Last Day - US National Strategy for Social Marketing

August 10, 2007
Day 42 --Last Day

It is my last day at the National Social Marketing Centre (NCSM) and this phase of the Fulbright Senior Specialist Program. Tomorrow, Linda and I head for Ireland and a week of exploring the southern and western coast before going home to the USA.

I hope that this blog clearly tells the story of our wonderful and, for me at least, life-changing experience here in London. Seldom does someone in my position at a small, state health department, have the chance to observe—even participate—in public health operate on a national—or even global scale. It is a humbling and awe-inspiring experience. A great big "thank you" to all our new friends at NSMC, Kings College and others places in London and England!

As I mentioned in an earlier segment of this record, the experience leads me to consider a national strategy for the development of social marketing in the US. The argument goes something like this….using obesity as an example.

According to the English Department of Health document on the Healthy Living Social Marketing Initiative (2006) “the prevalence of obesity in the UK, in common with countries across the world, continues to rise. If present trends continue, 33% of men and 28% of women will be obese by 2010. The rate of increase in obesity among children and young people is very similar to that of adults, rising from 9.6% to 14.9% in boys and 10.3% to 12.5% in girls up to the age of 11 years in 1995 and 2003 respectively, and predicted to be 17% and 19% respectively by 2010. Given that weight is frequently gained throughout adult life, there is a legitimate concern that the prevalence of obesity is set to escalate further. Moreover, the magnitude and duration of excess weight are strongly associated with the burden of related ill- health. Accordingly, childhood obesity is sometimes referred to as ‘a ticking time-bomb’ of disease.”

It goes on to say that “the ‘Healthy Living’ Social Marketing Initiative provides a framework to deliver a concerted national programme of work that drives deep-rooted shifts in cultural values and social norms. A key aim must be to reduce the negative impact of the ‘obesogenic’ environment and instead create a positive climate that supports and facilitates the necessary changes in the diet and activity habits of parents and their children to achieve and maintain a healthy weight. We must reduce the impact of the ‘obesogenic’ environment and create a positive climate for change….. through collective working towards the common goal of improved health and well-being for the population at large and children in particular.” (emphasis mine).

In the US, the prevalence of overweight and obesity has increased sharply for both adults and children since the mid-seventies. Data from two NHANES surveys show that among adults aged 20–74 years the prevalence of obesity increased from 15.0% (in the 1976–1980 survey) to 32.9% (in the 2003–2004 survey). The two surveys also show increases in overweight among children and teens. For children aged 2–5 years, the prevalence of overweight increased from 5.0% to 13.9%; for those aged 6–11 years, prevalence increased from 6.5% to 18.8%; and for those aged 12–19 years, prevalence increased from 5.0% to 17.4%. These increasing rates raise concern because of their implications for Americans’ health and because in spite of current efforts, that the situation is worsening rather than improving. (Source: http://www.cdc.gov/nccdphp/dnpa/obesity/)

Unlike the English experience, the US does not have a unified national strategy for the development of social marketing to support a “collective working towards the common goal of improved health and well-being for the population.” Given the evidence amassed by the NSMC and others in support of the effectiveness of social marketing to improve the behavioral outcomes of public health programs, I believe that a national strategy is not only possible, it is essential to a sustained contribution of social marketing to improved US health objectives.

Rev 8/7/07

DRAFT
Framework for an American National Strategy for Social Marketing (for developing the social marketing community (in public health?)*


Introduction:
The independent review of the first English national review of social marketing (It’s Our Health, 2006 http://www.nsms.org.uk/images/CoreFiles/itsourhealth.pdf) found that the adoption of social marketing in a systematic way will increase the impact and effectiveness of health-related programs and campaigns at the national level. It also concluded that current approaches were unlikely to deliver policy goals or provide sufficient leadership and coordination; that social marketing could use resources more effectively, but was underdeveloped and required research and evaluation to maximize its value.

This is not the first acknowledgement of the potential contribution of social marketing on a grand scale. Indeed, both the US Agency for International Development (USAID) http://www.psp-one.com/content/resource/detail/4070/ and the English Department for International Development (DFID) http://www.dfidhealthrc.org/publications/srh.html
promote the extensive research and practice of social marketing programs around the world. There are, of course, many other examples both from home and abroad.

The English experience, in particular, raises an interesting question about the need for a national strategy to promote social marketing in the US. How could the field move forward to link together the resources and networks and develop a capacity to mobilize and sustain the potential of social marketing to increase the impact and effectiveness of health-related programs and campaigns at the national level in the US? The purpose of this paper is to present a draft framework for further discussion of this strategy, at least for public health, extending if possible to its possible final form and process for achievement.

The US Social Marketing “Community”

First, it may be useful the think of social marketing as a “community” in the US, as opposed to a single profession, discipline, field or other line of work. Community has at least two elements that are useful for this purpose. First, community connotes individual, groups and institutions interacting with one another rather than just a population defined organizationally, demographically or geo-politically. So the social marketing community has training, research and practice components and includes various kinds and levels or organizations (governmental, private, academic, professional, etc.) Second, these interactions are based on common interests, both general and specific, rather than on a scope of professional knowledge or practice. In other words, the community may include those interested in public health as well as those interested in environmental sustainability, public administration, education or other areas of “social good.” It is well-known that social marketing includes more than just public health, but there may be less recognition that to be successful in establishing a national strategy, social marketing in public health will have to involve partners in different professionals, contexts and primary interests.

So planning is about the entire community, not only public health or universities or government agencies…an important, albeit challenging starting place.

The American Value Context:
The US faces a unique opportunity to create and achieve a strategic plan for social marketing. The English experience indicates that there is somewhat of an aversion to the term “marketing” in that society. In America, the aversion is more about the term “social”—giving rise to visions of increasing taxes, more government, run-amok welfare and even an American version of the “nanny state.” This is less applicable, of course, among those who envision government and institutions as vehicles for social improvement and change—such as many in public health and other similarly disposed fields.

Fortunately for strategic purposes at least, “marketing” resonates with core American values of enterprise, individual choice, business is “good” and responding to consumer demand. With thoughtful planning, we can position social marketing as an approach to public health (and other non-commercial “goods”) that is customer centered—asking about consumer wants and needs instead of prescribing what they “should” want and need. This notion couples nicely with social marketing as an approach that can significantly improve impact and mobilize resources more effectively than more traditional, “top-down” methods.


Aim of a strategic plan for social marketing
The aim of a strategic plan is to create an integrated national capacity to use social marketing as a systematic approach to design and implement effective customer-centered programs of behaviour change for promoting public health, reducing inequalities and achieving other social benefits. Capacity is the key word here. It recognizes, first, that our current US capacity is underdeveloped, second, that development is a long-term process and third, that it involves complex relationships among training, research and practice.


The American social marketing strategic plan
What would the result of a national social marketing strategy look like?

This national strategy is intended to achieve both horizontal and vertical integration of social marketing—horizontal meaning across governmental, academic, professional, financing, public/private sectors and “fields of practice”. Vertical integration pertains to national, federal/state/local governmental, community, agency and individual sectors of activity.

Policy oriented:
First of all, social marketing would play a key role in the design and implementation of national policy, both in federal and private sectors. There are at least two existing precedents for this role. The US Agency or International Development (USAID) strongly supports and uses social marketing as a systematic approach to health, sustainability and other behaviors throughout the world. A second precedent refers to the customer-centric nature of the American business and economic sectors—where choice, exchange and competition are central. Indeed, social marketing is often defined as the adoption of commercial marketing technologies. The English experience indicates that it would not be enough just to practice at the program level and leave the policy development to others. Social marketing needs a strong policy base as a leverage point for other aspects of the strategic framework. Its use and funding must become part of the national agenda for public health and other areas of interest.

Inclusive partnerships:
Next social marketing would have to be widely applicable across policy areas and fields of practice. Social marketing is useful in health, sustainability, public safety and many other areas. While public health may provide a key launching pad for a national strategy (and the primary objective of this framework), it must accommodate these other areas as equal partners in order to build a critical mass necessary to drive policy, funding and other critical elements. This is a difficult requirement. The fear of losing control and getting co-opted by another stronger (or more energetic) group lurks in the shadows. However, it is unlikely that public health either can or should achieve a national strategy monolithically. Just imagine the power of a technology for positive behavior change that transcends individual fields and sectors!

Practice Standards and credentialing

Defining social marketing as a community of experts and practitioners makes a logical first step. The objective here is three-fold: (1) to clearly identify the area of knowledge, technology and practice in which all social marketers participate; (2) to establish the competency and ethical standards of practice and (3) to create a process for officially recognizing the satisfactory training and achievement of those standards. This process could be similar to that of the National Commission for Health Education Credentialing (NCHEC) that provides Certified Health Education Specialist (CHES) credentials to qualified professionals. There are many other examples from other fields and disciplines.

Community and Professional organization

Professionalization and credentialing activities would take place in the context of a community and professional organization (CPO). The primary roles of the CPO are to:
Promote professional social marketing
Serve the members of the organization
Provide an organizational home for the profession
Provide policy leadership and advocacy for the profession (including research and training) and its various interests
Financially support the CPO and related activities

Also the CPO can develop and support communication networks, using new and emerging technologies to establish interaction channels that are timely, convenient and powerful tools for sharing research, evaluation and best practices—as well as other professional communications.

Research
Social marketing already benefits from a wide array of research in public health and other areas. However, as the methodology is applied to a wider variety and more extensive number of behaviors, both the opportunity for and necessity of research will become more apparent. One of the goals of a national strategy for social marketing should be a generous and stable resource base for research, especially including applied research and evaluation. These resources could derive from either government or private resources (or both) and support social marketing research across various acute and chronic health problems as well as other community and policy objectives.

Research (like education and training) should be trans-institutional, building on the existing strengths and experiences of key centers to form new centers and a network of organizations engaged in social marketing and related research.

Education and training
A national emphasis on social marketing will require new resources for training—including financial resources as well as institutions and faculty with expertise/experience in social marketing. The UK completed an assessment of academic resources http://www.nsms.org.uk/images/CoreFiles/NSMC-R4_aacademic_sector.pdf and found them to be “underdeveloped”. It is uncertain as to whether a similar report exists for the US—clearly a prerequisite of planning in this area.

Education and training should encompass undergraduate, graduate and adult/continuing education and other professional training using a variety of formats (classroom, conferences, field schools) and technologies (local and distance-learning). Again, training need to be trans-institutional, perhaps with some concentrated specialty sites, but forming a national network sufficient to meet the emerging demands for social marketing training. In addition, given the increasing restrictions on travel, particularly for professionals in local government agencies, such training should be widely available both through distance learning technologies and through strategically located support centers.

Partnerships

After pointing out some of the pros and cons of both public and private stakeholders in social marketing (http://www.nsms.org.uk/images/CoreFiles/NSMC-R8_national_stakeholder_research.pdf ) the National Social Marketing Centre nonetheless reaffirmed the critical necessity of partnerships to the success of the national strategy. Partners could be approached based on 1) the degree of interest and readiness to partner and 2) the critical contribution to the success of the social marketing strategy.

It is premature to propose a list, however there already are numerous US organizations, both public and private, academic and practice oriented with keen interests in social marketing related to public health and other fields.

What would the strategic planning process include?

The specific details on the planning process are probably best left to another time, but the general nature of the process merits some discussion. This should be a funded planning process, including a core staff, organizational home and operations budget to support meetings, planning documents, consultants, travel and other expenses. One or more of the governmental or private organizations (or both) may be willing to support the process. The process should be transparent and inclusive, probably starting with a small representative, planning group to discuss, refine and plan the strategy; then expanding to a more participative model with specific workgroups.

___________________*My appreciation (and apologies) to Jeff French, Jim Lindenberger, Craig Lefebvre, Carol Bryant (and others) from whom I have adopted some ideas and discussed this project.