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Blackwell Publishing LtdOxford, UKOBRObesity Reviews1467-7881© 2007 Queen’s Printer and Controller of HMSO; published with permission;

Journal compilation © 2007 The International Association for the Study of Obesity? 20078189193Review ArticleMeaning, effectiveness and future of social marketing M. Stead et al.

obesity reviews

The meaning, effectiveness and future of social marketing
M. Stead, G. Hastings and L. McDermott

Institute for Social Marketing, University of Stirling and The Open University, Stirling, UK

Keywords: Behaviour change, effectiveness, obesity, social marketing.

Accepted 24 November 2006

Address for correspondence: 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

OnlineOpen: This article is available free online at www.blackwell-synergy.com

obesity reviews (2007) 8 (Suppl. 1), 189–193

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

This paper was commissioned by the Foresight programme of the Office of Science and Innovation, Department of Trade and Industry © 2007 Queen’s Printer and Controller of HMSO; published with permission Journal compilation © 2007 The International Association for the Study of Obesity. obesity reviews 8 (Suppl. 1), 189–193

189

cigarettes or fast food on people’s health behaviour. Social marketing interventions that sought to target nutritional behaviours in several domains at once (for example. one examining social marketing alcohol.12). not to benefit the organization doing the social marketing. 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). The reviews found reasonable evidence that interventions This paper was commissioned by the Foresight programme of the Office of Science and Innovation. and the behaviour of policymakers and legislators. The evidence base to support this approach is gradually growing. in perhaps convincing them to pass legislation on smoking. and operated at both a brand and category level. but still moderately. tobacco and drugs interventions. say. This effect was independent of other factors. this found convincing evidence that food promotion has an effect on children. say. published with permission Journal compilation © 2007 The International Association for the Study of Obesity. or working better. social marketing is predicated on the idea that the same methods can be used to improve health. reducing fat intake) could be just as effective as those concerned with change in just one domain (for example. or to improve housing policy. drinking and diet are all good examples – shows that we cannot ignore the potential detrimental impact of marketing for. fruit and vegetable intake only). The first of these was a full-scale systematic review of the effectiveness of social marketing nutrition interventions (28). social marketing can be applied ‘upstream’ (11. particularly in the areas of food preferences. rather than only working. or persuade them not to stock confectionery at checkouts. regardless of how the intervention approach was defined by the study’s authors. But there is reason to be optimistic as some recent research has improved this situation. Stead et al. particularly in the promotion of family planning (25. 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). and to have a more limited effect on dietrelated physiological outcomes such as blood pressure. This latter finding might be expected. 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. For example. such as parental attitudes. and changes are likely to take a much longer time to occur and be detected. How effective are social marketing interventions? Just as commercial marketing can influence behaviour in a way that is often harmful to health. organizations and policymakers. What impact does marketing have on behaviour? The impact of commercial marketing on behaviour has been examined in numerous studies. In addition. (29)). However. when they have a narrow behavioural focus. increasing fruit and vegetable intake. They appeared to be less. obesity reviews 8 (Suppl. Social marketing interventions were defined as those which. The same criteria for defining social marketing were used in two literature reviews conducted for the National Social Marketing Centre. 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). A number of reviews have examined social marketing effectiveness in an international development context. or the behaviour of retailers.26). 189–193 . knowledge and psychosocial variables such as self-efficacy and perceptions of the benefits of eating more healthily. and one examining social marketing physical activity interventions. This introduces one final dimension to social marketing: the critical appraisal of commercial marketing. to make them more compliant with the law on selling tobacco or alcohol to minors. met all six of Andreasen’s criteria for a social marketing programme (6) (see Table 1 adapted from McDermott et al. social marketing interventions could achieve both narrower and broader goals. but also to that of professionals. It might seek to change the behaviour of professionals – for example. This is what distinguishes social marketing from other forms of marketing (10). 1). as shown above. 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. as these kinds of outcomes are arguably more difficult to influence. to encourage general practitioners or dentists to be more proactive in prevention. these have been somewhat limited by their narrow definition of social marketing (which in these particular reviews is often taken to mean. purchase and consumption behaviour. free distribution of condoms) and by their use of non-systematic methods. a series of recent reviews has sought to bring a more consistent approach to assessing the effectiveness of social marketing.190 Meaning. Furthermore. Department of Trade and Industry © 2007 Queen’s Printer and Controller of HMSO. primarily. or to restrict advertising to children (13). The review found that social marketing nutrition interventions were strongly and equally effective at influencing nutrition behaviour. effectiveness and future of social marketing M. As well as downstream. effective at influencing the stage of change in relation to diet. body mass index and cholesterol. This suggests that social marketing interventions can produce changes across a relatively wide spectrum of behaviours. Using rigorous and systematic review procedures. obesity reviews society. Competitive analysis of many health behaviours – smoking.

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.g. The next 25 years Recent trends in both commercial and social marketing have seen a move to relational rather than transactional thinking. the marketer would have to provide a unique offering for each of us – which in most instances is completely impractical. smoking status. However. so to be truly consumer-oriented. Business has learnt that it is much more profitable to retain existing customers than continually win new ones. 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.g. values and needs Formative research is conducted to identify these Intervention elements are pre-tested with the target group Different segmentation variables are considered when selecting the intervention target group Intervention strategy is tailored for the selected segment/s Intervention considers the best strategic application of the ‘marketing mix’. The net effect is an increase in inequalities. The offered benefit may be intangible (e. because variations between sectors of the population will mean that some will pick up on them better than others. This consists of the four Ps of ‘product’. Social marketing has adopted similar thinking. This is particularly apparent with inequalities: time and again.obesity reviews Meaning. This ties in with the Wanless concept of ‘full engagement’ being the only way to bring about a ‘step change’ in health improvement. behavioural (e. not social marketing Intervention considers what will motivate people to engage voluntarily with the intervention and offers them something beneficial in return. would argue strongly for customized offerings being developed and delivered specifically to disadvantaged communities. The interventions seem also to have had some effects on the behaviour of retailers. obesity reviews 8 (Suppl. A social marketing approach to inequalities. This has put a premium on high-quality service. although small numbers of programmes were nonetheless effective in this area. then. There is modest evidence of impact on levels of physical activity and psychosocial outcomes. the most needy) segments are then selected for customized attention.g. training is provided to intervention delivery agents). Stead et al. This paper was commissioned by the Foresight programme of the Office of Science and Innovation. The evidence is more mixed for adult smoking cessation. difficulties arise because we are all different. customer relationship management and strategic thinking. alcohol use and illicit drug use reported significant positive effects in the short term. and to have encouraged adoption of policies and other environmental-level changes. Effects tended to dissipate in the medium and longer term. 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 most promising (or in social marketing. Interventions that only use the promotion P are social advertising.g. with an apparently weaker effect on physical activity-related physiological outcomes. Implications for tackling inequalities Marketers succeed by meeting people’s needs. 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). effectiveness and future of social marketing M. ‘price’. short-term values) characteristics can all be used as segmentation tools. Department of Trade and Industry © 2007 Queen’s Printer and Controller of HMSO. 1). ‘place’ and ‘promotion’. 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. Personal (including demographic. 191 Table 1 Andreasen’s benchmark criteria Benchmark 1 Behaviour change 2 Consumer research Explanation Intervention seeks to change behaviour and has specific measurable behavioural objectives Intervention is based on an understanding of consumer experiences. published with permission Journal compilation © 2007 The International Association for the Study of Obesity. personal satisfaction) or tangible (e. low-income groups have responded less well to generalized offerings than their more affluent fellow citizens. A majority of the interventions that sought to prevent youth smoking. psychographic and geodemographic factors). rewards for participating in the programme and making behavioural changes) Forces competing with the behaviour change are analysed. 189–193 . although several of the tobacco and alcohol interventions still displayed some positive effects 2 years after the intervention.g. dietary habits) and benefits/barriers to engagement (e. Intervention considers the appeal of competing behaviours (including current behaviour) and uses strategies that seek to remove or minimise this competition 3 Segmentation and targeting 4 Marketing mix 5 Exchange 6 Competition developed using social marketing principles can be effective (30). These results are broadly comparable with systematic reviews of other types of substance use prevention interventions (31–33). long-term vs. Other Ps might include ‘policy change’ or ‘people’(e.

2003. 21: 545–553. Haddix A. 2004. environmental and policy-level changes. Stead et al. Mackintosh AM. Berry CC. and it can bring new ideas to the inequalities debate. 21. Hastings G. O’Hagan FJ. Pollay RW.foodstandards. 9. Department for International Development Health Systems Resource Centre. beliefs. Prentice Hall: London.htm (Accessed October 2006). 25 years of social marketing: looking back to the future. This paper was commissioned by the Foresight programme of the Office of Science and Innovation. Butterworth Heinemann: Oxford. Aitken PP. Social marketing. June. 92: 615–622. JAMA 1998. it can inform the debate on how the obesogenic commercial environment should be addressed. 7. 2. Consumer Council and Department of Health. obesity reviews 8 (Suppl. 25. Farkas AJ. 51: 3–18. Marketing and exchange. Anderson S. 12. Public Health White Paper.html (accessed October 2006). 321: 366–371. 27. Social. Annex 5: Effectiveness. Gordon R. Prepared for the Food Standards Agency. Gordon R. 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