As social marketing communicators, we are challenged with the task of promoting complex issues that impact the daily lives of Americans. On July 15, four distinguished panelists, Dr. Sandeep Jauhar (Director of the Heart Failure Program at Long Island Jewish Medical Center), Bill Novelli (Distinguished Professor at the McDonough School of Business), Debbie Witchey (Executive Vice President, Healthcare Leadership Council) and Robert Davis (President & Editor in Chief of Everwell TV and author of “The Healthy Skeptic”) participated in a lively discussion on “How Social Change Happens in the 21st Century.”
The session began with the following question: What are the main challenges that communications professionals face today in bringing about significant behavior change? How has this shifted over the past decade? Panelists approached these questions through several different lenses, including that of obesity and the rising rates of obesity among children.
The panelists addressed the question, “why is it so difficult to motivate an individual to do the “right” thing” when they: a) acknowledge that the action or behavior is the best one to take; b) have the tools and the means to take the prescribed action; and c) are exposed to repeated messaging that reminds them to take the action?
Novelli discussed the fact that there are admittedly many different factors at play here—including a cultural shift that has effectively made obesity a “normal” part of our daily lives. Dr. Jauhar commented that one thing is clear; the current message of “eat less” is not working when it comes to encouraging individuals to maintain a healthy weight.
So what then is the “formula” we need to adopt as communicators? While not exhaustive, the panel proposed the following elements during the course of the discussion:
Creative Pressure Points—Referencing the “truth” campaign, Novelli noted the success that this anti-smoking campaign has had among young adults. Specifically, the campaign leveraged this group’s inherent need to rebel against an entity and the campaign organizers made that entity the tobacco industry.
Work with the Media to Paint a Clear Picture of the Implications of Scientific findings—The science is always changing and we need avoid oversimplifying the issue. We saw this issue take center stage when the U.S. Preventive Task Force published recommendations on breast cancer. Their recommendations were not a surprise to the public health community, but some media painted the picture that the task force was “flip flopping” on the issue. Davis’ recommendation was to give audiences more context around an issue to allow room for future interpretation and to provide the information necessary for the audience to make an informed decision.
Understanding Environmental Factors—Often times the issue is not as black and white as it may appear. Witchey, an expert in community interventions and grassroots program planning recounted a story about how she developed training modules to educate those in a community where heart attack rates were increasing. However, she soon realized that the health interventions she designed had not made any impact on the rate of heart attack deaths. Only after talking with community members did she learn that one of the fundamental problems involved ambulance response times—drivers could not locate the patients’ houses due to the fact that few had address numbers and there was generally poor street lighting. She quickly worked to integrate these elements into her work and consequently helped lower the rate of heart attack deaths.
Public/Private Partnerships—Everyone agreed that no one can solve this issue on his or her own; partnerships are a critical element of success. Davis did warn that partnerships must be entered into with caution so as not to damage or degrade either party.
Carrots and Sticks—Motivating individuals through incentives and punitive factors is being adopted by some campaigns. Take for example West Virginia’s 2006 plan to reward Medicaid patients who “signed a pledge to enroll in a wellness plan and to follow their doctors’ orders with special benefits.” According to Dr. Jauhar, “those who did not sign up were enrolled in a more restrictive plan that, among other things, limited drug coverage to only four prescriptions a month.” Dr. Jauhar’s point is that “sticks” do not work. He reported that “as of August 2009, only 15 percent of 160,000 eligible patients in West Virginia had signed up for the program.” Like other similar carrot and stick type initiatives, “there are simply too many external factors that impact our ability to be persuaded by carrots and sticks. In this instance, “patients with limited transportation options were having a hard time committing to regular office visits. And experts say there is no evidence that restricting benefits for noncompliant patients has promoted healthy behaviors.”
Not Enough Time—Panelists agreed that more time is needed with patients in the health care setting, specifically to allow health care practitioners, such as doctors, nurse practitioners, and physician assistants to be able to reinforce prevention messages. The current model of physician reimbursement does not encourage health care providers to spend time with patients beyond a minimum, and herein lays a root problem with the way health care treatment is perceived and administered. Some panelists indicated that help might be on the way with calls for changes in reimbursement and health reform legislation.
Each of these elements plays a critical factor in determining a formula for success. However, the bottom line is that there is no definitive answer. Any “formula” we have now will inevitably change. As Davis so appropriately noted, as science, technology, and our understanding of issues such as obesity change and evolve so too will our approach to addressing the issue.
Natalie Adler, Senior Vice President at Ogilvy Public Relations contributed to this post.