alone. For example, the Expert Patients Programme in the UK enables people with personal experience of managing long term conditions to share their knowledge and expertise with others. [Ed Note: and here’s a social network site 'specifically designed for organizing helpers, where everyone can pitch in with meals delivery, rides, and other tasks necessary for life to run smoothly during times of medical crisis, end-of-life caring, or family caregiver exhaustion.' Just a thought...]

The Government will therefore extend opportunities for people to become directly involved in making decisions about the treatment and service they receive – the parent, student, patient, tenant or victim of crime becoming a genuine partner in deciding on the best approach. Parents, for example, will be able to influence and support the education of their children through regular interaction with their school via email and text message, as well as regular parents’ meetings and reports...The internet has given a powerful voice to consumers to give feedback on private sector services – that feedback is now spreading to public services and must be embraced. NHS Choices is a large scale example of the public sector soliciting feedback on health care, building on the example of websites such as patientopinion.com. The challenge for public service providers is to listen to and work with websites that provide a rich seam of feedback, even if that feedback makes for uncomfortable reading.

A deeper form of user engagement involves transferring control of resources to the service user. For example, individual budgets in social care have shown that when people are given control over the funds to be spent on them, they often make changes that significantly improve the care they receive: bringing support closer to home; fitting services more closely around the needs and resources of their family; and getting better value for money in the services they buy.

And the finale - 

As the Government seeks to move the public services forward, the next stage of our reform programme must put power directly into the hands of citizens, driving services to become more responsive and personalised to each individual’s needs and aspirations – and provide a strong set of incentives for the system to innovate and improve. As a consequence:

• Services should reflect people’s aspirations and lifestyles to offer users the increased personal control they demand, and adapt to meet new demands such as more flexible opening hours or better online access.

• Services must be designed around people’s complex and interrelated needs, for instance providing those with long term health conditions with greater continuity of care between their home and hospital.
  

• A stronger relationship needs to be created between the citizen and public service professionals. Only when citizens are treated as equal partners do they bring their knowledge, time and energy to address challenges such as preventing ill-health.
  

If these excerpts captured your fancy, stay tuned as I will have guest bloggers over the next several weeks posting here to inspire a conversation with you and others about how health communications, social marketing and health information technologies can contribute to our public health goals for the Year 2020. We will also be posting some pages at the Social Marketing wiki for more extensive discussions and debates. Pass the word along and join us. 

Tips for the Lotsa Helping Hands site to Joe Starinchak and for the Cabinet Report to Alan Moore.