Social Marketing - Its Place in Public Health

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SOCIAL MARKETING:

Its Place in Public Health

Jack C. Ling, Barbara A. K. Franklin, Jani F. Lindtadt

and Suan A. N. Gearn Inteatioal ommuicatio hacemet eter ulae Uivesity School ofPubc Heath ad opca Medce ew Oeas ousaa 70112

KEY WORDS: oc ozton conity edcton heth concton ethoo d y

INTRODUCTION

Social marking is on prcivd as a conradicion in rms and an odd fifor publc al profssional. or if marking businss of sllinggoods and srvic is pursud singlnddlyclusiv of al or con-sidraions bu pof w vnuay cas w soca pupos of public al Y in lss an 20 yars social marking for al asmrgd as a rcognid pracic

Mulipl cannls of mass communicion and nw mods of knowldgdiffusion av oucd all bu mor rmo and isolad communiisMssags aimd a infuncing prsonal coics and dcisions com fromsvral sourcs a any givn im and ofn a cross purposs. sfulinformaion racs an vr largr numbr of popl and impros prospcsfor good al Bu sam cannls of informaion av also convydwords and imags armful o al canging nvironmn of communicaion provids an imporan backdop for ffors o cang aiud and bavior of wic social marking is n ampl. Tis aricl rviws

origin of social marking is pracics is srngs and waknsss and isplac in fuur of public al

0167525/92/050010200

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34 NG

What I Scial Markting?

ory years ago, Wiebe (7) ased, "Wy can you sell broerood andraional inking lie you sell soap? ew responded o is callenge a e

ime. e use of adverising media for a social purpose ad eised for decades and audiences were familiar wi public service announcemensPSs) and campaigns a popularied suc slogans as "ncle Sam WansYou However, mareers did no consider social causes in erms of produc,price, and place unil e 0s and 70s (0) By e lae 0s, sucmareers as Ricard Mano were applying e full range of mareingecniues o nuriion and oer eal educaion campaigns (4). Te gener-al eigened social consciousness a e ime may well ave elped iniiaemareings probe ino e social arena. Some advocaes of cange leedand used mareing ecniques o advance eir causes

n 7, mareing professor Pilip Koler and is collaboraor, eraldalman, called e applicaion of mareing pracices o nonprofi and socialpurposes "social mareing. Tey decribed i as a "a promising frameworfor planning and implemening social cange 3). Social mareing a-emps o persuade a specific audience, mainly roug various media, oadop an idea, a pracice a produc or all ree is a social cangemanagemen sraegy a ranslaes scienific findings ino acion programs. combines elemens of radiional approaces and mode communicaionand educaion ecnologies in an inegraed, planned framewor.

Social mareing uses mareing's concepual framewor of e 4 PsProduc, Price, Place, and Promoion Social markeers adoped severalmeods of commercial mareing audience analysis and segmenaion consumer researc produc concepualiaion and developmen message de-velopmen and esing direced communicaion faciliaion ecange eoryand e use of paid agens, voluneers, and incenives.

udience analysis is needed o idenify segmens for specic approacesonsumer researc yields valuable daa abou e wans and needs of argeedsegmens and provides a basis for produc design and message developmenTesing sarpens e effeciveness of producs and messages Specic can-nels appropriae o e argeed segmes are cosen for produc disribuionand message disseminaion. Paid and volunay agens reinforce and faciliaemessage disseminaion and produc disribuion by faceoface communicaion ncenives are employed o moivae e sales force and simulaeconsumer demand. Ecange eory illuminaes e relaionsip beweenprice and perceived bene

owever, ere is no a universally acceped deniion of legiimae socialmareing Suc lac of consensus as conribued o misconcepions aboue role of socia mareing in public eal and as probably fueled sepi-cism and criicism loug e merican Mareing ssociaion as been

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SOIAL MARKING 343

challenged prvide a sandardized deniin (45), he fficia definiivesaeen has e be wrien (6).

REVIEW OF THE LITERATURE AD EXPERIECES

iterature

Scial arkeers have wrien an arices abu heir experiences Besidesdiscussing and arguing fr heir respecive definiins, he have wrienabu heir successes he diiculies encunered and he lessns beleaed In addiin heriss fr varius fieds have explained and cri- iqued scial arkeing. The lieraure n scial markeing nw spans sme 40 ears, cuning Wiebes riginal challenge. Bu he bulk f he wrien

wrk is cncenraed in he as 25 ears and can be divided rugh in hreeperds: earl her experiences evaluaed, and increasing accepance

EARL THEORY In he ae 1960s and ear 970s, herss aeped define and jusif scia arkeing aid criicis fr all sides. There werefur cenral quesins: Wha is scial markeing? Wha is is rle? Is ipssible? Is i markeing?

Irnical, Wiebe has sed been gven credi fr his wn hughfulanswer his chaenge "Adverising des n ve pepe uniaera

acin I ves he in ineracin wih scial mechaniss I is hecrucial imprance f he reail sre viewed as a scial echanism whichfaciiaes he desired behavir ha scia scieniss fen see verkwhen he ea fr behavira changes cmparable hse achieved badverisers (67) Alhugh Wiebe uses he wrd adverising, his insisencen an adequae and cpaible scial echanis and his cncep f "dis-

ance (he effr audience ebers beieve he new pduc r behavir requires, cmpared wih is benefi) indicae ha he was alking abu scialarkeing (e cmprehensive use f markeing ehds fr a scial cause)and n ere scia adverising (he use f adverising edia publicize ascia cause)

Debae n he re f arkeing fr scial causes began in eaes in he lae960s and acceleraed in he 1970s, much f i in he arkeing jualsMrin's "An Oulandish Idea Hw a Mkeing Man Wud ave India (50)led he wa fllwed b nuerus discussins f hw arkeing shuldchange r braden is cncep mee he needs f scie (2, , 25294,

45). azer (5) prpsed ha arkeings respnsibii was n prialfulled hrugh ecnic pcesses whereas Dawsn (8) and avidge (4)prediced he new quesin fr arkeers wuld sn be wheher he prducr service shuld be sld a all Kler & ev (28) prpsed "dearkeing reduce deand fr cerain prducs Agains his backdrp f quesining

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44 G E AL

and edefntn wthn he aketng ed Kte & Zatan (1) ppedcal aketng a an appach t panned ca change and utlned teental featue.

Nt evene geeted aketng expanded e wth enthua. Luck(45) bected that epacng a tangble pduct wth a cpex bunde f deaand pactce veextended the exchangefvaue cncept whch even caaketng ppnent ageed wa at the heat f the aketng dcplne.Taka (64) nted that the ngng debate abut ca aketng wa un-knwn gned b t f the bune cnt f wh the eentacnce eaned ae f pft. everthee the new dea tk hld and b 97 eveal ept and cae ude f ca ketng pject began tappea n the teatue (9 6).

EXPRNCS VALUATD In the ate 1970 and ea 1980 whe the-t wanged pacttne eage apped the new appach t eveafeld ntabl fa pannng and aked De t wk? Hw de t wk?

What ae the cntant?Dung th ped an thet tued the atentn awa f the

debate ve defntn and twad the gwng und f data f caaketng ert (2744455) Bk and atce that expaned the caaketng pce and gave gudene f the pacttne ncluded Kte'

Marketing for Nonprofit Organizations (2); Man' Social Marketing: ANew Imperative for Public Health 49) appcatn t pecfc eld uch anutn (24); and tude f taeg x channe and evauatn (1 49)

In 1980 Fx & Kte (15) decbed the evutn f ca advengnt cal cuncatn and cal aketng. Scal aketng added fueleent t ca cuncatn: aketng eeach pduct devepent ue f ncentve and factatn weve bectve evaluatn wa ack-ng. exape B (4) depled the tendenc f pject t ue afte

nl befe and ae tude wth n cntr gup a pactce that ghtdentf neffectve pga bu cd nt hw caual eatnhp between pga and utce. The a gave nceaed attentn t thecndtn n whch ca aketng eff wee t uccefu and t thecnant and dcute ke t be encunteed.

Cnaceptve cal aketng pvded eal weldcuented uc-cee. Population Reports (61) uazed the eut f 0 cntaceptveca aketng prject n 27 cunte wth a ength bblgaph. Theepr cncluded that ca aketng wa uccefu n prvdng ptectn

agant unwanted pegnance at a we ct than t the appacheNevehee paale between cecal and ca aketng wee -pefect Rhchld (54) f exape dentfed pobeatc dffeence wh

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SOCIAL MARTING 5

regard prduc prce segenan and especall he cnsruc f nvlveen He suggesed ha he publcs nvlveen wh scal causesa be bdal (ver hgh r ver lw whereas publc nvlveen wh

cnsuer gds s pcall ddlerange hus akng he prnal ls used fr arkeng cercal cnsuer gds nadequae fr scal asksBl &vell (5) prduced a lan f prbles ha arkeers faced n

he publc healh aena The ced he fllwng dffcules anng cnsuer reseach and daa especall behavral daa; srng he relavenuence f deernans f ehavr; classfng and narrwargeng segens; frulang and shapng sple prduc cnceps; prcng; chsngchannels and desgnng appeals preesng ehds and aerals -pleenng lnge psnng saeges; and gnng hse segens

s vulnerale and fen s negavel rened he essage Organza- nal prles ncluded pr undersandng f arkeng acves; rea-en f plans as archval raher han acn dcuens; and nsunalanesa

Furher pbles ccur because raher han encuragng peple dsehng as cercal arkeers d scal arkeers us fen dscuage ehavs ha a e aacve he audence deepl nganedSln (62) cncluded ha "arkeng cnceps cann e appledwhlesale scal capagns whu a grea deal f hugh and sensv-

veean arkeer has sad Is a husand es harder d scalarkeng han packaged gds arkeng (5) Scal arkeng fnshed sfrs decade wh cauus ps a re reasc esan f bh sls and s penal

CEASING ACCEANCE B he lae 1980s scal arkeng had becean acceped pracce whle akng se surprsng new frs Hweverfundaenal quesns sll have n been answered Des scal arkengdelver wha prses? Wha s he pac f cnnecng arkeng and

scal causes? Wha effec des have a he susanable ehavr level? Is cseffecve? Is ehcal?

Snce he lae 980s hee have een e plcans gude he scalarkeer ncludng a cprehensve ex b Kler & Rber (0) Lefevre& Flra (7) revewed he scal arkeng feld fr he perspecve f healh prn/educan The ced he renan cnsuer needs asscal arkengs s pran cnrun despe such barrers as heprpens f publc healh prgras e epedven The cncluded ha alhug n a panacea "healh akeng has he pena f reachng he lges pssble gup f pepe a e leas cs wh he s effecvecnsuersasfng prgra f pracners hrughl undersand s cn-ceps and lans and have asered s sklls lhugh here has been a

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46 LING AL

brader accepance f arkeng prncpe n any healh phere erean crcal f cal arkeng ehcal denn pac and capaciy delver wha i prie.

Conces about Social Marketing

THCAL SSUS Quein abu he ehc f cal arkeig urfacedn afer he cncep wa nrduced. A early a 979 acznak e al (2)plled re han 00 expe uch a prfer f ehic pychlgy andecnc and arkeng pracner and fund a wde range f ehcacnce. Se repnden fered ha arkeer were geing in ver heir

head by acqurng cal pwer whu a ful ene f he iue r heir repnbiliy. In he wrd f ne "cal arkeng culd uaey perae

a a fr f hugh cnrl by he ecncaly pwerful. Markeer werein genera re favrable ward he new dcplne bu hey had her cnce. Se feed ha he publc wuld aciae keing wh cnveral caue and hu percee he a "neprpagand (ha hefed f arkeng wuld uer fr he an f cal caue). Th aurprng aern becaue he he uually n he her f n debaeabu he arkeing f caue. aczniak e al fund genera cnce hacal keing wld likely perae wih any cnl d reglain incna wh healh educan whe prfeinal acan gave eru

aenn elfped ehca cde.Becaue adverng a key cpnen f arkeng he debae n he

ehcal apec f adverng ha e bearng n cal arkeng. Sefeel ha he negave apec f adveing wegh he benef f a calarkeng capagn n aer hw nble he caue. Pllay (5) repred hecnen 50 ned huane and cal cence chlar: Adverngeffec ang her hng rvalze real experence ad engender aea cync anxey drepec fr age and radn f elfeee and a preccupan wh ex and cpen. Hlbrk (20)

repnded ha adverng a r f ceal nr whch reec anywhlee value uch a faly affecn genery par pveancpan and y. Thee ppe pn f vew prbably e frdfferen aeen f he eri f he cnuer cey and capacy prvide han fulllen.

Healh edcar a expreed ehcal cnce abu he new dcplne.Se cnce relaed he cncep f vicblang and he debae abuperan veru cercn curren n he 970 and 980 (1 1 2 8 557 68). Vcblang ccur when ndvdual are held repnbe fr

heir prble hu bcuring iniuinal and ciea frce ver whch hey ay have lle cnrl (fr exape ecnc au wrkng cn-diin pblic plce and law) Markeng eff ually addre n

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SOIAL MARKTING 347

dvduals ad courag ndvdual avor cag, us mplcly oldngndvduals rspons for soluo o polms

I ca aso agud, owvr a socal makg s a ool, k

lpon, wc can usd for a posv nd suc as fosrng umannracon, or for a ngav puos, suc as osc cals I s rvw,w rgard socal markng as an nsrumn, u cal dmnsons of socal markng clary dsrv connung anon

DSEMPOWEENT In addon o cal concs, socal markg as ccd as nffcual or v counproducv. or sac, Wr 56) ccd socal makgs mpass o commrcal producs, yclamg a s a odds w posopy of commuy mpowm

Wr allgd a oral rydraon soluo (ORS) manufacurrs, oprva and govm, wr rlucan o accp a cralasd ORS for far of couragg omasd ms ccordg o s vw, v sllng of ORS cras dpndncy and dracs from mpowrng knowldg of prncpl of rang darra

Socal makg as also crcd for racg wog audcsura (46) pod ou a n Baglads, mass mda cals, suc aslvso and prss, a pmaly assl o m ad ura lS agus a a lracy ra of 16% amog wom maks sucoal

lloards and nwspaprs uslss for mos mors urrmor, mporannformaon aou conracpv us and sd ffcs was o mad avaan a form appropra o arg audc unl ar sals dcrasd causof usr dssasfacon. ura concludd a socal markng s no rspon-sv o nds ad concs of usr, u s drv y markng andsals sgnals dfnd y Ws commrcal markng pracc.

THE COMMERCAZATON OF HEATH NFORMATON In 80s, w gnral ascndancy of supply sd conomcs and popular

ackowdgmn of succss of mark mcansms durng lar alf of dcad, as agans commrcalsm susdd. ommrcal rmsgand ncrasng accpac, vn counrs wr conoms adlog cnraly plannd Pulc al srvcs cam producs, po-p cam cls ad consumrs, ad organaos w a poduc odsu am "vndors dcad saw a makd gow n praccof socal markng for al, as wl as alrlad commrcal markngand causrad markng

Halrlad commrcal markng mrgd n la 80s, wn

Klogg ompany cd Naonal acr Insu (NI) ndngs markngs gfr ra cra. Klogg ducad pulc, wl crasg s mark sa fom 6% o 42% us, sad a maor makg

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348 LING AL

end 6) Keogg camed ha afe he campagn ove 90% of Amecansknew he becance message and had head an aveage of 35 mes Theeducaona aspecs of he campagn wee quesoned by Levy & Sokes (38)

howeve because he benefs dd no geneaze o ohe hghfbe ceeas un hose companes mouned he own cance educaon/mrkeng campagns Ahough nonpof souces geneay enjoy geae cedby hanpof souces he KeoggCI combnaon s peceved as amos as cedbe as he nonpof souce aone 9) Thus Keogg may have ased scedby whe CI ganed geae exposue a no cos as a esu of whaFemuh e a 6) caed "seducve coaboaon

Causeeaed makeng s a sma commeca/soca makeng bend In hs saegy copoaons donae a pecenage of he pofs o a cause hus

endng makeng expese and suppo o a cause whe enhancng hemages and makng pofs In he eay 970s fo exampe he US Com-m ee fo he Uned aons Ineatona Chden Emegency Fund U-CEF) coopeaed wh sevea compaes ha announced n he makengeffos he suppo o UNICEF hus yng he amoun of he contbuons o the voume of saes of he podcs Caesa (7) descibes ohe exampessuch as mec xpess pege dn n n h Su

enovaon fund each me s cd ws used Duing ha peod AmeicanExpess ased $7 mon fo he enovaon pojec whe nceasng he

use of s cards by 0% Sudes o measue mpac fo he copoae sponsosas we as fo pubc heah ae needed 6)

As he 990s begn ou evew of he eaue shows ha soca makeng has become moe pevasve n pubc heah Ahough some compan ha s ofen adoped pecemea and whou a sysem of opeaona pocedues has aved a he end of s second decade wh a measue of mauygeneay consdeed a usefu pacce bu s no fuy undesood by many

heah pofessonas

Examples of Social Marketin om Developin CountriesAhough mkeng s deepy ooed n busness pacce n he Uned Saesand ohe deveoped counies he debeae pacce of makeng fo pubc heah has found s mos compee expesson n he ess deveoped counesaous soca makeng acves have been undeaken fo nuion faypannng and ohe pubc heah poecs n Asa snce he ae 960s andeay 970s; subsequeny hese acves wee exended o Afica LanAmeca and he Mdde Eas Pubc heah pobems n he deveopngnaons re so ge and ugen ha boh mmedae acons and nnovave

appoaches e equed Fo he adopon of pubc heah makeng paccesn deveopng counies s foruous ha he few mode mass medaavaabe e usuay govemen owned and opeaed and heefoe moeobged n pincpe o devoe me o soca deveopmen ave he

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SOIAL MARKING 34

verwheng and sees npsc pwer f hese cenrazed edawas evden pubc heah prfessnas The famy pannng pneers ndevepng cunres knew ha her case was cnrversa and were eager argue her case n varus pubc fra, parcuary hrugh he meda

Thus, fay pannng has fen ed he way n nnvave cuncansraeges, ncudng sca markeng echnques

Nne usrave prjecs chsen fr her varey f subjecs, apprachesand gegraphc represenan have been dvded n hree grups (see Tabe) The nfrman s based n dcuens and reprs prvded by hensuns respnsbe fr he prjecs he descrpns are necessary brefReaders are encuraged refer he surces and nsuns ced fr recmpee nfrman ncudng sasca daa

The abvemenned sandard sca markeng prcedures were used n hese prjecs, excep where parcuar echnques are enned Theseexampes d n ye demnsrae ngerm mpac n behavra change

herefre, he cs f behavra change s n avaabe Mre evauans andsudes are needed deerne cseffecveness

TNBL PODUCTS A darrhea dsease cnr prgra n Egypacheved pressve resus In Deceber 1984 ne year n he campagn,apprxaey 0% f he hers surveyed recgnzed he dangers f de

Tab xamples of social marketing

Pm

Tangibe Proucs

gypt-ational onro of Diarrhea Diseases

Project (DDP)Dominican Republicontaceptive Socia

Meing

anglaeshonraceptive Social Marketing

Kenyaonom Pomotion

Susaine ealh Practices

ameroonWeaning Projec

ndonesia-Weaning Proec

MaaysiaPMDM DaahDrug Prevention

Sevices iliation

oombiaational Vaccination usae Phiippines-xpane Pogram mmuniation

Oz Ivvd D

John Snow Public ealh Grup 19831988

Fuures Grou. D, Doremus 1984989

Porter & oveli, John Shor

ssociaes Popuaion Services nteationa, 19498

Manoff nt

Populaion Services nteationa 1994

R Manoff nt, ucationa 1985989Developmen enter

Manoff nteational 9841989

Govement of Malaysia 196presen

F WO, PO 9841994ealthOM D 984

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50 G ET A

drain cpared wi 2% in Ma 98 95% knew f ral redrainerap ORT) and ang se w used ORT n 1984 appxael60% ixed e sluin crecl cpared wi 25% in 198 (58)

In e Dnican Repulic cnracepive scal arkeing ipleened Prfailia a lcal fail planning assciain acieved is ecvesincreased availal f Mcrgnn ir cnr pills, increased use anglwer sciecnic wen increased cnacepive prevalence and in-creased nvlveen f e prvae secr wi cnsequen expanded ar-ke ules In cllarain wi a prvae secr rals anufacurer Pr-faila reduced e pce f Micrgnn 50% and sld e ral under anew lg In a fiveear peid Pfailia generaed enug sales revenue recver all peraing css and ece selfsucien Micrgnn purcas

ers represened an expanded arke (4% new acceprs) as well as randswicers alread in e cercial arke (66%) e 89% f e clienssurveed planned cninue using Micrgnn (7 6) Equall i-pressive, wever, s e verall rend n he al rals arke Durng eveear perd, e cnracepive scial arkeing prgra cnriued a30% increase in e al rals are, wiu eding e arke sares f er leading rals anufacurers

Banglades is acclaied as aving ne f e s successful cnracepivescial arkeing precs In ne decade e prgra sld ver 10 illin

cnds and ver 2.2 illn ccles f ral cnracepin In 1984 eprec seved 40% f all cnraepve acceprs (an eing rral) sellng lwcs pducs rug real and wlesale ules Qualaiveresearc ecniques suc as fcus grup discussins and indep inerviewswere used denif e ar resisance pins using cnacepinInvesigars cncluded a en suld e e priar arge audience f eedia pgra, ecause e were e s resisan ignran and unwllng cnsider fail planning Reserc cnceing cuen users cnfireda usands were an ipran surce f inscin Fueen ns aer

e radi prin f e capaign egan e nuer f persns w elievedha de fail planning eds are unsafe decreased and nepersnaldiscussins au fail planning and recgniin f e persnal ecnic enes f fal planning increased Cnracepive scial arkeing effsin Banglades drew aenin e pivae and pulic secrs expandedhe arke, and used indgenus insuins in prgra plannng, peran,and evaluain ( 46 58).

Thug ass eda in Kena, scal arkeing epaszed e qualiiage f Kinga cnd reeced in prduc design, package and derae

cs Cercal spkeepers and a le sales ea were used as cnddisruin cannels and prved effecive in exending accessiili ralareas Te prinal capaign ad a signican ipac n cnacepivepracice Cuen ed users ang surve respndens rse f 21%

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SOCIA MARKTING 5

5% in ne ear whereas the cnrl grup shwed litte change In addi tin t prting sles the cpign created high level f brnd wreness. Afer six mnths f marketing 85% f male surve respndents were

aware f Knga cndms Of thse wh had heard f Kinga 80% wereable t describe its purpse as a cntraceptive raher than as a venerealdisease prphlactic a functin hat was deliberatel included in hecapign essages Befre being educted but Kinga nl 2% f surve respndents spntaneusl mentined cndms when discussingcntraceptive ethds Six mnths int the campaign this figure hadrisen 57% ()

SUSTAINED HEALH PACTCES The Caern Weaning Prject indicates

ha scial arketing techniques can be successful in strengthening cmmunitbased health educatin in remte areas The Camern Prject pr-vided a unique pprunit t empl scial marketing under extremel tughcnditins because f the limited resurces f he implementing agenc (apivte vluntar rganiatin) nd the diicult scial and eclgical envirnmen. Despte the difficult circumstances under which the prgram was undertaken mderate gains were demnstrated mprved skills f CAREstaff in cnducting quantitative and qualitive research appling apprpriatecmmunicatns skills and disseinating simplified infrmatin imprved

knwledge levels and infnt feeding practices ng illiterte rral thers(21)

The Indnesi Wening Prject was designed t develp lwcst nutri inallsund sustainable slutins t reduce weaning prbles. In additin radi psters and recipe leaets cmmunit leaders and health wrkerschanneled ntitin eductin t ther Evlutin using cntl nd csegrups shwed that knwledge f wening methds nutritinallsund feed-ing practice nd child grwth increased st ng cmmunities that alsreceived facetface cmunicatin frm helth wrkers (4, 48), thus

shwing the imprtance f a marketing apprach rather than a mediabasedadvertising capaign

The Dadah/drg preventin prgram (PEMADAM) in Mlasia is exceptinal because it markets scial plcies. The cprehensive capaigncmbines arketing principles and ther strtegies such as cmmunit andnatinallevel invlveent in a brad apprch t drug preventin eductin

ha aims t make drg abuse sciall unacceptable PEMADAM is attemping insill scietal principles thrugh scial arketing aied at linking an understanding f huan behavir with eective scial planning at a tiewhen scial issues are critical (6, 71)

SRVE ULZAON In Clmbia the drive fr universal child im-munizatin cbined cmunicain and arketing strategies bilizatin

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352 LNG AL

o poitical wil an uppot om vaiou cto o ocity an poymnto volunt at a gasoots lvl oca la an halth pomot winuntial in iminating inomation in th community though hom

visit. Th statgy of binging man in contact with th vic, which thy call channling, hlp inca immunization covag fom 20% in99 to 0% among chiln un on an 80% un fou in 984 23) Thpinc pompt UICE to instiut a boa appach to its immunization pogams in oth pats of th wol

In th Philippins immunization poct mass mia motivat moth to bing thi chiln to th clinic o factofac ucation Ths statg ispogssing towa th goal o 8% immunization covag b 993 In a990 uvy ampl comput covag among 223monthol chiln

wa 4% though th covag ct ha bn moat a ubstantiact in timin of covag ha bn obsv. Th pcntag o chilnwho complt th nti si o vaccinations bo thi it bithainca om 322% to 2% within on ya In aition, a igniicantimpovmnt in clint nowlg, spcially concing th logitic of vaccination, was not. Mobili national uppo has bn sponsibl fomuch of th succss to at ()

In ths illustativ cass, social mating has bn ctiv in incasingaccptanc o tangibl poucts such as th conom an th OS pact To

chang halth pactics howv social mating ns to b pat o a boa tatg that inclus linags with svic liv ills lingan community ucation I th goal i utain bhavio chang, an i thchang ha tctual implications social mating p s has lss impact

Views om Practitioners

o thi viw w contact pactition fo a moii Dlphi inquiyTh iv who pon cooboat h fining in th ampl pocts of tangibl pucts. amil planning pojcts hav oun socia mating

paticulal ctiv in gtting thi pucts accpt Conacptiv socialmating pogams a poviing potction to ov 8 million coupls in thvloping countis which psnts 12 million biths avoi annuallo about a 2% cmnt in annual wol population gwth (P D. Hav,Population Svic Intational)

To masu impact, th quantit o ach conacptiv sol i convtinto coupl ya of potction CY) uy o 3 amily planningpoct which mat contacption an tilization in tn vopingcountis, foun that th cost of poviing CYPs was $2 p ya signifi-

canty low than oth mtho of living amily planning in th countstui 22) Howv maus oth than cot uch as p an post-ss of population, shoul b u to valuat impact bcaus istibution

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SOL MARKING 353

saes f cnacepives des n awas ean ha he devices ae effecive- used (. Rin, Ppuain Cunicain Serices).

As a esu f is eeciveness in akeing angibe pducs, se

paciines nw pan use scia akeing pre he prducs, suchas Viain A suppeens agains xephhaia aniaaia drugs, andpphaxis and eaen f sexua ansied diseases (P D Have)

Se paciines aised cnce ve he high cs f uning a sciaakeing pjec. f a age pprin f budges is spen n adveising andpackaging, s a fu pice hen scia akeing pecs ae hadsusainabe (J. Rin). In such cases dependence upn exea subsidiesand echnica assisance us cninue.

Paciines as expessed cnces abu cs and accessiii. One

pinen paciine agued ha scia akeing fai panning pjecspvide sevces ha ae n panizing and d n undeine he digni f ecipiens because he prducs ae puchased hrugh an essenia neuaake sse in which virua a grups paicipae (P. D. Hare).Hweve, even subsidized pducs such as he ORS packe, can ce cse a da's wage in an cunies. If prducs ha us be puchased ae hese fcus f a scia akeing pjec cerain segens f he ppuain

usua he pes wi be excuded. Thus, nueus appaches ae needed achieve cveage, incuding heah educain, cunicain, aining

and scia akeing wih diffeenia picing ageed f vaus ppainsegens achieve cveage (56).

Sevea paciines uged srice pfessina sandads, such as geaerig in segening audiences and aiing essages f e ipac n behavi. These sandads wud equie an accdain beween heakeing pespecive, which ages segens s ike change, and hepubic heah/epideigica pespecive which is pica cnceed wih he pes, highes risk, and eas accessibe ppuains (M. Rasusn,Acade f ducaina Deepen).

Inepesna cunicain saegies ae ipran. The Sanfd Three-Cuni Hea Disease Sud and he subsequen Five Ci Prjec e-pred ha quai edia capaigns can inf, ivae, and pducechanges, bu faceface cunicain is needed f skibuiding,niing, and feedback (4, 7) Thugh en cied as a pjec haincuded akeing he TheeCuni Sud did n cnscius epakeing saegies a he ie ( Maccb, Sanfd Cene f Reseach inDisease Pevenin).

When scia akeing fis appeaed, enhusiasic suppes hugh iigh sve an pubic heah prbes. Hweve paciines, whieaguing f is effecive use have been cauius abu is ipac and awae f equisie cndiins. Me rigrus anasis and bjecive evauain f scia

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makting poct woul claly lp valiat th ctivn an cot-ffctivn of th pactic.

STRENGTHS AND WEANESSES

Strenths o the Soial Marketn Approah in Publi Health

KNWN TH AUDN Social makting ha ha a bncial impat on how th public halth cto ucat th public an pua communitian iniviual to aopt halthy pactic. With it mphai on clint ociamakting ha hapn th focu on th public. t ha bought mo pci-ion to auinc analyi an gmntation In aition to mogaphicpychogaphic ata attitu pfnc ponality tait) an ocial tuc- tu ata chuch wokit family) a incaingly n a vital in igningpojct Th ata povi citica infoation fo th foulation of btt tagt an mo ffctiv mag thu laing to mo appopatmag ign mo ctiv livy an abov all btt cption by

th pubic th ultimat bnficiai of public halth mau.

SYSTMAT US F QUATAT THDS Makt a ilignt uof focu goup an oth qualitativ ach mtho which a inight to th quantitativ infomation gath by uch intumnt a qutionnai.Halth ucato hav long u gou icuion imaily to olv community iu. But thi mo cnt u of focu goup to obtain cutomviw of thi campaign an pouc an to ptt mag val thpoitiv inunc of mating.

US F NNTS Social makt mak libat an ytmatic uof incntiv an pcial pomotion ot uch a contt an comptition which u wa to a cint to th makt plac. Thi mhowa not a gula fatu of th motivational o of public halth pojctin th pat. Puit might coni any off of a a kin of bby but th comptition fo atntion in th mit of th ploing commcial clutt ha ma it an accptab actic

SR MNTRIN Mot public halth pojct pay inucint attntion to monitong an oftn nglct managmnt. Social makt a commit to clo tacking of pog an impotant managmnt pincipl.

STRAI US F MASS MDIA Social makt u of ma mia in

living mag to pcific· auic to cat awan o fot an infoc ctain halth pactic conat haply with th mia outach of th maoty of public halth poct. Makting poct which uually

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icu itsiv a proog us o broacast mia purcas air timsots spciicay aim at targt auics, wras uru pubicat procts o p o t argss o t mia or r air tim I

t attr situatio, it is t mia program irctors wo, as a obigatio to agoo caus, ci wic Ps to air a w W Ps ar boacasturig sack ours oc or twic a mot, ty ca ary b pct to av t sam impact as a systmatic, wargt mia campaig

RALST XPTATNS tug isktakig is part o t commrciawor, trprurs o ot tak o impossib os a wou rus ayopss vtur. ocia marktrs oow tat traitio I pubic at,owvr, ocias ar too o ask o urtak a ,5prso ob

wit $500 a o prso uc oom procts ro cribiity, wic, i tu, urts pubic ats staig i its comptitio wit otr vopmtprioritis ocia marktig caot p but improv t cacs o pubicat programs troug mor raistic stimatios o t rquirmts or succss

ASPRNG HGH SANDARDS Just as imporat, socia marktig, witits roots i t commrcia wor, ot aspirs to attai t bst iormatiomatias a tat Tis as ar may pubic at prossioas wo

av a too o b comp to accpt sco rat work as a rsut o pria bugtary costraits.

RCGNN F PRC Opratig rom t cocptua ramwork o t 4Ps maktrs acpt tat tr is a pic or ay w prouct or bavior vi a voutary cag, atoug ot cssariy i motay trms ubicat prossioas av oy rcty accpt tat cost coms i mayoms, suc as icovic, oppotuity costs, a icogrc wit ocacutur. T otio, i it is goo or yo, you must wat it, sti igrs i t

at i, but socia marktrs o ot mak suc a assumptio I act,marktrs ask, How ca w mak pop wat it?

Weaknesses and Negative Aspecs o Social Marketing inPublic Health

M, MNY, AND HUMAN RQURMNS Marktig practics rquira avy ivstmt o tim, moy, a uma rsourcs tat may pubicat agcis caot aor Howvr w sig a proct may b,

witout popr acig a sta, it wi ot succ spcia vt tograt support a promot a at practic rquirs caru prpaatioa impmtatio it caot b a by voutrs ao.

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Social markeing will coninue o rn ino bureaucraic obacle uch a unealiic ime frame inadequae funding and underaffing. Becaue gov-emen are principal player in public healh epecially in he developing

coune many of hee bureaucraic conrain will no go away. ocialmarkeing paciioner hould develop innovaive way o overcome heeobacle and adap hemelve o he eaiie of developmen and he conain of he bureaucraic envionmen. Oherwie ocial markeing mayfae a gradual diminuion of i role in public healh.

MARKTING ELEMNTS MISSNG Makeing i par of a commercial ener-pie wih many elemen ome of which are miing in he public healharena hecking he requiremen o commercial markeing again he reali-

ie of ocial makeing for public heah program i a good way o idenifyinheren problem The commercial equaion ypically include reearch for new produc marke uvey of public inere in poenial new producmanufacure of produc wih qualiy conrol; he dynamic priceproducneed

angle and he ineracion wih wholeale and eail nework o ge poducdirbued and made acceible; commiion andor bonue o moivaeae foce dimia of incompeen anpcie fo mimanagemendividend fo hae holde and goemen eglaoy oveigh ny one of

hee elemen affec he oher a each erve a a check and balance for he

enire enerprie. Too ofen everal of hee elemen are miing in public healh iniiaive

Pehap he fo mo inacale oacle o he cce of ocial makeing in public healh are apec of he 4 P 2). Public healh doe no have he eibiliy o adu produc and ervice o clien inere and pefer-ence Commercial companie oen drop a produc line when produc prove

unpopla. I i moe diffcul o diconine a needed public healh eviceIn ocial mareing prce or he clien' aemen of he co of he erviceor produc may include uch facor a ravel ime effor epended phyical

dicomfo and he ocial conequence of innovaive behavior which mayange aoo no o he clie pecepion of hi o he abiliy ochange. or example he co in erm of effo and inconvenience fo ualwomen o ake heir children o e immunized i he enemy of many im-munizaion progam lhogh a nework of eail poin a convenienlocaion i a ine qua non for any ucceful commercial markeing eor here i a limi on he number of place a which public healh produc areavailable Behavior change hrough ocial markeing require he commi-men o a ained pomoional effo. Howeve few plic healh pojec

have he reource o uppor prolonged promoion aciviie

THE DE OF Ps AND OE EE EVCE? Social markee' pracice of buying air ime may have a eriou negaive impac on he fure of

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S he health ectr ha deeded bradcatg ervce t gve freea te t P ay cutre, e the bradcat eda have bee ad

t ar ublc health t, they are lger wllg t gve free ar tme t

health 9) he ae culd be tre fr the rt eda. Payg fr te adace create a eru rble fr the radt f free rmt fr ublc health. Effrt t luece ublc ervce ar te lce may be a gdtartg lace t tackle th ue

A BROADER APPROACH

lled Pctces

Becaue cal arketg t the ly ractce the eld f cal chage,

t ueful t tuch u the alled ractce f develmet cmmucat, health educat ad rmt, ad ublc relat lthugh they havedfferet tartg t, ad each ha develed a theretcal fraewrk fr t methd f wrk, they all ecurage ele t chage atttude ad behavr a facltate the adt f ew behavr hey all ted t have aeclectc arach ad have beefted varuly fr ychlgy athrlgy, ad clgy deed, each f thee ractce quck t crrate thatwhch t erceve t be f value

Develet cucat ecalt are cceed wth tereral,

gru ad edated cmucat May f the ce fr a backgrudf a cmucat ther have ther rt tereral cuca

t. Bth gu tre the rtace f the twway dalgu, eecallywhe wrkg wth cute, whch emhaze the crtcal race f meetg ele felt eed Develmet cmucat tratege wclude educat ad cal arketg eleet

r decade, health educat ha chaed the rcle cutyvlveet Health educatr are eected t ut the teret f the cuty frt degg ay rect. hey cder cucat a kll ad

arketg a tl Health educatr al ehaze udertadg the varudeterat f health behavr Health educat tudet are w requred

t take cucat ad cal arketg cure a art f ther trag. a eale f th dvetalg f dle, the Wrld Healh Orgaa t WHO eer cttee ew arache t health educat rary heath care urged health educa ractter 982 t adt aelereted arach he cttee al called fr tregtheg thecucat kll f health educat ecalt (0)

ublc relat bega a a way t rve ublc ercet fr ttut ad dvdual. May f t early ractter cae f jual. hrugh evut, t w ecae eda utreach, ecal evet,hue cmmucat, ad cmmuty educat May uverte thatgrat ublc relat degree w ffer cure cucat, advert

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38 G AL

ing oualism and mareting Pulic relations secialists no only roectheir insiution's or clien's views o he ulic u also reflec he ulic'sinterest and erceion in heir feedac o emloyers and hel devise olicies

and strategies enecial o oh heir emloyers and he ulic. oh he health educaion secialiss and ulic relaions raciioners in he U haverecently introduced an accreditation rogram o ensure rofessional and ethical sandards among heir rans.

ocial mareting and is allied ractices all claim ha teir resecivearoaches are comrehensive. They most certainly have overlaing claimsand methodologies. ll of them require their ractitioners to analyze audiences design ailored messages o sui secic segmens and retestaroaches and maerials. They all wor wih mass media sess oerations

research and data collection faciliae behavior change ractice emathyorient themselves closely to their audiences and recognize the rinciles of involvemen and emowermen 4.

A Prosetive Loo

With the advent of the lifestyle illnesses social mareing which deendseay on mea s ey t ay a gger e n ubc ea ifestyle

illnesses such as cancer heart diseases sychosocial disorders malnutritionand oveution accidens and seually ransied diseases are in fac

ransmitale y he imac of words and images on lifestyle imilarlywords and images are needed o comat hem With the elosion of humaninteraction and communication aetted y more han 4 million annualavelers in recen years hese diseases need o be aroached not asnoncommunicale diseases as most are cuently classified but as new"communicale diseases With its discilined aroach to mass media worsocial mareing can and should lay a useful role in comaing these newcomunicale diseases .

ince social mareting carved out its niche in ulic healh in he s and

98s many healh rofessionals and develoment secialiss have realized tha social change is a comle and challenging rocess. ealth ehavior canno e searaed from such issues as olicy economic and social circumsances ersonal attiudes olitical and religious allegiances societal normsand the entrenched interess of usinesses instiutions and cerain rofessional grous. Increasingly health and develoment secialists areadvocating a roader loo at these rolems and tacling hem in a morecomrehensive way. t the inteational level WO and UNICEF nowsuort a roader aroach to change.

WHO' S HLH PROMOON The World Health Organizaion recenlycalled for acion in healh romoion a roader version of healh educaion

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SOCIAL MARKETING 359

whch ncude advocacy for heath upportve aw and pubc pocenterectora odarty aance wth variou oca nttuton partnerhpwth ma meda and graoot educaton tratege to empower peope for

heath acton. Dr Hiroh Nakama Drector enera of WHO ha ad . Heath a poduct of ocal acton . . Actve communty artcpatonand uppotve oca poce are neceary for progre (9. The evovng WHO concept encompae fetye nd other oca economc envronmenta and perona factor conducve to heath

UNCF'S SOCA OBZATO In aunchng t Chd Survva andDeveopment ntatve 1983, UNICE ha found t neceary to mo- be vaiou oceta ector for evera nepenve nteventon to avemon of ve Soca mobaton SOCMOB a th mutectora effot caed a proce that eek to factate and enhance the appoach todeveopment ue that am t on to ce rom cro eve up tonton ce

Soca mobton enabe naton govement and deveoment a tance agence to move beyond the proect phae of many deveopmentprogam. It rt am to create the poca w for contuctve change and then to tranate that w nto the eabhment of vabe oca ervcepoce and acton to meet bac need

A contnuum of mutuay renforcng wereearched carefuy targeted igorouy mpemented actvte requred for the mobaton proceThe umbrea of SOCMOB cover advocacy marketng meda tranngcommunty educaton and graroot organaton actvte.

Oen thee actvte are undetaken by variou group wthout a boadtrategy tht conder the crtc nkge between nd mong them Theyoften wnd up a oated ometme pectacuar effort that e out kerework 42. The SOCMOB appoach am at avodng th frework

yndrome.Becaue many deveopment obectve nvove far reachng change SOC-MOB a promng trategy for pecc heath program a we a moregoba ue that affect deveopment generay. Where needed SOCMOBcan be ued to generate the critcal potca w that eenta for deveopment t ao am at the nvovement of ndvdua at the communtyeve n adotng potve behavor.

There a pace for marketng n both thee approche a they tre theneed to undertand peope nd tor nput to the pecfc requrement of the

communte conceed. The eement of marketng condered mot crtcafor promotng heathy behavor ncude conumer or market reearch productor ervce quty a dtibuton network product or brand mage prce andconumer affordabty accebty conumer atfacton and promoton

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G ET

H. S. hion WHO). M medi whih he ei e in mrkeinre rner no merey hnne for heh mee 4).

owrd e beinnin of he 980 Fo & Koe ) edied h wihin he dede mkein woud be eur feure of owin numbe onon oniion. hi i einy he e he heh eo ioneed. Soi mkein wi he imue demnd nd fineune hedein nd deiery of heh mee nd erie h eure e inubi he. he new hu of NCE nd WHO wo of he keydeeomen orniion he ob ee re ikey o onim hi in heyer o ome.

Neehee oi mrkein nno oe ubi heh obem on iown. Wihin he rnk of mkeer here i n ie u for ineedmkein ommuniion whih inude ommuniion nd eduionohe. Soi mkein oo my be moin owrd he broder roh. No on o frred oi mkee omined h hehw imy no of he mrkein domin. my i be o b mrkeini f beomin of he heh domin

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Social Marketing - Its Place in Public Health

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