Social Marketing

We had a different sort of test this week, where we had to write an essay in near-exam conditions, the difference being that we'd been given details of all that was required in advance. Which meant researching and essentially writing the essay in advance, and then regurgitating it in a classroom for 90 minutes. In previous years, we might have been expected to write the whole thing in our own time and hand it in to a deadline. Having considered this alternative, I think I prefer this 'seen test' method - the other sort would have needed a great deal more research and a ton of references.

The subject, Social Marketing, started being considered in earnest in the UK for health in 2004, although the idea had been around since the 1970's. It arose from the realisation that telling people what was good for them was not achieving a great deal, and resistance to change, habit and convenience was enough to keep people not exercising, smoking and eating too much. Even though goodness knows enough information had been provided and they should know better.

Those concerned with improving public health turned to this idea of social marketing, which simply means selling a behaviour in the same way as cigarettes or hamburger-and-fries. Not only by providing information, but also by making the behaviour attractive and desirable, considering the competition, and addressing the true price of change in terms of abandoning one activity and/or adopting another.

The change in the way that smoking cessation was approached is a good example: a whole mix of other things was added to the simple message that smoking is bad for you. Taxation and legislation banning smoking almost everywhere raised the financial and behavioural cost of smoking; prominent smoking cessation clinics, prescribable nicotine patches and fake therapeutic cigarettes lowered the 'cost' of giving up. Adverts that showed how smoking isn't cool by rubbing the contents of an ashtray into an attractive model's hair made smoking less desirable. Addressing individual behaviour, environmental factors and social norms together is a much more powerful 'product' combination than a sentence on a packet of cigarettes and the absence of sponsorship in sport.

This is the approach that will need to be taken in addressing obesity. Telling people not to eat so much will never work on its own because eating is a much more addictive behaviour than smoking, and unlike cigarettes we can't cut it out completely. Eating too much, or eating the less healthy kinds of food needs to become something we simply don't want to do, but this is an incredibly difficult proposition, because no food is inherently bad as long as it forms part of a healthy balanced diet. Chocolate should never become as socially unacceptable as cigarettes, but it should be easier to find something healthy, tasty and reasonably priced to eat at a motorway service station. The approach taken with smoking appears to me to be hugely encouraging, and time will tell if it is successful. Perhaps the next big campaign in a similar style will be weight management.

Anyway, the particular example of Social Marketing that I wrote about in my essay was a small project in a district council office in Norfolk in 2007-8, where they tried to address the issue of employees eating no fruit and veg at work, and eating lunch at their desks.

I've worked in various places, some of which had a strong 'lunch away from your desk' ethos, and others where there simply wasn't anywhere to go. When I worked in Coventry the whole team took a break and sat together around a proper table for lunch. At my clinical placement over the summer, the dietitians had nowhere in the building to sit other than their desks, or there was the hospital canteen 10 minutes walk away, and only 30 minutes allowed for lunch.

In Norfolk they provided one-to-one consultations with a dietitian, refurbished the staff eating area, invited a chef to provide taster sessions and advice at a launch event, and worked with local businesses to provide an 'Honesty Fruit Bowl' and a 'Healthy Lunch Pack'. Evaluation after a year showed modest improvement, with more people rating their lunch as 'healthy', more fruit and veg being eaten at work, and fewer people eating at their desk.

There isn't any more recent information about the project, and I'd be very interested to know whether the eating area has been maintained or allowed to deteriorate, and whether the fruit bowl and lunch packs are still going. Until I'd had the experience of eating away from my desk at work, I didn't realise what a difference it made. Of course, it helped that I liked nearly all the people in that office, but even so, if I'd been a permanent member of staff instead of on a 12-week placement, I would have looked into ways of improving my lunchtime in that dietetic department.