Social marketing for public health systems change

Can social marketing efforts to promote individual behavior change inhibit progress instead of advancing it? On one topic at least, the answer appears to be yes.

A couple months ago I had the pleasure of attending the Robert Wood Johnson Foundation’s Childhood Obesity Program Leaders’ Advance, which brings together leaders in the fight against childhood obesity to discuss strategies and approaches for reversing the increases we’ve seen in the past 30 years. The meeting was held in Oakland, California, and included a visit with the Alameda County Public Health Department to learn about their efforts. An official from the department posed a question to the group, “What do we think is the biggest barrier to the success of community efforts to reduce obesity?” What he didn’t say was: funding, poverty, racism, education, or the food and beverage industries. His answer might surprise you — individualism.

Individual-focused messaging has led Americans to believe obesity is caused by personal choices. Click To Tweet

It turns out that decades of messaging about our individual eating and physical activity choices, all with the intention of improving the health of Americans, has inadvertently created a barrier to the systems approaches that are now recognized as needed to reduce obesity. Individual-focused messaging has led Americans to believe obesity is a personal problem caused by personal choices, and therefore investments in systems changes aren’t particularly needed. While personal choices are, of course, a factor in obesity, they’re not the largest one. But the individualism frame continues to undermine support for changes to the systems, policy and environmental factors that are the real drivers of obesity.

Infographic showing contributors to healthMy favorite public health graphic from the past few years is one that quantifies the contributors to health in America. It always stuns people to learn that, of changeable factors (not genetics), individual health behaviors only contribute 30 percent to our health and our health care system only 20 percent. Fully half of what determines our health are non-health factors, such as where we live, our income and our education, typically known as the social determinants of health. As public health has shifted to addressing these systems and environmental factors to improve health, social marketing approaches need to shift as well, so that we don’t continue to overemphasize the role of individual-based solutions.

Going forward, those in the field of social marketing need to ask: What is the right role for social marketing in promoting systems and environmental changes? And how do we balance individual behavior change efforts within a system change approach? Social marketing can change social norms, redefine a problem and redefine solutions to build support for systems and environmental changes through a different set of goals, target audiences and messaging. A new approach may also offer a different timing and sequencing of individual behavior change campaigns, conducting them only after systems and environmental changes are underway. Or, maybe the balance is struck through continual, consistent, blended messaging that highlights how systems changes are needed to make desired individual healthy choices easier.

As the approach to public health continues to shift toward community-wide systems and environmental strategies, these are the questions and approaches we must consider. Whose behavior to better change but our own?

Image credit : U.S. Centers for Disease Control and Prevention. Invest in Your Community—4 Considerations to Improve Health and Well-Being for All. Reprinted in part, with permission.

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