The meaning, effectiveness and future of social marketing

Authors


L McDermott, The Institute for Social Marketing, Cottrell Building, Stirling and the Open University, Stirling FK9 4LA, UK. E-mail: laura.mcdermott@stir.ac.uk

Background

The unique feature of social marketing is that it takes learning from the commercial sector and applies it to the resolution of social and health problems. This idea dates back to 1951, when Wiebe asked the question ‘Can brotherhood be sold like soap?’ For the first time, people began to think seriously that methods used very successfully to influence behaviour in the commercial sector might transfer to a non-profit arena. Wiebe evaluated four different social change campaigns, and concluded that the more similarities they had with commercial marketing, the more successful they were.

Over the next two to three decades, marketers and public health experts developed and refined this thinking, learning particularly from international development efforts, where social marketing was used to inform family planning and disease control programmes (1). Social marketing thinking and techniques spread to the developed world, and social marketing is now located at the centre of health improvement in several countries. In the USA, social marketing is increasingly being advocated as a core public health strategy for influencing voluntary lifestyle behaviours such as smoking, drinking, drug use and diet (2).

Last year in the UK, the potential of social marketing was recognized in the White Paper on Public Health, which talks of the ‘power of social marketing’ and ‘marketing tools applied to social good’ being ‘used to build public awareness and change behaviour’ (3). The National Social Marketing Centre, led by the National Consumer Council and the Department of Health, has been established to ‘help realise the full potential of effective social marketing in contributing to national and local efforts to improve health and reduce health inequalities’ (4).

Social marketing – like generic marketing – is not a theory in itself. Rather, it is a framework or structure that draws from many other bodies of knowledge such as psychology, sociology, anthropology and communications theory to help us understand how to influence people’s behaviour (5). Several definitions of social marketing exist, but one of the most useful is Andreasen’s, which describes social marketing as follows:

Social marketing is the application of commercial marketing technologies to the analysis, planning, execution and evaluation of programs designed to influence the voluntary behaviour of target audiences in order to improve their personal welfare and that of society. (6)

Four key features are illustrated in this definition. The first is a focus on voluntary behaviour change: social marketing is not about coercion or enforcement. The second is that social marketers try to induce change by applying the principle of exchange– the recognition that there must be a clear benefit for the customer if change is to occur (7). Third is marketing techniques such as consumer-oriented market research, segmentation and targeting, and the marketing mix that should be used (6,8,9). Finally, the end goal of social marketing is to improve individual welfare and society, not to benefit the organization doing the social marketing. This is what distinguishes social marketing from other forms of marketing (10).

The emphasis on society as well as the individual also illustrates another key point about social marketing: it can apply not only to the behaviour of individuals, but also to that of professionals, organizations and policymakers. As well as downstream, social marketing can be applied ‘upstream’ (11,12). It might seek to change the behaviour of professionals – for example, to encourage general practitioners or dentists to be more proactive in prevention; or the behaviour of retailers, say, to make them more compliant with the law on selling tobacco or alcohol to minors, or persuade them not to stock confectionery at checkouts; and the behaviour of policymakers and legislators, in perhaps convincing them to pass legislation on smoking, or to improve housing policy, or to restrict advertising to children (13).

This introduces one final dimension to social marketing: the critical appraisal of commercial marketing. Competitive analysis of many health behaviours – smoking, drinking and diet are all good examples – shows that we cannot ignore the potential detrimental impact of marketing for, say, cigarettes or fast food on people’s health behaviour.

What impact does marketing have on behaviour?

The impact of commercial marketing on behaviour has been examined in numerous studies. Several decades of international research have shown that advertising and other forms of tobacco marketing encourage young people to take up smoking and adults to continue smoking (14–19) and there is a growing body of evidence to suggest that alcohol marketing plays an important role in encouraging and sustaining drinking (20–23). One of the most systematic examinations of the effect of marketing on health behaviour was the 2003 review for the Food Standards Agency on the effects of food promotion on children’s diet (24). Using rigorous and systematic review procedures, this found convincing evidence that food promotion has an effect on children, particularly in the areas of food preferences, purchase and consumption behaviour. This effect was independent of other factors, such as parental attitudes, and operated at both a brand and category level.

How effective are social marketing interventions?

Just as commercial marketing can influence behaviour in a way that is often harmful to health, as shown above, social marketing is predicated on the idea that the same methods can be used to improve health. The evidence base to support this approach is gradually growing. A number of reviews have examined social marketing effectiveness in an international development context, particularly in the promotion of family planning (25,26). However, these have been somewhat limited by their narrow definition of social marketing (which in these particular reviews is often taken to mean, primarily, free distribution of condoms) and by their use of non-systematic methods.

But there is reason to be optimistic as some recent research has improved this situation. For example, a report published by the UK Department for International Development provides a more systematic account of social marketing and its effectiveness in changing a range of health behaviours in developing countries (27). In addition, a series of recent reviews has sought to bring a more consistent approach to assessing the effectiveness of social marketing. The first of these was a full-scale systematic review of the effectiveness of social marketing nutrition interventions (28). Social marketing interventions were defined as those which, regardless of how the intervention approach was defined by the study’s authors, met all six of Andreasen’s criteria for a social marketing programme (6) (see Table 1 adapted from McDermott et al. (29)).

Table 1.  Andreasen’s benchmark criteria
BenchmarkExplanation
1 Behaviour changeIntervention seeks to change behaviour and has specific measurable behavioural objectives
2 Consumer researchIntervention is based on an understanding of consumer experiences, values and needs
Formative research is conducted to identify these
Intervention elements are pre-tested with the target group
3 Segmentation and targetingDifferent segmentation variables are considered when selecting the intervention target group
4 Marketing mixIntervention strategy is tailored for the selected segment/s
Intervention considers the best strategic application of the ‘marketing mix’. This consists of the four Ps of ‘product’, ‘price’, ‘place’ and ‘promotion’. Other Ps might include ‘policy change’ or ‘people’(e.g. training is provided to intervention delivery agents). Interventions that only use the promotion P are social advertising, not social marketing
5 ExchangeIntervention considers what will motivate people to engage voluntarily with the intervention and offers them something beneficial in return. The offered benefit may be intangible (e.g. personal satisfaction) or tangible (e.g. rewards for participating in the programme and making behavioural changes)
6 CompetitionForces competing with the behaviour change are analysed. Intervention considers the appeal of competing behaviours (including current behaviour) and uses strategies that seek to remove or minimise this competition

The review found that social marketing nutrition interventions were strongly and equally effective at influencing nutrition behaviour, knowledge and psychosocial variables such as self-efficacy and perceptions of the benefits of eating more healthily. They appeared to be less, but still moderately, effective at influencing the stage of change in relation to diet, and to have a more limited effect on diet-related physiological outcomes such as blood pressure, body mass index and cholesterol. This latter finding might be expected, as these kinds of outcomes are arguably more difficult to influence, and changes are likely to take a much longer time to occur and be detected. Furthermore, social marketing interventions could achieve both narrower and broader goals. Social marketing interventions that sought to target nutritional behaviours in several domains at once (for example, increasing fruit and vegetable intake, reducing fat intake) could be just as effective as those concerned with change in just one domain (for example, fruit and vegetable intake only). This suggests that social marketing interventions can produce changes across a relatively wide spectrum of behaviours, rather than only working, or working better, when they have a narrow behavioural focus. There are clear cost-effectiveness implications if it is possible to design social marketing interventions that can produce changes in several behaviours and risk factors at once.

The same criteria for defining social marketing were used in two literature reviews conducted for the National Social Marketing Centre, one examining social marketing alcohol, tobacco and drugs interventions, and one examining social marketing physical activity interventions. The reviews found reasonable evidence that interventions developed using social marketing principles can be effective (30). A majority of the interventions that sought to prevent youth smoking, alcohol use and illicit drug use reported significant positive effects in the short term. Effects tended to dissipate in the medium and longer term, although several of the tobacco and alcohol interventions still displayed some positive effects 2 years after the intervention. These results are broadly comparable with systematic reviews of other types of substance use prevention interventions (31–33). The evidence is more mixed for adult smoking cessation, although small numbers of programmes were nonetheless effective in this area. There is modest evidence of impact on levels of physical activity and psychosocial outcomes, with an apparently weaker effect on physical activity-related physiological outcomes. The interventions seem also to have had some effects on the behaviour of retailers, and to have encouraged adoption of policies and other environmental-level changes, although the data on these are less robust and it is often difficult to attribute changes to the interventions rather than to other events and trends in the community. The reviews also imply that the quality of implementation of the intervention may have a bearing on effectiveness although this needs to be more directly researched.

Implications for tackling inequalities

Marketers succeed by meeting people’s needs. However, difficulties arise because we are all different, so to be truly consumer-oriented, the marketer would have to provide a unique offering for each of us – which in most instances is completely impractical. A compromise is to divide the population into reasonably homogeneous segments and then choose particular ones to approach with an offering that better matches their needs than one designed for the population as a whole. Personal (including demographic, psychographic and geodemographic factors), behavioural (e.g. smoking status, dietary habits) and benefits/barriers to engagement (e.g. long-term vs. short-term values) characteristics can all be used as segmentation tools. The most promising (or in social marketing, the most needy) segments are then selected for customized attention.

It might be argued that this raises the spectre of rationing: why should some individuals benefit from an intervention and not others? The social marketing response is that such preferential treatment happens anyway with standardized offerings, because variations between sectors of the population will mean that some will pick up on them better than others. This is particularly apparent with inequalities: time and again, low-income groups have responded less well to generalized offerings than their more affluent fellow citizens. The net effect is an increase in inequalities. A social marketing approach to inequalities, then, would argue strongly for customized offerings being developed and delivered specifically to disadvantaged communities.

The next 25 years

Recent trends in both commercial and social marketing have seen a move to relational rather than transactional thinking. Business has learnt that it is much more profitable to retain existing customers than continually win new ones. This has put a premium on high-quality service, customer relationship management and strategic thinking. Social marketing has adopted similar thinking, recognizing the potential for people who are delighted with health improvement offerings (such as the smoking cessation services) to become much more committed to health improvement (34). This ties in with the Wanless concept of ‘full engagement’ being the only way to bring about a ‘step change’ in health improvement.

These, however, are radical ideas when set alongside the intervention mentality and political short-termism that tends to dominate health improvement.

Implications for tackling obesity

Social marketing has great potential in the fight against obesity. It has a proven track record in changing both dietary and exercise behaviour; it can inform the debate on how the obesogenic commercial environment should be addressed; and it can bring new ideas to the inequalities debate. However, if it is going to realize its potential, Government must embrace the need for a long-term strategic approach. Funding needs to be measured in decades not years, goals have to incorporate the prospect of generational change, and activity has to be coherent and co-ordinated. Consider how the marketing deployed by McDonald’s and Coca-Cola has changed the world in the last 30 years. Public health organizations need to match the longevity, influence and evocative branding of the corporation. Only this way can the kind of cultural change envisaged by Derek Wanless be brought about.

Conflict of Interest Statement

No conflict of interest was declared.

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