Public Health and Social Marketing: helping Local Authorities walk before they can run

With responsibility (and a £5.45 billion budget over 2 years) for public health moving to Local Authorities from April 2013, I thought it timely to shine a spot-light on the chief executive of Public Health England.

Recent profiles of Duncan Selbie, chief executive of Public Health England, paint a picture of a modest, disarming leader, with a common touch that has been developed through a non-traditional rise up the NHS leadership ladder. Mr Selbie is not from the traditional medical or academic background that is common-place among his peers. It might be this practical nature that has allowed him to establish a track record of implementing change that is based on the reality faced by his patients and employees.

He understands that public health is related to other equality factors; that education, housing, age and social interaction can have a determinable affect on someone’s health. This understanding is good news and should encourage a joined-up approach by Local Authorities, community groups and health organisations to tackle public health issues.

However, what does he think about behaviour change and social marketing in relation to public health? To my knowledge he has not been probed directly about it, but a recent article I read in The Times might provide some information; in it Mr Selbie comments:

“I cannot be a super-nanny. Telling people what to do, directing them and ordering them, writing strategies and putting together toolkits are a complete waste of time. You create an environment where people feel able to do the best they can, to run towards problems and not be afraid.”

He’s right (partially). No one wants to be told what to do, but creating this ‘environment where people feel able to do the best they can’ is a big challenge. Let’s take the example of cancer awareness. Simply supplying people with information on what to look for and then telling them where to go assumes that they will act on a rational basis. This is, of course, incorrect. People can know what to do and still not do it. Information must be framed in a way that resonates with the target audience – this requires insight, targeted interventions, appropriate reassurance and timely reminders.

You’re never going to create a society where people consciously ‘run towards problems’. It’s within human nature to make things as easy as possible for ourselves; it’s hard-wired into our brains to help us process a deluge of daily information. However through incorporating social marketing techniques you can look to dilute the problem and provide easy, simple steps for people to resolve it.

With such a big change occurring in the public health landscape, my advice for Mr Selbie is to encourage Local Authorities to first of all understand the barriers local residents face in trying to lead a healthy life. After all, we want to ensure Local Authorities don’t run before they can walk

Alex Bone, Project Manager, Corporate Culture

How small-scale behaviour change programmes can heal the pharma industry

For more than a decade we’ve been told the pharma industry faces a crisis. Due to the difficulty of developing new blockbuster drugs, companies can no longer rely on organic growth. The market’s saturated, the industry’s reputation has suffered and people are disillusioned, yet a viable solution is within the industry’s grasp.

Recent strategic changes by some of the pharma industry’s main players have brought improvements. For example, GlaxoSmithKline and AstraZeneca have adopted a focus on shared value – where success is viewed in terms of their ability to improve health outcomes – through macro-level projects, which are focused on productivity in the value chain and reconceiving products and markets. 

One of the key pillars of shared value is developing local markets by using behaviour change campaigns, empowering patients to make educated decisions about their health, thereby increasing the sophistication of demand for healthcare. Alongside the clear societal benefit that this provides, there are real commercial opportunities for businesses to leverage, creating shared value.

Whilst the recent macro-level projects by GSK and AstraZeneca have been hugely positive steps, local and smaller-scale behaviour change projects are just as important. A targeted £50k diabetes awareness campaign in London might seem small, but as a principle and a way of working, the potential of these types of projects to impact the wider picture is huge – they put the patient at their heart, which is the cornerstone for positive health outcomes.

Adopting a behaviour change mindset provides opportunity for the industry to step closer to patient-focused ideals. By placing a focus on healthy behaviours, the pharma industry can begin to develop a strategy that empowers people to make informed decisions about their own health and treatment options; the outcome may be as simple as someone proactively visiting their GP for an informed conversation about a specific health issue.

The results often speak for themselves. Trailblazing behaviour change programmes have led to people taking ownership of issues, creating their own ‘communities of interest’, and becoming advocates for the issues driving the programme.  A fantastic example of this was the recent breast cancer awareness programme in Northern England, which saw over 240 community-led events being delivered, engaging nearly 10,000 women, which ultimately led to a significant behaviour change in terms of 9% increase in women checking breasts and an increase in knowledge of risk factors. This is clearly likely to lead more women presenting to the GP, talking about their symptoms and hopefully earlier diagnosis.

Behaviour change techniques consider people in the round, with a wide variety of strategic options to engage them at different touchpoints, ranging from lower-cost interventions such as face-to-face engagement projects within local communities, through to collaborations with cross-sector partners.  Pfizer recently partnered with Liverpool Heart and Chest Hospital to deliver a programme focused on heart health amongst women in Merseyside. This was delivered via local hairdressers, based on insight which suggested that the only time that the target consumers had time to think about themselves was at the salon. The approach was therefore built around this, providing tangible and clear cut-through. This simple yet effective practice leads to new ways of engaging with individuals, offering alternative thinking, identifying different channels through which to start conversations about heart disease and as a result build trust.

It is crucial for any programme to be bold and specific about what health behaviours they are seeking to influence. In this way, strategies can be developed that are personalised and tailored to the individual. This allows the industry to focus investments in areas that are going to make a real impact against commercial objectives, with the confidence of having specific behavioural insight that guides decision-making. For example, a recent CRUK/Bristol-Myers Squib melanoma programme focused on driving men aged 50+ to visit their GP with moles that they were concerned about.  Targeted as a demographic group less likely to visit the surgery in the first instance, this tailored campaign  reached out to a seldom seen and heard audience and improved patient-doctor engagement. 

By using behaviour change practice, pharma companies can increase patient knowledge, confidence and ability to take control of their health decisions. There is an opportunity for the industry to align investment with the increasing focus on personalisation across the wider healthcare sector, and take approaches to build shared value into relationships with their consumers.

 

 James Kirk, Project Director, Corporate Culture 

A nudge from government is not enough

Lord Krebs, the President Elect of the British Science Association has this week criticised the Government’s reliance on ‘nudge’ approaches (or persuading people to buy / do things through subtle psychological manipulation) saying that ‘nudging’ alone does not deliver sustainable behaviour change and will not provide the answer to the array of societal challenges we face. 

The Government naturally likes ‘nudging’ approaches given they are a light touch alternative to regulation but unless these approaches can delivery sustained changes across the whole host of behaviours we need to alter (climate change to recycling to saving to health behaviours… the list goes on) then we need to see the Government adopting rounded behaviour change approaches that draw on the full range of behavioural sciences, psychology, neurology etc rather than taking the easy option. 

As Lord Krebs says ‘a huge change in behaviour needed… we require a massive shove rather than a nudge’. We will have to wait to see whether there is any change in approach…

http://www.guardian.co.uk/science/2012/sep/06/nudge-government?CMP=twt_gu

Is increased competition in school really what is going to 'inspire a generation' as David Cameron asserts? Behaviour change theory would suggest it's a bit more complex than that! Jess Ennis herself has been on the news this evening disagreeing with our PM by saying "it's not about competition to start with, it's just about having fun"...

Net gains in EU fishing policy

CEFAS Project 50%

In recent weeks, we’ve read – with cautious optimism – about the developments at the European Council in Luxembourg, where EU ministers have committed to ending the controversial policy of discarding dead fish caught by accident under its quota system.

This is an issue we’ve been concerned about for some time. Back in 2009, we helped the Centre for Environment, Fisheries and Aquaculture Science (CEFAS) with a pilot social marketing campaign, Project 50%, which successfully reduced the amount of juvenile fish being thrown overboard by trawler skippers in Devon by 52%.

So we’re pleased to hear that, under the new agreement, discards of mackerel and herring would be banned by January 2014, and a phased ban on discarding cod, haddock, plaice and sole would be in operation by 2018.

There’s also plenty more to do to turn these commitments into reality, not least in making these provisional dates a legally binding timetable for action. In fact, some claim this is too little, too late, with stocks of many species precariously low and that this intervention may not necessarily help them to recover. But, as is often the case, slow progress is better than no progress.

For consumers of the end product, and the retailers that sell it, ensuring the long-term sustainability of the marine supply chain is an ongoing challenge, and one that this type of intervention alone is unlikely to resolve. What is also required is a continued shift in consumer habits: sales of previously unfashionable species such as pollock and coley are growing, and there has been an increase in proactive purchases of Marine Stewardship Council (MSC) sustainable certified fish.

What is also required is a business model that is commercially viable for all intermediaries, as the recent debate about milk pricing and relationships between farmers, processors and retailers has highlighted.

But we’re still pleased to see that the debate is still active and progress towards sustainable fish stocks, a viable fishing industry and a healthy marine environment continues to be made.

For more information on our CEFAS project, read the in-depth case study PDF.

Recent press coverage:

guardian.co.uk: Fishing discards practice thrown overboard by EU 

bbc.co.uk: EU Council agrees to end fish discards

bbc.co.uk: South East fishermen welcome fish discard ban

The opportunity the Olympics provide for sustained behaviour change

About a third of UK adults are not doing enough physical activity, causing 5.3m deaths a year, according to estimates in the recent Lancet study into exercise and public health. 

With the Olympics looming and over 4 billion people expected to be watching, are healthcare providers, the Government, local authorities and those involved in delivering sport doing enough to seize this once-in-a-lifetime chance to get people off their sofas and into their sports gear? And how can we ensure that levels don’t just spike but that we actually see sustained change in behaviour? Following the 2004 Athens Olympics, Greece saw a 10% increase in physical activity levels, but levels had dipped back below pre-Olympics levels by 2009. Similar studies focusing on Manchester after the 2002 Commonwealth Games found sports participation fell after the event, and that the gap in participation between rich and the poor areas of the city increased.

Physical activity isn’t a new public policy priority but we’re not seeing behaviour change at the scale or pace required. It’s clear that it’s time for a new way of thinking to make real Olympic legacy happen. 

If the goal is to get more people participating in regular physical activity and sport (or for that matter any change in behaviour) then one of the major ways to achieve change is through applying the principles of social marketing. It’s simply not possible to see sustained change at the pace and scale required until we getting better at asking and answering the following questions:

  1. What behaviour are we trying to change? Are we trying to motivate people who already play sport infrequently to play more, or encourage those who are currently inactive to start? 
  2. Who is the audience? We need to be brave enough to be specific. Campaigns aimed at change behaviour too often try to be all-inclusive and in doing so fail to achieve real change among anyone. 
  3. What is the motivation of the target audience? It sounds obvious but a programme aimed at young people would have different messages to persuade them to act than communications aimed at older people.
  4. What interventions will people respond to? Understanding which groups will respond to what type of intervention, message and channel of communication is vital. We need to ensure we have completed all the previous stages before designing and delivering solutions. We also need to be mindful that we might need new ways of delivering sport and new ways of reaching and engaging new audiences. Improvements may also be seen if we team up and work together: lots of public and private sector organisations share the same goal of increasing participation in sport yet work in silo and don’t collaborate or share resources. 

If we can increase participation in sport using behaviour change approaches, it’s this that will prove to be the real legacy of the Olympics… it’s not too late but we’ve got to move quickly to capitalise on the opportunity that we’ve got.

Happiness: implications for policy

Despite being within the grips of an economic crisis the British population seem to be, on the majority, in buoyant spirits according to the Office of National Statistics new study to measure well-being. Three quarters the population rated their current lives as seven out of ten on satisfaction levels.

It bears no surprise that if people live in a nice area, own a house, are in a stable relationship, are employed and enjoy good health are more satisfied with life. There are also issues of causality between data; that is, does marriage make people happier, or is it that happier people are more likely to get married? Without pulling apart the data it’s difficult to know.

One interesting outcome of the data is the ability to plot the ‘happiest’ places in the UK. From the statistics it is clear that Eilean Siar, Orkney & Shetland are the happiest places to live, with over 80% of residents giving a score of 7 or higher, while London has the least happy citizens. When asked why those living in the former places were happy residents talked about their feeling of ‘belonging’ to the local community. A challenge to replicate through policy initiatives (as we’ve seen with the Big Society), but the introduction of 1,000 additional Co-op banks on the high street, among other initiatives, may help this. 

A lot of people have questioned what the point of measuring ‘Happiness’ and subsequent ‘Belonging’ is and how this will impact policy development? It may seem a frivolous use of public money; however, there is evidence that suggests that a happier person is a healthier person, which clearly is in the public’s interest. In Malcolm Gladstone’s recent book called ‘Outliers’ he starts by talking about a town called Roseto and the mystery of why its residents are less likely to die of illness compared to other neighbouring towns. The only reason scientists could determine was the simple fact that townsfolk, worked together, socialised together and looked out for one another.

And here is where the policy bods look-up and take note, if a government can understand and replicate the causes of happiness within a free-market economy then preventive savings could be made to health and social costs. The ultimate sustainable health behaviour change campaign might therefore encourage a healthy 50-year-old to join their local walking club and provide free group membership to the National Trust. According to Roseto, walking together is better than walking alone. 

Sustainable behaviour change requires ongoing commitment to behaviour change communications

A report released today by the Transport Select Committee shows that the number of road deaths in has increased for the first time in nearly a decade. Road accidents are the main killer of 16-24 year olds in Britain, with 1,901 people killed in 2010-11, 51 more than in 2009. The largest increase is among pedestrians, where the number of deaths rose by 12% to 453, while more than 25,000 road users were either killed or seriously injured in total. 

These latest stats come on the back of the government slashing funding for road safety campaigns in 2010 in the wake of the last general election as part of its clamp down on government marketing and communications. Given the length of time it takes to track and measure changes in behaviour, these stats provide some of the first hard evidence of the public impact of the government’s approach to marketing and communications. They also reinforce the fact that sustained behaviour change requires sustained investment in behaviour change communications. It’s not sufficient to communicate once; you need to continually reinforce messages and support people to act and continue to act to change their behaviour. This is even more important given the group most at risk of road accidents are 16-24 year olds and the younger end of this age range may not have been engaged via previous campaigns given their youth. 

The RAC has been vocal in urging the government to reinstate funding for road safety campaigns aimed at changing behaviour. Let’s also hope the government apply the learning from today’s report to their approach to marketing and communication in other crucial areas of behaviour change.

An innovative way to conduct research with young people We’re always on the look out for new and innovative ways to engage people to gather insights. A recent project with Liverpool PCT allowed us to help develop a novel ‘opinion pod’ approach to conducting primary research with young people in an engaging, effective way.  Liverpool PCT was looking to understand and explore the behaviours, attitudes and motivations of young people around health and wellbeing in the context of their lifestyles. To ensure we reached young people who may not have online access at home, we developed customisable and transportable ‘pods’. These use an interactive interface to engage with the respondent in a private environment, providing raw and powerful video feedback. With a high level of uptake seen across several different locations, including youth centres, this exciting tool has already produced some extremely useful results… we are looking forward to using this methodology on other projects. 
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An innovative way to conduct research with young people

We’re always on the look out for new and innovative ways to engage people to gather insights. A recent project with Liverpool PCT allowed us to help develop a novel ‘opinion pod’ approach to conducting primary research with young people in an engaging, effective way. 

Liverpool PCT was looking to understand and explore the behaviours, attitudes and motivations of young people around health and wellbeing in the context of their lifestyles.

To ensure we reached young people who may not have online access at home, we developed customisable and transportable ‘pods’. These use an interactive interface to engage with the respondent in a private environment, providing raw and powerful video feedback.

With a high level of uptake seen across several different locations, including youth centres, this exciting tool has already produced some extremely useful results… we are looking forward to using this methodology on other projects. 

100 days to go

With less than 100 days to go, CC is getting really excited about the Olympics, not just the event itself (or the tour of the Olympic park we’ve got coming up!), but the opportunity that the Olympics presents for a step-change in participation in sport in the UK. 

We’ve been doing loads of work in the sport sector in the last year, particularly the last 6 months, and everywhere you look there is more evidence of how sport links to other sectors and other priorities… all areas that we are doing a lot of work in:

  • Take health for example - sport and physical activity impacts so many other health outcomes such as obesity, mental wellbeing, confidence, cancer risk, productivity, self-esteem…the list goes on…
  • Or the localism agenda and meeting local targets - many local sports providers are charities or public sector organisations with a mission to improve the quality of life and health of whole communities through leisure, fitness and sports activities that are accessible for all, therefore contributing to local targets
  • Another one would be corporate performance and employee productivity - new research shows a proven link between physical activity and workplace productivity which makes a clear business case for workplace wellness, and the potential to deliver sustained costs savings across reduced health pensions, absenteeism and employee turnover. In short, the potential to deliver the practical, financial and far-reaching advantages of a satisfied engaged and committed workforce. http://www.hrmagazine.co.uk/hro/features/1021007/lacaster-university-foundation-chronic-disease-prevention-reveal-direct-link-physical-activity-workplace-productivity   

If we can increase participation in sport using behaviour change approaches, it’s these outcomes (in addition to others such as talent development and facilities development) that will prove to be the real legacy of the Olympics… it’s going to be an exciting next 6 months to see whether we, as a nation, can really capitalise on the opportunity that we have got.