UNIVERSITY OF WEST LONDON

An investigation into government health communications – in the context of a current alcohol campaign
Submitted in part requirement for the degree of MSc Corporate Communications, University of West London
Fiona Cordy SEPTEMBER 2012

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ACKNOWLEDGEMENTS To Mike Cordy for his patience and forbearance during what has been an extremely difficult time, what with job commitments, children’s exams, relocation to a new country (for him) and more. To Duncan and Rosie Cordy likewise. To Stephen Roberts, my tutor, for his sound advice and for making himself available at awkward times. To Cecile Lowe, course leader, for her enthusiasm and support, Gloria Walker for her experience in the field and wise words and all the others on the University of West London MSC Corporate Communications lecturers’ panel. Finally, to my fellow students for their many ideas and shared experiences – all the best to you all.

ATTESTATION I understand the nature of plagiarism and I am aware of the University’s policy on this.

Signed

Date

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ABSTRACT Governments invest a huge amount of time and money in educating the public around public health issues. In the context of a current campaign to promote awareness of drinking habits, this study investigates whether people are over-exposed to such campaigns, whether they are appropriately targeted, how people view attempts to enforce such campaigns using punitive measures, and whether Integrated Marketing Communications and other corporate communications techniques are being usefully employed to get the best out of such campaigns. The study employs a variety of research methods: an examination of comments about the campaign on the BBC website, a questionnaire involving 100 people and an analysis of ‘letters to the editor’. It finds significant discrepancies between the views of the people who commented on the website and those who replied to the questionnaire and recognises the differences between each group of people – the former group, which is self-selected, may be those who feel particularly strongly about the issue and are therefore motivated to comment, while the latter, which consists of people connected to the author, may be indifferent.

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CONTENTS 1.INTRODUCTION ................................................................................................................................ 1 2.REVIEW OF LITERATURE................................................................................................................... 4 What and why do governments need to communicate? ............................................................... 4 Barriers to government communication ........................................................................................ 5 Differences between public and private sector communications .................................................. 7 Similarities in public and private sector communications .............................................................. 8 Two-way communications ............................................................................................................ 10 The Four Ps.................................................................................................................................... 11 Influences and filters..................................................................................................................... 11 Agenda Setting .............................................................................................................................. 12 3.METHODOLOGY ............................................................................................................................. 14 Website research .......................................................................................................................... 16 Questionnaire ............................................................................................................................... 17 4.ANALYSIS ........................................................................................................................................ 20 Secondary sources ........................................................................................................................ 20 Themes analysis ............................................................................................................................ 21 Research on key words ................................................................................................................. 23 The reaction to minimum pricing ................................................................................................. 26 Minimum pricing - initial analysis by theme ................................................................................. 26 Minimum pricing - key word analysis ........................................................................................... 27 Use of ”tax” as a key word ............................................................................................................ 27 Analysis of ‘letters to the editor’ ................................................................................................... 27 The author’s own questionnaire ................................................................................................... 28 Minimum pricing ........................................................................................................................... 31 What aspects of the campaign are people aware of? .................................................................. 34 5.EVALUATION .................................................................................................................................. 39 Corporate Social Responsibility .................................................................................................... 39 Stakeholder theory ....................................................................................................................... 39 Stakeholder perception of campaign ............................................................................................ 40 The use of data and information .................................................................................................. 41 Integrated Marketing and Communication .................................................................................. 42 Two-way communications ............................................................................................................ 43 Branding ........................................................................................................................................ 43 iii

Minimum pricing ........................................................................................................................... 44 6.CONCLUSION.................................................................................................................................. 46 7. BIBLIOGRAPHY ............................................................................................................................ 488 APPENDIX A ..................................................................................................................................... 511 Pilot test questions ......................................................................................................................... 511 APPENDIX B ..................................................................................................................................... 544 Final questionnaire ......................................................................................................................... 544

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TABLE OF FIGURES

Figure 1: analysis of sample by themes ................................................................................................ 21 Figure 2: research on key words by number of occurrences ................................................................ 23 Figure 3: research on key words showing ratios of those in favour of campaign to those against: .... 23 Figure 4: research on "emotive" or "biased" key words....................................................................... 25 Figure 5: Fiona's alcohol survey - numbers who skipped questions..................................................... 28 Figure 6: Fiona's alcohol survey question one ...................................................................................... 29 Figure 7: Fiona's alcohol survey question six ........................................................................................ 30 Figure 8: Fiona's alcohol survey question nine ..................................................................................... 31 Figure 9: Fiona's alcohol survey question seven................................................................................. 322 Figure 10: Fiona's alcohol survey question eight ................................................................................ 333 Figure 11: Fiona's alcohol survey question two .................................................................................. 355 Figure 12: Fiona's alcohol survey question three ............................................................................... 366 Figure 13: Fiona's alcohol survey questions four and five .................................................................. 377

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1.INTRODUCTION
The UK has a long history of alcohol usage. Archaeological evidence shows that ancient Britons were quaffing alcohol back during the Stone Age and when the Romans invaded, they introduced their habit of drinking wine diluted with water. Later on, beer was drunk as a food as it contained grain, but it had the added advantage that it as it was boiled, the process killed unhealthy bacteria. Like many citizens of northern countries, Britons have used and abused alcohol in social situations where their Mediterranean counterparts might have been content with a stroll round the town square and making a cup of coffee or a sparkling water last all evening. Drinking with the aim of inebriation is socially acceptable and getting drunk has been a rite of passage for young people. Binge drinking is common among teenagers, many use alcohol for stress relief and poor drinking habits have often continued through till middle age and beyond. Alcohol-related harm is now estimated to cost society £21 billion annually, and alcohol is one of the three biggest lifestyle risk factors for disease and death in the UK after smoking and obesity, according to the Home Office (2012 p.3). In addition to the havoc it can wreak to an individual’s health, alcohol is also a known factor in street violence, domestic violence, costs untold sums in damage to property and uses up substantial government resources. While the UK is not alone in its abuse of alcohol - a World Health Organisation report in 2011 calls for coherent action on alcohol across the European Union - the problem is so severe that the government launched an alcohol strategy in March 2012. This will attempt to curb the serving of drinks to people who are already drunk and provide support to hospitals and police dealing with the problems of drunkenness. One of the key points within this strategy is to introduce a minimum price for alcohol, probably of 40p a unit, although the Scottish government has already announced plans to set this at 50p per unit. The thinking behind this is that cheap alcohol is part of the problem and too many people are drinking at home before they even set foot in a pub. It will also include a review of drinking guidelines – to target, among others, people who drink just a little over the recommended limits and think they may not be at risk of alcohol-related illness. These moves are the culmination of a drink campaign launched in February 2012 which focusses on this particular group of people. The government is using this campaign to prepare stakeholders, using a technique known as “agenda setting”. This recent project is the latest in a long line of alcohol campaigns. The “Know your Limits” campaign in 2008, was aimed 18 to 24 year olds, although it also reached out to younger, illegal drinkers. It used as its key message a shocking depiction of young people in very desperate straits

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at the end of a hard night’s drinking. In 2010, the Alcohol Effects programme highlighted the unseen damage that alcohol can cause, including mouth and breast cancer, high blood pressure and stroke. Alcohol is not the only subject of public health and information campaigns. The Central Office of information (COI) was formed in 1946 and spawned numerous memorable and long lasting campaigns, including the 1970s seat belt campaign “Clunk Click, Every Trip”, which prepared the ground for a change in the law; and the Green Cross Code children’s road safety campaign, also from the 1970s, which led to an 11 per cent fall in casualties but needed constant reinforcement. Even before the COI’s formation, “Your Country Needs You” and “Keep Calm and Carry On” were famous slogans from the two world wars, indicating that the tradition of public information dates back for as long as half the adult population has had the vote. Although the COI closed in early 2012, this work will be carried on by individual departments. The discipline of social marketing refers to the notion of using marketing and communications techniques to achieve behavioural changes and takes the aims of these campaigns a whole step further. In fact, in 2010, in Kent, an NHS primary care trust took part in a scheme in which people were paid to lose weight. Another scheme in Scotland gave pregnant women shopping vouchers for stopping smoking, while toys have been given to children for eating their fruit and vegetables, according to Donnelly (2010). Public health officials might argue that these moves are justified: Sandel (2012) pointed out that half of UK health spending goes on treating the consequences of unhealthy behaviour, while only half a per cent of the NHS budget is spent on encouraging healthy behaviour and asked: “Is the use of financial incentives or bribes consistent with true freedom of choice or is it implicitly coercive?” But some people feel that using public health information campaigns is also an intrusive intervention into people’s lives. As an article in The Economist (2011) pointed out recently: “There is a lot of advice around these days”. Is there in fact too much advice around and is it in fact going further than mere advice? Commenting on proposals to strip cigarette packets of all branding, Clarke said (2012): The point at which you so police somebody else’s wellbeing that you’re prepared to order them, put penalties on them if they won’t stop doing what you think they shouldn’t do, is a step you should take cautiously.

It is this “policing of someone else’s wellbeing” which interests the author. Blacker (2012) says that until recently, doctors worked with individual patients but now they are pestering us on a daily basis 2

with “prescriptions” on how to live: “like secular priests scolding us from the pulpit of science.” For doctors, read also governments who also appear to have taken upon themselves the duty of telling people how to conduct their lives. These issues have led the author to question how far people think this work should go. The government has a corporate reputation to maintain and part of maintaining that reputation is around fulfilling obligations to ensure the long term health of its population, as well as preventing the consequences of anti-social behaviour induced through drink. While commercial organisations measure their reputation in shares and sales, governments measure them in votes. Furthermore, the government has stakeholders to satisfy and in the context of this study, the stakeholders would be voters, taxpayers, public services (police, health workers), awareness groups, as well as balancing these against the rival but lucrative claims of retailers and suppliers. It has a huge amount of data at its disposal but needs to ensure this is fed through to the public in a way that they find acceptable. From a personal point of view, this author has tended to feel successive governments overdo the paternalistic approach towards its key stakeholders and wanted to establish whether the government was using sensitive and targeted communications theory in order to achieve the best possible results in their interests. It was felt that focussing on a current communications campaign and establishing some answers to the following questions would be a useful step towards achieving this goal. a. What is the public's perception of such a campaign (nanny state/necessary intervention? b. How do people view the extension of the campaign using regulation such as minimum alcohol pricing? c. What aspects of the government's integrated alcohol campaign are people aware of? (ie research, press, TV advert, posters, web content etc?)

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2.REVIEW OF LITERATURE
Public sector communications is big business. Communicators are employed in the health service, education, foreign office, local authorities and more, as well as the many privatised industries offering public services such as electricity, water, gas and the railways. This review sets out to show that good corporate communications is as essential for government as for any large organisation. It will then discuss the importance of Integrated Marketing Communications within that context and discuss some of the elements of IMC, as well as behaviour change and other concepts that can influence public behaviour. Some of the literature referred to describes the concept of social marketing and while this is often taken to have a much wider definition than communication/public relations, there are many elements that are common to both. Indeed, French et al (2009, p.321) say that communications campaigns and social marketing are: “synonymous in many practioners’ minds.” What and why do governments need to communicate? Phillis (2004, p.3) argues that: “Government needs to be at least as good as any other sector in communication, and arguably should set new standards”. Liu and Horsley describe one of the attributes of government communications as “public good” (2007, p.378) and quote Viteritti (2007, p.379) saying: “Meaningful communication between government and the people” is “a political, albeit moral, obligation that originates from the basic covenant that exists between the government and the people”. This obligation to communicate is therefore one of the core

functions underpinning a democratic government and should be coordinated by a: “management function that is responsible for overseeing and coordinating the work done by different practitioners in different specialist disciplines” a definition of corporate communications, according to Cornelissen (2008, p.5). Glenny (2008, p.154) suggests that the management of strategic relations provides a: “constructive framework to examine the role communication plays in the public sector and quotes Davis (2004) who states: “public relations has become a, possibly the, most important component of modern politics.” While much of this public sector communication serves the purpose of defending the government as executor of the policies outlined through its political activities, any government also has an extremely important executive role in running the day to day operations of the country. Glenny (2008, p.153) describes this as the “apolitical or non-partisan” activities of a government and it is this role which concerns this study, in particular by focussing on the current government campaign to highlight awareness of the impact on health of excess alcohol 4

consumption. Neuberger (2011, p.12) says the need for the state to develop and pursue policies which are of benefit to individuals and the wider public is accepted and it is part of the role of government to intervene: “for example, to tackle obesity and reduce harmful alcohol consumption on the ground that individual health is a good which the government have a responsibility to promote.” If the role of Cornelissen’s “management function” mentioned above is to support the corporate objectives and goals of a government, then the promotion of preventative healthcare must rate high in its priorities, leading as it does, to improved wellbeing and morale in society as a whole, and also keeping down costs associated with expensive health interventions. Marmot (2008, p.15) says: “Action taken to reduce health inequalities will benefit society in many ways. It will have economic benefits in reducing losses from illness associated with health inequalities. These currently account for productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs.” Darzi (2008, p.36) argues that the modernised NHS must be more proactive, focussing on public health initiatives in alcohol, drugs, sexual health, tackling obesity and improved mental health. The material and financial cost to the government of, for example, not solving the binge drinking crisis in the UK was pointed out in The Guardian (2012), which cited a recent report which predicts that binge drinking will cost the NHS £3.8bn by 2015 and result in 1.5m A&E admissions a year. Barriers to government communication Having established the need to communicate health information, the next step is to look at the barriers to this activity. Government promotional activity can often be distrusted. Liu and Horsley (2007, p.380) describe a: “poor public perception of government communication. “ There is: “a deep distrust amongst the general public of much of what it is told by government”, according to Phillis (2004, p.29). This is in part due to the legacy of propaganda use in Soviet Russia and Nazi Germany. There is a “persistent notion that government public relations is not an entirely proper or legitimate activity, that it constitutes a form of propaganda,” says Heise in Glenny (2008, p.154), which has led to an intense fear of a repetition of those events in the early and middle parts of the twentieth century . The notion of “spin” which grew up during the Blair years, has also added to this suspicion of government communication, particularly in relation to the print and broadcast media. It is associated with a: “partisan form of communications,” says Phillis (2004, p.6). The doctrine of personal responsibility, beloved of conservative politicians in the UK and abroad, 5

which decrees the obligation of the individual to make his or her choices on how to conduct their lives, also has a role to play in this fear of the “nanny state”, which has grown as people have become more educated and have more leisure to make their own choices and to live their lives in their own way. Thaler and Sunstein (2008, p. 6) say: Those who reject paternalism often claim that humans do a terrific job of making choices, and if not terrific, certainly better than anyone else would do (especially if that someone else works for the government) Rogers (2012, p.16) describes: “a strong libertarian strand in the British psyche that will always stand up for personal choice.” Phelan (2012) quotes Stop Smoking expert Allen Carr as saying national No Smoking Day is the day on which: “any self-respecting smoker will point-blank refuse to stop, because they don’t like being told what to do.” Tench and Yeomans (2006, p.581) suggest that messages can be perceived in different ways by different people and while an elderly person may ignore certain public messages about special allowances because they associate governments with taxation, the message may be more effective if it’s aimed indirectly through a carer. Murray in French et al (2009, p.1) says some people even believe: “big state interventions breed dependency and sometimes even encourage people to behave in ways that are not good for them or society as a whole.” French et al (p.4) goes on to add that as people become more empowered, they: “trust governments and state organisations less.” Aside from this inbuilt mistrust, the literature also suggests that the public sector has not got the measure of the population when it comes to implementing its communications. Scriven (2010, p.153) even suggests: “Many health campaigns in the media are driven by the need to do something and to be seen doing it” and French et al (2009, p.12) discuss political pressure to: “be seen to be acting”. Tench and Yeomans (2006, p.588) say advertising is used for this reason because it is highly visible. Phillis again says (2004, p.6): “Interest in government communication is low, unless it concerns a personal issue such as a local school or hospital or crime in their community” and in Tones and Tilford (2001, p.349), Mendelsohn adds: “Among the ’needs’ we all have is not to be bombarded with information we already have or do not have any use for (eg information asserting that excessive drinking may be bad for us).” Indeed, a GI Insight poll of 1,000 consumers (PR Week 26 June 2008) reported on a:

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Perceived gulf between the relevancy of communications from commercial organisations, compared with the far less well-targeted messages reaching people from public sector bodies. The survey found the public sector scored 18-19 per cent below average and was three per cent behind banks, and one per cent behind building societies and mobile phone companies. Supermarkets were 19 per cent above average. Thaler and Sunstein (2008, p.10) suggest some people will happily accept messages from private institutions but object to government efforts to influence choice with the goal of improving people’s lives. Differences between public and private sector communications Tones and Tilford (2001, p.348) point out that commercial organisations have a huge advantage over the public sector, however, in that there is a possibility, even a probability that their “product” is something consumers actually want or need. The product which is being promoted by health education is frequently intangible and offers gratification at some indeterminate time in the (often distant) future. This almost exactly reverses the pattern of commercial sales techniques which promise immediate gratification, often on credit. Moreover, behaviourists understand that most people are driven by the conviction that the consequences of negative habits simply will not happen to them, particularly when they are young and these consequences seem so far off. “Unrealistic optimism can explain a lot of individual risk taking, especially in the domain of risks to life and health,” say Thaler and Sunstein (2008, p.32). In fact, it’s worse than that, argue Tones and Tilford, because the messages associated with these products, such as “take more exercise” or “look after yourself” (2001, p.349) are inaccessible and less tangible than commercial goods or services that can be bought on the high street or internet. In fact, the pains associated with health campaigns, are often worse than the gains. For example: “Like smoking, alcohol consumption provides considerable gratification, both physical and social.” (Tones and Tilford p2001, p.378), who see alcohol as posing a complex health education message in comparison to, say, smoking. The message: seeks to promote ‘moderate’ or ‘sensible’ drinking and requires the individual to calculate relative strengths of different liquor; it requires judgement and decision making.

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The situation is further complicated by the need for government to mollify big business. Drinks manufacturers account for a significant contribution to the UK economy. They employ many people and pay significant taxes. They fund a huge lobbying industry fighting any restriction on: “promotion, pricing or availability,” says Rogers (2012, p.17), who adds: Drinks companies are in a difficult position. Even though many – like Diageo – have invested millions in CSR and now purvey responsible drinking messages, the fact is they can only succeed in the long term by selling more booze. There is huge irony in that these companies are paying rather tax pounds to the UK economy but some of it, albeit a fraction of this amount is actually being ploughed back into health education on the effects of alcohol. McKinley quoted in Tones and Tilford (2001, p.342) says: How embarrassingly ineffective are our mass media efforts in the health field…. When compared with many of the tax-exempt promotional efforts on behalf of the illness generating activities or large scale corporations. The irony is further exacerbated when the huge sums ploughed into advertising by drinks companies on alcohol advertising are considered. Dawson, P (2012 p.37) says: “Health promotion messages pale in the face of the advertising might of the global drinks industry.” Tones and Tilford (2001, p.378) agree that: “expenditure on health education has been completely insignificant compared with the promotion on alcohol,” and point out that direct and indirect messages in the media about alcohol tend to demonstrate its social acceptability. A further difference between commercial and social marketing say French et al (2009, p.32) is that despite the fact that business is increasingly looking to add value to its stakeholder relationships through corporate social responsibility, this will only ever be a secondary aim in contrast to public good initiatives, where the primary aim is “social good”. Nevertheless, there is a need for the public sector to follow the lead of the private sector which is: “very responsive to people’s needs and wants,“ say the authors (2009, p.4). Similarities in public and private sector communications While there is much that therefore differentiates and adds to the complexity of a government communications campaign in comparison to the private sector there is also much in common. For example, the use of integrated marketing communications (IMC) theory can be applied to the public sector. The campaign to raise awareness of the risks of drinking, launched in early February 2012, ticks many of the boxes associated with IMC, including branding, pre-campaign 8

research, planned messaging, use of a variety of different tools (press and PR, advertising, leafleting, electronic “freebies” such as a drinks calculator and social media), in an apparently coordinated way. French et al (2009, p.12) say media promotions, advertising and other forms of mass communications should be used as part of a: “planned and coordinated strategy, and not as the default solution.” In a world where people receive an estimated 13,000 messages in a lifetime, integrated communication strategies are needed to break through the “clutter”, says Cornelissen (2008, p.24). Cheng et al (2010 p.10) quote Schultz and Shultz on the philosophy and benefits of an integrated approach, namely: effective “orchestration and delivery of messages into the marketplace,” and applying “the strengths of each communication discipline or technique so that the whole is greater than the sum of the parts and the optimal message impact is achieved.” Cornelissen (2008, p.25) agrees that using messages to complement each other across various media can lead to greater communication impact than any one single message. “ For Schultz (2012, p.14), this is about focussing on customers rather than products and services, aligning the entire organisation internally and externally to do so and developing a process that puts a value on customers and invests the “right” organisational resources in communicating with those customers over time. For Fill (2009, p.264), the modern interpretation of IMC includes the notion that it is “customer-driven”. French et al (2009, p.4) discusses the idea that services and interventions should be designed to meet “customers’ needs, not the needs of the bureaucracy.” Hawkins, Bulmer and Eagle (2011, p.229) quote Kliatchko's definition of IMC as: “an audiencedriven business process of strategically managing stakeholders, content, channels, and results of brand communication programs” and find that the application of IMC in health promotion contexts: “can result in effective communication that leads to real behaviour change” (2011, p.237). With the focus on audiences, customers and consumers, the notion of dialogue rises to the fore. Informational and persuasive communication strategies are weighed in favour of the sender and do not take into account the needs of the receiver.

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Two-way communications As mentioned earlier, there is evidence to suggest that many people are distrustful of government messages and dislike being told what to do by a paternalistic state but a focus on dialogue rather than monologue, where: “the goal is to exchange views and to reach mutual understanding between both parties,” Cornelissen (2008, p.56) would appear to be a more meaningful way of engaging the doubters. Sweden has a state-controlled service monopoly on the sale of drinks, known as Systembolaget and this organisation’s vision excludes dictating whether it is right or wrong to drink but includes inspiring people: “to become interested in what they drink and to focus on quality, not quantity of what they are drinking” Cheng et al (2010, p.178). It is this invitation to “become interested” which is key to two-way communications, with its suggestion that people have a role to play in the evaluation of how they choose and use alcohol. Theorists tend to suggest, however, that government communications fail in respect of two-way symmetrical communication. Garnett in Liu and Horsley (2008, p.380) says: “Government’s traditional use of one-way models of communication, rather than two-way models, often limits dialogue, thereby diminishing the role of public feedback. Glenny (2004, p.155) adds: “In many discussions, government communication is portrayed as a one-way flow of information with a strong focus on mass media.” Dozier et al, quoted in Tench and Yeomans, (2006, p.578) say: “Public communications campaigns fit in with the two-way asymmetric model of communication” to influence a change in knowledge, attitudes and behaviours. Tench and Yeomans suggest there is evidence that public sector communication is moving towards a: “More symmetric style of communication.” Phillis (2004, p.3) recommends redefining communications to mean: A continuous dialogue with all interested parties, encompassing a broader range of skills and techniques than those associated with media relations. The focus of attention should be the general public. Phillis adds (2004, p.6): that government communication works most effectively when it engages members of the public in a two-way conversation and that modern communication is a “service” for citizens that involves: “listening as much as talking (p.12). French et al (2009, p.4) discuss the need to engage, listen and help to change people, instead of “hectoring” them.

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The Four Ps Within the IMC framework, another commonality between the commercial and the public sector is the use of the notion of the four Ps – product, price, place and promotion as four key tools for scoping any communications project. Cheng et al (2010, p.2) describe the discipline of social marketing, which uses marketing techniques including the four Ps to influence behaviour changes for the benefit of the individual and society. They suggest that in the public arena, the product might be: The benefits that the target audience will experience or expect in exchange for performing the targeted behaviour… (eg a healthier life and the reduction in the risk of becoming obese or overweight). However, as mentioned earlier the similarity ends here because as Tones and Tilford (2001, p.347) point out, while commercial campaigns are able to drop a product that doesn’t work and try again with something new, the health promoter must soldier on: Health education frequently seeks to sell a product which commercial advertisers would consider no one in their right mind would buy! Potential customers are not uncommonly urged to stop doing something they find enjoyable and start doing. Commercial campaigners are also able to offer instant gratification, say the authors, while the health promoter’s offering is intangible and realisable a long time off in the distant future. Other parallels with mainstream marketing’s Four Ps include price, which would be: “The costs that the target audience will “pay” for adopting the desired behaviour that leads to the promised benefits” and in the case of health promotion, this could be: “time, effort, energy, psychological costs and/or physical discomfort.” Place is where and when the desired behaviour is performed or how the marketing outputs are delivered – Tench and Yeomans (2006, p.585) cite the example of a campaign to encourage condom use in which condom vending machines were introduced in public toilets to avoid subjecting people to a potentially embarrassing visit to the local pharmacy. As with commercial marketing, promotion is about choosing and implementing messages and delivery channels. Influences and filters Sunstein and Thaler (2008) discuss three social influences that have been found to influence behaviour change – information, peer pressure and priming. They cite research that people are more likely to carry out a particular behaviour if it is made easy for them by the provision of 11

information. For example, students who would have known the location of the health centre in Yale were shown to turn up in larger numbers for tetanus shots when they were given a map than those who weren’t. Priming works by providing cues – briefcases and boardroom tables

were found to make people more competitive – asking people how many times they plan to floss their teeth apparently results in increased flossing. Finally, there’s safety in numbers (2008, p.64): Campaigns to inform people that drinking is not ‘the norm’ have been successful : Incidents of alcohol abuse are easily recalled and the consequence is to inflate perceptions. College students are influenced by their beliefs about what other college students do, and hence alcohol abuse will inevitably increase if students have an exaggerated sense of how much other students are drinking. Tench and Yeomans (2006, p.583) describe this as: the “group situation” and suggest peers are likely to reinforce the message or discourage acceptance by the individual. The authors say there are four filters which effect message reception of which this is one – the others are whether the message “grabs” attention, whether the individual is motivated to do something about the message and how the message is perceived. Tone and content are important in the latter – Tench and Yeomans say health messages: “have to tread a fine line between arousing too high a level of anxiety among the ‘worried well’ and encouraging message avoidance among high-risk groups. Agenda Setting Press relations are one of the key elements in IMC and in particular, agenda setting which is highly used in the public sector in order to highlight an issue and get it talked about. Indeed, says Weaver in Merilaenen and Voss (2011, p.296) the media agenda is: “formed together by politicians, their advisors and journalists.” The theory, which is attributed to McCombs and Shaw and quoted in Tench and Yeomans (2006) and Tones and Tilford (2001), suggests that once a concept has been introduced into the public domain, it is then much easier to get people to think about it and talk about it. Merilaenen and Voss (2011, p.296) say: “what the media report, people at large may see as more important” but this is qualified by Murrow is quoted in Tones Tilford (2001, p.363): “Mass media might not be at all effective in telling people what to think but were stunningly successful in telling them what to think about.”

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In our example of the alcohol campaign, agenda setting was widely used – gaining coverage in most of the national newspapers, as well as being the subject of a Panorama broadcast by political spin doctor Alastair Campbell, who highlighted the consequences of professional people drinking over the recommend amounts on a regular basis. The McCombs and Shaw theory states that not only does agenda setting get people talking but it also helps people weigh up: “how much importance to attach to an issue from the amount of information in a news story and its position.” (Tones and Tilford 2001, p.363). The alcohol campaign certainly got people talking: a BBC article (2012) on its launch got 687 comments. The authors point out that: while agenda setting alone is often not seen as enough to achieve the desired results, governments often use it in order to raise awareness and prepare the ground for legislation. Again in the case of our alcohol campaign, this looks likely to be the case – at the time of writing, the Government is widely expected to introduce a minimum price for alcohol as part of its alcohol strategy. Merilaenen and Voss (2011, p.297) suggest that agenda setting is becoming much more publicled due to the worldwide web and ultimately, this may mean a huge difference to the nature of the tool, which fits in with the need mentioned earlier for public health communications to become more customer-driven and two-way. The public sector clearly has more hurdles to cross in conveying its messages in health campaigns. Social marketeers would argue that the IMC mix is simply not enough and that further planning and drilling down is needed. Cheng et al (2010, p.388-9 describe a four-decade campaign in Victoria, Australia to minimise drink driving – this comprised a legislation element, an enforcement element and an advertising element. Tones and Tilford (2001, p.366) say: The over-riding lesson is that the best results will be attained when mass media are used to support a wide range of integrated activities, including inter-personal education.” This author will be seeking to ask: What do the general public think of government attempts to persuade them to adopt behaviour which is less harmful to their long term health?

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3.METHODOLOGY
A review of the literature available, with a focus on the campaign in question, has led the author to the following research questions: 1. What is the public's perception of such a campaign (nanny state/necessary intervention)? 2. How do people view the extension of the campaign using regulation such as minimum alcohol pricing? 3. What aspects of the government's integrated alcohol campaign are people aware of? (ie research, press, TV advert, posters, web content etc?) Ghauri and Gronhaug quoted in Saunders et al (2007 p.5) suggest the purpose for research may include: “describing, explaining, understanding, criticising and analysing” and in fact the author feels she has run the gamut of this list in undertaking her research – as well as trawling, identifying, sampling, scouring, clarifying, comparing and exhausting the possibilities. In the course of this work, the author considered a number of different approaches to the collection of productive data. These included: 1. Interviews with professional communications practitioners 2. Focus groups of members of the public 3. A survey of public attitudes 4. Analysis of comments on social media cites 5. Analysis of letters to the editor in national newspapers On closer examination of these possibilities, it was felt that the first option would have been interesting as a way of examining whether the current campaign in particular works from a theoretical point of view. However, the literature review covers much of what professionals could add to the theory behind the success of public health campaigns in general and in addition, the author felt the success of this project lay in drilling down to what the public, as key stakeholder, is experiencing. Focus groups were considered and discounted as an option due to the practical difficulties of getting people together and also because the author felt that a questionnaire would enable her to identify the views of a greater number of people and thus lead to a richer picture of people’s views. The review of the literature led the author on a seemingly endless trail of avenues to explore in the quest to understand the problem and in undertaking this task, she stumbled upon what seemed to be a huge seam of data that because it has been so recently published, was extremely unlikely to 14

have been mined before and it was so full of opinions, points of view, debate, meaning and so on, that it practically begged to be analysed. This secondary data, which came from comments on a BBC article about the campaign in question, was useful because it contained a wealth of observations (687 in number) from unnamed people all over the country. The only processing that had taken place was the elimination of comments by the website editor on the grounds that they were offensive - so it was virtually raw data. Saunders et al (2009, p.262) suggests that many secondary data sets are of higher quality: “than you could ever collect yourself”. The fact that it comes from the BBC website gives it a certain ”authority” (Dochartaigh quoted in Saunders 2009, p.265) On the other hand, it should be acknowledged that there may be a bias due to the demographic of people who read the BBC website and respond to articles. The BBC website was chosen over similar pieces in The Guardian and The Daily Telegraph websites. This was partly due to the number of comments available but also because, although the BBC can be seen to identify with a particular group of people: ie the liberal intelligentsia, it tends to be politically more broadly neutral than either of the other two sources. An attempt to extend this sample through reviewing Letters to the Editor in newspapers, however, proved unsatisfactory. An initial search on the term ‘Letters’ in the Proquest newspaper database over three months yielded 26,400 entries. Trying to limit this to newspapers published during ten days at the beginning of February yielded 29,515. Changing the search term to ‘Letters to the Editor’ reduced this to 4,543. Adding the word alcohol to the search reduced the count to 20 items, and for some unidentified reason, these were dated outside the specified ten days. One of these items, a letter to the Stoke-on-Trent Sentinel, was a comment on the current health service changes and only mentioned alcohol in passing. The others came from The Guardian (1), The Daily Telegraph (1) and The Times (3). All of the others were duplicates of each other, leaving a core of only five different entries. However, within these five entries, there was often more than one letter. Having embarked on this course, however, it became clear that this secondary data would not stand alone in the quest to answer the author’s questions but needed supplementing in order to provide a fuller and reflection of the true picture. It also became clear after an initial perusal that the kind of people who tend to comment on website articles are those who feel very strongly about the matter in hand and very often the people who feel so strongly do so because they are against a particular course or courses of action. In other words, this cohort of responders was largely self-selected. Luker (2008 p110) says the thing to avoid: “at all costs”, is choosing the sample to influence the

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outcome. While this was not the author’s intention, she chose to also conduct some primary research of her own in order to provide a fuller picture. This combination of data collection methods may not conform to what Luker (2008 p40) calls ”canonical” social science but it is nevertheless backed up by academic thought. Saunders et el (2009 p.147) say there is no simple answer to the question of which data examination and collection techniques to use but in the final analysis, the methods used by the author were the ones that presented themselves as the most obvious when the time arrived. Luker (2008, p.5) says: “a good salsa-dancing social scientist should be open to whatever methods will help you understand that part of the social world that challenges and intrigues you.” In the case of this study, this has resulted in what is described in Sanders et al (2009, p.146) as “mixed model research” – a combination of quantitative and qualitative techniques and analysis procedures at all stages of the research. This can mean, for example, quantifying qualitative data, which is precisely one of the techniques this author has employed with the BBC website sample. Website research It could be argued that the website comments demonstrated that often elusive implementation of good communications practice: two-way symmetrical communications; albeit through a third party. Other than this, however, from the point of view of this study, they offered very little insight into the effectiveness of the campaign from an IMC point of view and could broadly only be used to show that   People are aware of the issue and To provide insight into the first two research questions – the third, involving more technical input, would have to be posed to people individually. The comments on the website numbered 687. These included comments on other comments as well as several people who commented more than once. In fact one responder posted 35 times, while another posted 32 and yet another 27. A decision was taken to include only comments that were in response to the original article in the analysis and also to exclude repeat comments. This was because:  The aim of the research was to analyse individual viewpoints rather than the body of the content. If, for example, the word ‘nanny’ as in ‘nanny state’ was mentioned in more than one comment by a single individual, it wouldn’t be accurate in quantitative terms.

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The comments on comments could often only be understood in the context of the original post and it was felt that this would add to the complexity of the analysis and lead to possible errors

As far as possible the author wanted to keep to the original research questions - the comments on other comments often tended to go off at tangents from the original subject matter. At times they could also get slightly personal

As a result of this piece of work left, the comments were pared down to 370. The disadvantage may be that the author cannot be sure this did not affect the balance of the research. The research then proceeded with an overview of these remaining comments to glean an understanding of the direction of feeling and to identify search terms that could be used in a Microsoft word search. The author was also aware that her choice of key words could be influenced by her own views on this matter, so in addition to analysing these, she also conducted a themes search on a smaller sample. This produced an interesting initial overview of the data. However, according to Stacks (2002, p.109), such “latent content is hard to count; therefore it has reliability and validity problems.” As a result, the author decided it would be also meaningful to analyse also by looking at key words and coding them according to whether they were broadly for the campaign or against and in the case of the second research question, for or against minimum pricing. This would be employing “manifest units of analysis”, (Stacks 2002, p.110). According to Colorado State University (2012), this method makes it: “possible to see trends, for example, that are indicative of much larger ideas.” In conducting the word search, if a word came up more than once in a comment, it was only counted once. The items were searched by semantic root (ie choice/choose was searched on CHO with entries such as ‘school’ being discounted. Similarly, price/pricing was searched on PRIC). In order to come up with answers, throughout this research, a judgement call had to be made on whether the comments were pro or anti-campaign. As the nature of these comments was fundamentally discursive – almost reflecting a dinner party conversation - it was not always possible to do this and another category was created to cover all unclear or ambiguous comments. Questionnaire As discussed, this process was supplemented by a self-administered questionnaire using Survey Monkey software. The practicalities of the exercise indicated that a convenience sampling technique through the author’s circle of friends and acquaintances was the most appropriate.

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Stacks (2002, p.157) points out that such nonprobability samples: “are often the only way to quickly and efficiently gather data” but adds that there are: “restrictions placed on interpretation of data” and an “increased amount of error” from sampling and measurement. In designing the questionnaires, the author followed recommendations in Saunders et al (2009, p.356), who itemise individual question design, questionnaire layout, explanation of the purpose, pilot testing and careful administration as factors that can result in maximisation of: “Response rates, validity and reliability.” Questionnaires work best with: “standardised questions that you can be confident will be interpreted the same way by all respondents”, says Robson in Saunders et al (2009, p.356). As a rule, the questions used were of a list type, asking the respondent to choose one or more from a number of items but after a pilot test, it was felt that question one was more suited to a Likert rating, because it was about the respondent’s opinion. The other questions were more around what the respondents felt were questions of fact and the list style is useful when: “you need to be sure that the respondent has considered all possible responses.” While the questions were of closed nature, most included the option to add a comment in order to solicit alternative views. The limitations of the Survey Monkey approach (ten questions only) meant that no filtering questions were possible. The author would also have liked to insert demographic questions in order to analyse by age and background but this was not possible within the limited number of questions. A pilot test involving five people was conducted before posting the survey (Appendix 1), in order to determine if there were any areas where questions didn’t work or might be phrased in a different way. The pilot revealed that:   Not everyone was familiar with the alcohol campaign in question A visual identifier would help the person responding to the survey – particularly as not everyone is consciously aware of the campaign. It was decided to use a still taken from the online advertisement (which was also used in a TV campaign) as a logo for the survey. It was felt this might serve as a prompt to jog people’s memories.  Some of the questions which were initially designed in a list format, might be more appropriate designed using the Likert scale. For example, question one initially contained a list of suggested answers and although responders were able to tick more than one box, it was pointed out that the answers weren’t mutually exclusive and would be better framed using a rating scale for each point.  Finally changes were made to the question order in order to improve the flow. 18

As there was not huge scope to tailor a survey, some items, such as an introduction and explanation, had to be included in the email and Facebook content where people were asked to take part in the research. The revised survey was posted on the author’s Facebook page, a couple of Facebook group pages and sent out via email to a number of contacts known to the author and family. Two reminders were sent out at weekly intervals. Although a convenience sample, this covered age groups from 18 to 60 plus. The disadvantage of this approach is that the demographic served is broadly similar to that of the author’s, ie middle class, educated urban dwellers, mainly based in London. The on-line survey facility was employed in order to conduct an alternative study into opinions as it was felt to be a convenient method of getting a reasonably large cross sample of views. A copy of the survey questionnaire is included in Appendix 2. The disadvantage of Survey Monkey is that the user is limited to only ten questions unless one is prepared to sign up to a direct debit plan. The author would have liked to include some more questions, in particular the question: “Are you familiar with the current alcohol campaign and if not, please skip to question xx?” A decision was taken to exclude this and certain other questions. Similarly, the basic plan limits one to a fairly rigid survey format. Finally, as some people (particularly the elderly) are not familiar with technology, they are ruled out of taking part in the research. In reporting the questionnaire data, a descriptive approach was employed, which according to Stacks (2002 p.209) describes: “how the data gathered are distributed within the sample of census observed.” The data was imported into an Excel spreadsheet and wherever the numbers added up to 100 per cent, it was shown in a pie chart which provides a clear visual representation of the comparative items. For example, the website themes content, where it was quantitively described, was output in pie charts, because it could be categorised into percentages of people who were either for/against/unclear about a certain question. The key word analysis could have been represented in individual pie charts but the use of a column chart approach allowed the words to be compared against each other, as well as coded into “for” and “against” – in other words, the four parts of the question could be shown in the same diagram. The rest of the research could not be broken down into parts of a whole and therefore was represented in column charts.

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4.ANALYSIS
Secondary sources The total number of comments on the BBC website numbered 687 and amounted to 40,446 words. Of these comments, seven were removed by the moderator for breaking house rules and six individuals had all users’ posts removed. Several of the commentators posted several times and one posted 35 times. An initial scan of the original comments led the author to drill down to a smaller more manageable section. The Methodology section provides an account of how this was carried out. However a number of common themes emerged from this initial scan.

In general, people did not comment on the nature of the campaign itself. Their comments are more along the lines of whether they welcome government intervention or not, although quite a few commented on the details of the research which was used as a background to the campaign. Commentators had to adopt a moniker, and these in themselves were quite illuminating, and certainly entertaining, including names such as: “Son of Maggie and Norman”, “Leftrightleftright”, “Golgotha” and “Socialreject”. For example, “Son of Maggie and Norman’s comments included: “Please please please leave us alone” - presumably a plea for the hands-off kind of government the former prime minister and her right hand man would favour. “Leftrightleftright” suggests a reaction against being frogmarched into the kind of behaviour the government would like us to show. The emerging ideas questioned whether there was anything new in the advice offered in the campaign, often proved defiant about government intervention in how one led one’s life, questioned the consistency of government statistics, suggested people wouldn’t pay any attention, discussed information overload, suggested politicians themselves could set a better example and discussed quality versus quantity of life. Some suggested more work is needed into why people drink so much. Significantly fewer people made comments about who should fund the healthcare bill for those people who drink excessively, acknowledged the need to do something, said the government’s work didn’t go far enough and provided alternative and additional suggestions. As discussed in the Methodology, the samples were refined in order to provide a fuller analysis of the material available. This resulted in a larger sample for an analysis on key words and a smaller sample for a fuller themes analysis.

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Themes analysis Figure 1: analysis of sample by themes

Analysis of sample by themes
For intervention Against intervention 7% Ambiguous No position

7%

23%

63%

The themes analysis was based on 30 consecutive comments from the middle of the key word sample on comments numbered 312 to 370. This sample consisted of a total of 1774 words. The longest comment was 84 words and the shortest ten. The average length of a comment was 59 words Of these 30, seven could be said to be in favour of government intervention, 19 are against, two do not appear to take a position and two were felt by the author to be unclear. Of the two that do not take a position, one laments the lack of moderation in current moeurs, but implies this is an inherent fault in society rather than something which the government should act against. Chart one shows 63 per cent of people against intervention. Of the two which were unclear, one quotes the proverb “Give a man – or woman – enough rope and … ‘nough said”. This could be seen as suggesting the government is currently giving too much

rope, but alternatively it could be interpreted as indicating that it’s up to individuals to take responsibility for their own lives. The comments that appear to be against intervention range from the defiant: “Am I the only one tempted to Google how to make bathtub gin?” (five similar comments counted) to the angry: “Who in their right mind would listen to government anymore?” (this comment also ticked the defiant box). The term “health police” was noted and this was used elsewhere in the larger keyword sample. Other comments suggested the government has a hidden agenda, although it could be 21

argued that the use of the agenda setting technique mentioned in the literature review made the government’s intentions more than clear. The government has not tried to hide that it is trying to gauge reaction to a possible price hike before making a final announcement about how it will be implemented. Some commentators suggested the government’s figures are questionable. One, for example, felt that the number of units that could be drunk before causing harm was much higher and others suggested that the source of the research was vague or that the government had “bigged up” the statistics. This latter commentator pointed out that 26,000 people die from medical mistreatment, suggesting that in the scheme of things, this, rather than drink campaigns, should be prioritised. Other themes which came up in this sample and have been noted in the larger sample, were the suggestions that stress is a huge factor in ill health and that because death is inevitable, one should enjoy life in whatever way one can. The theme of “wasting money” on campaigns came up twice. As far as the comments in favour of action were concerned, one suggestion was that those against might themselves be heavy drinkers who simply don’t want to know about the consequences of their behaviour. Another pointed out that heavy drinking can result in huge costs to the state not only through illness and large attendances at A&E, but also through accidents and assaults involving the innocent people who are victims of alcohol-linked behaviour. Others made suggestions, such as discouraging drinking through retail purchases and trying to channel it into pubs where it is more controlled. This leads to the concept of minimum pricing. Another suggested raising the drinking age to 21. Others suggested that pubs should pick up the bill for social costs due to excess drinking but did not specify how this might work.

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Research on key words Figure 2: research on key words by number of occurrences
50 45 40 35 30 25 20 15 10 5 0 pro-campaign anti-campaign unclear

Figure 3: research on key words showing ratios of those in favour of campaign to those against:
120.00% 100.00% 80.00% 60.00% anti-campaign 40.00% 20.00% 0.00% pro-campaign

Analysis was then carried out using key words which had been identified through the themes analysis and the initial overview. These included words like life, die. Other words were chosen

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because they related to the research questions (price/pricing) and to aspects of IMC (campaign, advertising, research). These again were broadly classified as in favour of and against the research and unclear. The results are shown in chart two. Chart three shows the same key words but splits them up into ratios, so that the number of comments that are in favour of the campaign can be easily compared against those against. Chart three shows that with three exceptions, the sample indicates that large majorities are against the campaign. These exceptions are in the use of the words “aware”, “information” and to a lesser extent, “price/pricing”. Of the other words, the terms “aware”, “warning” and “choice” were chosen, because these are the fundamental reasons public health campaigns are carried out. “Awareness” is an over-used term in government and the health industry in particular but the concept implies that by informing the public, the government has taken steps to help people take responsibility for their own health. “Warning” is a step further. The population knows that it should take care but there are consequences if it fails to do so. “Choice” suggests that having supplied the information, (or even raised the price of alcohol), the government can do no more. In a democratic society, outlawing alcohol would probably be seen as unacceptable and, as prohibition in the USA showed, unworkable in practice. There are too many corporate interests to appease and the government would have no interest in duplicating the current debate over other outlawed drugs on a much larger scale. The term “aware” is the one category where there are more pro-campaigners than against but this is a very small sample of five examples only. Those proponents of “awareness", like those who advocate “information”, demonstrate the importance of education in order to allow choice. “Choice” is a fundamental message and while the antis (9) demand the right to make their own choice about the consequences of drinking, the pros (4) suggest it is important at least to provide this information, enabling people to make a choice. The four remaining words (price will be treated separately), “life” (38 comments), “die” (37 comments), “smoking (39 comments)” and “government (59 comments)” all appeared frequently. Usage of the first two of these words was often based around quality of life rather than longevity, as well as the fact that death is inevitable so people should enjoy life while they are able. The term “smoking” was frequently used as example of how government has relentlessly attempted to control lives by focussing on other potentially harmful activities. A typical comment here was: “Doctor, doctor: if I don't smoke, don't drink and don't go with women will I live to be 100? No; but it'll seem like it...” Of the “pro” comments, one pointed out that it was only by highlighting the dangers to others of smoking that perception of it changed from an acceptable activity to an anti-social one. 24

Comments containing the term “government” were probably the most frequent of all and many were furious, with very few (5 per cent) suggesting the campaign is due to the government’s better instincts. A common theme here was the notion of paternalism. At least three comments referred to the poor example being set through subsidised bars in the Houses of Parliament. A separate cohort of words and phrases were identified which were considered by the author as being particularly emotive and she felt these occurrences showed a particular bias against the campaign and therefore should be shown in a separate analysis. The research showed that where these words were used, there was virtually none, or very little existence of positive feelings towards the campaign. The only exception was where the phrases “nanny” as in “nanny state/nannying” and “health police” occurred, and this turned up five positive comments. Figure 4: research on "emotive" or "biased" key words

20 18 16 14 12 10 8 6 4 2 0 wast (e money) Leave us alone House of Commons nanny/health police pro-campaign anti-campaign unclear

Like the themes analysis, the keyword analysis contains very little reference to the actual nuts and bolts of the campaign itself – ie the IMC aspects. The word “publicity” occurs only twice and is used pejoratively, ie the campaign is seen as a “waste of money” and those involved as “experts” “seeking publicity.” The three references to “advertising” saw it as a waste of money and time. The use of the word “campaign” echoed the themes of waste and also brought out the suggestion that the public is sick and tired of being “preached” at, “stigmatise(d)”, “pariahise(d)” (sic) and “bombarded”. However, the one positive comment in this category was: “The myth is that you 25

can't have an alcohol problem unless you drink daily. For such people, and their number is not small, this would be a sensible campaign. Interestingly, where the word “information” is used, the campaign is better received. This is the one category where the pro-campaigners are equal with the antis. One comment perhaps summed it up by saying: “Give people the information and let them decide.” Another said they welcomed the information but not the initiatives that followed. Overall, there were 32 mentions of these terms

which relate to the technical aspects of the campaign, but these were based around people’s perceptions of its validity, rather than from an IMC point of view. The research that lead to the campaign proved material for discussion and a search on the terms: “study” “research” and “statistics” produced 43 mentions, which again proved overwhelmingly against the campaign (six comments were felt to be in favour.) Many of the comments were around how statistics can be misleading, misinterpreted, invalid and contradictory. The phrase: “lies, damned lies and statistics” was used. Another commentator suggested: “These reports have one thing in common the words CAN, COULD, MAY, SUGGESTS THAT, ESTIMATED, POSSIBLE, MIGHT AND MAYBE, never DOES.” (sic). However, one argument for the pro-campaigners suggests the need for continuous reinforcement of such public health messages: “Now we have the facts. Changing a cultural habit is difficult, facts need to [be] stated over and over, not everyone sees the same study the first time”. Others suggested that people need to see the facts so that they can then make their own choices. The reaction to minimum pricing The current campaign, in common with other similar campaigns, is seen as a precursor to follow-up actions which may be unpopular. While the above analysis suggests people’s perceptions of government health campaigns and this particular campaign are negative, a further question remains: what do people feel about the notion of minimum pricing as a way of controlling excess drinking? Minimum pricing - initial analysis by theme Of the original thirty comments, seven referred to the subject of raising the cost of alcohol, either through tax or through minimum pricing. Of these, two were for and five were against. The fors were divided between one advocating minimum pricing and one advocating tax. Those who advocated a tax increase suggested it should be fixed so that it only affects supermarkets, not the pub trade. One of those against suggested that if there was a minimum price for alcohol, why not one for, say fast food, which is also bad for health. Another pointed out that the campaign was really just paving the way for alcohol tax hikes. A common theme was the need to maintain and

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boost the role of the pub as a social hub and small business, by raising retail prices only. It was pointed out that anything that could reduce binge drinking can potentially save the NHS billions of pounds. Minimum pricing - key word analysis In the wider key word analysis, although the majority of people were still against the principle of minimum pricing, a significant minority, 36 per cent, felt it was a reasonable suggestion. This is compared to the 15.5 per cent (reducing to 14 per cent if the more emotive words are included) who are in favour of the campaign in general. Some of these “pro” comments were quite hard line: “Double the price”, “A less liberal attitude is required.” One commentator suggested that it is already within the power of local authorities to revoke alcohol licences, so a change in the law is not required. Others suggested that such a move would make no difference to the middle classes and only hit the poor, and that it would only hurt “responsible” and “moderate” drinkers. Use of ”tax” as a key word The use of the word “tax” was also considered as a key word because an additional tax on alcohol theoretically has same effect to the end user as minimum pricing. However, many of the comments containing this word were used in a completely different sense – referring to tax in general, rather than tax as means of increasing the price of alcohol. As a result, this was discounted. Analysis of ‘letters to the editor’ As stated in Methodology, a sample produced as a result of a database trawl produced very few letters on the subject. All in all, there were 14 different items, and they came from The Guardian (1), The Times, (10) and The Daily Telegraph (3) – hardly a representative sample. These letters dealt with the issue of minimum pricing rather than any other aspect of the campaign. Of these, two were in favour of minimum pricing – they included a group of doctors from the British Society of Gastroenterology, who described the move as a: “bold intervention” and praised the government’s alcohol strategy but called for alcohol care teams in order to give public health moves time to work. Of the other writers, three compared British behaviour with that of Germans, Swiss and Spanish and suggested the UK problem was cultural and that also, the Swiss police, for example, would not tolerate such behaviour. In another letter, it was suggested the police should be given more resources to deal with these problems. Other letters echoed comments from the BBC sample, suggesting that sanctions should be placed against the offenders and finally, four letters also referred to the subsidised bars in the Houses of

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Parliament – also a popular theme in the earlier analysis – suggesting a strong feeling of: “one rule for them” but an entirely different one for the ordinary citizen. The author’s own questionnaire This was based on ten questions in different formats, designed specifically with the aim of answering all three of the research questions. Question one, six and nine were around the principles of public health campaigns and the current campaign specifically. Questions two, three, four, five and ten were around the IMC aspects of the campaign and whether the practice meets the theory. Questions seven and eight were around the principle of minimum pricing. This survey received 100 replies by its closing date – going on to reach 101 all in all but the SurveyMonkey providers barred access beyond the first 100. This was a useful number, because it enabled percentages to be calculated very easily. The first observation around these results is that while most people answered the questions about campaigns in general (a maximum of two people skipped), the numbers who passed increased significantly when asked about the February 2012 campaign. Over all the questions, an average of 18.4 skipped the questions and the highest numbers of “skips” were in questions four and five which were about details of the campaign and numbered 28 and 31 respectively. In emails and also in the “other comments”, many people stated that they were not aware of the campaign. So in effect, up to 31 per cent of this sample were not aware of the campaign. Figure 5: Fiona's alcohol survey - numbers who skipped questions
35 30 25 20 15 10 5 0 one two three four five six seven eight nine ten

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Figure 6: Fiona's alcohol survey question one Governments frequently present campaigns to try and improve the nation’s health. What do you think of such campaigns?
80 70 60 50 40 30 20 10 0 People have the right These campaigns cost It' s the government's If people smoke less, to decide how they an awful lot of money duty to advise its drink less and eat live their lives and the which could be better people on health more healthily, the government should spent on other things issues government will save keep out of it money in the long term Strongly agree Agree Disagree Strongly disagree Skipped

Question one was designed to investigate people’s perceptions of public health campaigns and used four different elements to probe into this issue. The questions around government interference in lifestyles and the consequences of healthier lifestyles for long term government spending resulted in broadly similar numbers of those who agree and those who disagree. The most marked variations were in the question about whether it is a government duty to advise people on health issues – here 91 per cent felt it was and a high proportion of these felt – 23 per cent of the total felt strongly about this, while only 8 disagreed. Opinion was overwhelmingly in agreement with the suggestion that if people live healthier lifestyles, the government will save money in the long run, with a total of 81 per cent of people agreeing with this suggestion. In this case, almost half of those in agreement – 38 per cent, were strongly in agreement. In spite of this, however, opinion was not so heavily weighted in favour of spending money to promote healthier lifestyles. The ratio of those people who agreed with spending money on preventative campaigns to those who disagreed was 3:2. So while healthier lifestyles are seen as very important, a smaller proportion of people appear to believe that government campaigning will bring this about. Finally, there was not a huge disparity in this category between people who favour 29

government intervention and those who do not (53:46). In both cases, few people had strong opinions either for or against. Skipping to question six, there was also not a huge disparity between those who feel campaigns get some or a little attention (35 per cent) and those who believe they get little or no attention (27 per cent). Of these, only one person in each category felt they got a lot of attention or no attention at all. Figure 7: Fiona's alcohol survey question six How much attention does the public pay to health education campaigns like this one, in your opinion?

1% 15% 26% None at all Very little Not sure Some attention 34% 23% A lot of attention Skipped

1%

Question nine showed that 41 per cent of people felt that the campaigns were worth it, “if they can do some good,” and 28 per cent felt excess drinking was a serious problem that needed to be dealt with. Only nine per cent felt the current campaign was applicable to them as individuals. Similar numbers said they did not like being preached to and that there were too many campaigns of this ilk (12 and 11). Four people commented on this question. One said: “It doesn’t touch on middle age, middle class age over drinking,” although the author feels that this is one of the target demographic of this particular campaign – those people who have two or three glasses of wine every day with their meal, drink regularly with colleagues after work and so on but believe they don’t drink very much. Another comment pointed out the need to spread awareness of what healthcare workers and police have to go through as a regular part of their job.

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Figure 8: Fiona's alcohol survey question nine What is your reaction to the campaign?

45 40 35 30 25 20 15 10 5 0

See Appendix 2 for full details of question and options Overall, these answers show that it is this cohort strongly acknowledges the need to do something about the long term effects of unhealthy lifestyles, that a smaller majority of people feel that campaigns help but that not very many people felt that excess drinking was an issue that affected them personally. Minimum pricing This issue, which was addressed by questions seven and eight, asks what people feel about the suggestion that the government might increase alcohol prices to a minimum of 40p per unit and then asks in more depth what effects it might have.

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Figure 9: Fiona's alcohol survey question seven 7. The government wants to introduce minimum pricing which means that one unit of alcohol will cost at least 40p per unit. Will this proposal help?

14%

9% It will definitely help

11% 32%

It may help Not sure It's unlikely to help It won't help at all 27% 7% Skipped

In question seven, the numbers were more or less equally divided, with 41 thinking it would or might help and 38 thinking it was unlikely to, or definitely wouldn’t help. People didn’t have particularly strong feelings about this – the ratio of those feeling it would definitely make a difference to those who felt it may make a difference was slightly under one in three and of those who felt it won’t help at all to those who felt it was unlikely to help, was slightly over one in three. 11 per cent of people didn’t know and 14 per cent skipped the questions. Although a significant minority of people felt that minimum pricing wouldn’t help, when investigated further in question eight, only eight per cent of people felt the government should not interfere in this way. This suggests there will not be a huge outcry when the move is introduced, in spite of the fact that 30 per cent of people felt that the move penalises responsible drinkers – almost the same number of people who in question nine said they drink, but not enough to be worried about it. 43 per cent of people felt that the move may stop people filling up with supermarket drinks before they go out – this is felt to be a common cause of binge drinking and the regular drunkenness we see in town centres and A&E units all over the country – again this figure is a significant minority reinforcing the view that the move will be acceptable. 32

Figure 10: Fiona's alcohol survey question eight Which of the following comments do you agree with about the proposed changes to the price of alcohol? (You may tick more than one box)

45 40 35 30 25 20 15 10 5 0 It may stop It won’t It penalises people from make any ‘responsible’ ‘filling up’ difference – drinkers with people who supermarket want to drinks drink will before they continue go out This move The will penalise government should not heavy drinkers interfere in more and as this way they ‘cost’ the country more, it’s fair they should pay more Other Skipped

A radical but increasingly voiced opinion which appeared both in the previous website research and appears in the media at large, is that people should pay financially for the consequences of their behaviour. Minimum pricing would be one way of doing so, but only if the proceeds went into government coffers. However, under 15 per cent of people endorsed the suggestion that heavy drinkers should pay for the consequences of their habits. This could be an extension of the view

that the welfare state should be available to all, regardless of what they do but it would be interesting to extend this question with the suggestion that those who attend A&E because of drunkenness should have to pay on the spot. A significant minority (nearly 45 per cent of people) felt that it wouldn’t make any difference, yet nearly the same number said it may stop people filling up with alcohol before they go out. 33

Comments on the subject of minimum pricing echo the observation in the website research that the poor would be disproportionately affected by this and it would not particularly affect middle class drinkers. Another observer said they were “reliably informed” by an epidemiologist that long term changes to national habits take at least ten years. This begs the question whether the observer feels that minimum pricing is a small step in that long process. Another felt that minimum pricing might help reduce young people’s drinking.

What aspects of the campaign are people aware of? Turning to the technical aspects of the current campaign, addressed in questions, two, three, four, five and ten, the author wanted to know how these contributed to the overall success of a campaign. This particular campaign comes with a very narrow message, that: “drinking slightly over the lower-risk alcohol guidelines can seriously impact long-term health.” (Department of Health 2012) and comes on the back of research suggesting that: “85% of people did not realise it increases the risk of developing breast cancer; 66% the risk of bowel cancer; 63% the chance of pancreatitis; 59% the risk of mouth, throat and neck cancer; 30% the risk of high blood pressure and 37% did not realise that it reduces fertility”. The answers to the questionnaire show that 17 per cent of people skipped question two about the key messages of the campaign. This may be because they were not aware of the campaign. In the other” category, a further six per cent said they weren’t aware of the campaign – one of these said they weren’t aware of the campaign but was aware of the possibility of making alcohol more expensive. These two aspects of the campaign are in fact linked – as the literature review suggests, the first uses “agenda setting techniques” to set the scene for the second. 55 per cent of people felt the key message of the campaign was that drinking too much alcohol is bad for long term health, a message which is very close to the actual message that drinking just a little too much is bad for long term health (32 per cent). If the government really wants to hit just this target group, then it could be argued that the message has not hit the spot. Another postulation could be that people are so brainwashed by message about drinks, they have simply assumed the first message as a given. The second highest scoring answer to this question is that drinking too much alcohol leads to antisocial behaviour (37 per cent). This is another widely held perception that has been propagated by the media and public health gurus on many occasions, and is probably true – but in this case it is not the actual message of the campaign. Other suggestions get lower scores, (13-16 per cent) but is in

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fact the lowest scoring message (drinking too much alcohol can give you cancer), which is one of the secondary messages of our campaign. Figure 11: Fiona's alcohol survey question two What do you think the key messages of the government's latest alcohol campaign are? Tick one or more boxes

60 50 40 30 20 10 0

See Appendix 2 for full details of question and options In answering the question about who the campaign is aimed at, 21 skipped the question with a further five saying they had no idea who it is aimed at. This implies that over a quarter of the people don’t know about the campaign at all, despite extensive coverage in the media and TV advertising. Of the other categories, only 35 per cent felt that it was aimed at those who drink slightly over recommended levels – the actual target group. The same number felt it was aimed at youngsters, and 42 per cent thought it was aimed at binge drinkers – both common target groups who are

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commonly cited as the “problem” groups in this domain. Only nine per cent felt it was aimed at middle aged people who drink heavily. Figure 12: Fiona's alcohol survey question three

Who do you think the government's latest alcohol campaign is aimed at?

45 40 35 30 25 20 15 10 5 0

On the question of the campaign slogan, offered a choice of suggestions, only a quarter of responders got this correct: “Don’t let the drink sneak up on you.” More people (34 per cent) thought it was: “Don’t turn a night out into a nightmare,” a handful thought it was one of the other two and 28 per cent skipped. “Don’t turn a night out…” was actually the catchphrase of an Australian government campaign against binge drinking, which ran for nearly two years until June 2010. “Alcohol gave me wings then took away my sky,” and “Think, no drink” came from alcohol rehabilitation sites on the worldwide web.

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Figure 13: Fiona's alcohol survey questions four and five What is the catchphrase of the campaign?

2% 28% 25%

Alcohol gave me wings and then took away my sky Don’t let drink sneak up on you Think, no drink

6% 34% 5%

Don’t turn a night out into a nightmare Make your night last Skipped

What parts of the campaign have you noticed?
45 40 35 30 25 20 15 10 5 0

In this digital age, it is interesting that the TV advertising (43 per cent) was by far the most noted aspect of the campaign (by 43 per cent), followed by press coverage (24 per cent), albeit it a wide margin behind. The advertising took place during prime time TV viewing and the press coverage was picked up by most of the major newspapers, as well as the BBC website. The digital content 37

(website and Facebook page) rated low in this category. However, this could be due to the fact that audience would actively have to seek this out, rather than having it presented as part of one’s everyday TV viewing or newspaper scanning. The author thinks there may have been some Facebook advertising on the subject but this was not mentioned in the official campaign specifics and is merely a subliminal recollection. Interestingly, the campaign specifics mentioned leaflets, but not posters; although 11 per cent of people believe they saw the latter and no-one recalls seeing the former. As a final thought, it would have been interesting to have targeted these questions at a purely 16-25 year old audience to see if the results were much different. The last question, number ten, dealt with how people would like to feedback to the campaign. IMC commentators point out the importance of two way symmetrical campaigns in today’s info-glut era. Although this is seen to be the ideal in good communications practice, this author has seen very little information to suggest what form this would take and more particularly, how the initiators of the process would use the information. The BBC website page has proved itself to be a useful source of two-way communications, although the feedback is not directed back at the campaign providers and it is uncertain how much, if any, notice is taken of these comments by the Department of Health. Given, however, that this page received more than 670 comments, the results of the author’s questionnaire proved surprising: 50 per cent of people were not interested in providing feedback. Of those who were, the most popular way of feeding back was through a comments box on a web page, (13 per cent), with equal numbers (8 per cent) opting for a prepaid comments card or social media. 2 per cent said they would be interested in a meeting in their area. In the “other” box accompanying this section, one last comment offered a conclusion which the author felt summed up the feelings of many of the participants in this questionnaire and on the BBC website: “I believe in moderation in all things but a little of what you fancy does you good! I don't like to see all the pubs closing as it is a great loss to a community which the country is beginning to lack in a very unhelpful way.”

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5.EVALUATION
The literature review refers to the fact that public sector campaigning is an uphill struggle compared to commercial campaigning. In a commercial campaign, the enterprise is able to pre-research demand for the product and subsequently withdraw the product if it fails. This is potentially expensive but there is a degree of freedom in the choice and decisions to be made. The difference between public and commercial sector marketing communications is that the latter is usually concerned with promoting something that the public may want and which certainly gives gratification. The former however, is marketing a concept which involves the end user depriving themselves of something and the rewards of this deprivation are long term and may not even be tangible. This time factor is a significant issue for governments – many campaigns take years to show results. Corporate Social Responsibility However, there are certain expectations of the public sector and while there is choice in the extent to which they are followed through, there is no choice but to follow through in some way. The challenge is in getting this balance right. The author’s own questionnaire shows overwhelmingly that people expect governments to: “advise its people on health issues.” In her investigation of the literature, the author found that there was evidence that governments in most countries see this obligation to promote healthy lifestyles and behaviour that leads to improved wellbeing for all as a given. While the private sector views corporate social responsibility as an increasingly urgent responsibility, which also offers: “strategic and reputational advantages” (Cornelissen 2008 p44), the obligation to take care of its population whether through preventative healthcare or through eliminating the consequences to society of anti-social behaviour is part of the core business of government. Stakeholder theory Governments also differ in some respects from commercial companies on how stakeholder theory fits in with their corporate communications needs. Using Freeman’s stakeholder terminology (Cornelissen 2008 p.42), the government has no “owners” in equity terms but the people who keep it going financially and are therefore “economic” stakeholders, are individual (such as the people involved in this author’s research) and corporate taxpayers. Using the stakeholder salience model, (Cornelissen 2008), while voters are a government’s definitive stakeholder group, holding power, legitimacy and urgency, there are certain parts of the electorate that become more urgent as an election approaches – and these “floating voters” are key to a ruling party’s survival into the next 39

term. Nevertheless, in terms of the power-interest matrix (Cornelissen 2008), other key lobbying groups such as alcohol awareness groups, public servants including the police and hospital workers and the drinks industry also need to be kept informed and kept happy – the latter because they hold a lot of economic power as employers and tax payers and the former two groups because they are ”influencer” stakeholders (Freeman quoted in Cornelissen 2008, p.42) and have the potential to raise the stakes through the media and other channels. As an example, one of the most authoritative letters to the editor noted in the author’s research came from a group of doctors and academics, congratulating the Prime Minister on his “bold intervention to secure an effective alcohol strategy” (British Society of Gastroenterology 2012). Stakeholder perception of campaign The research in this study, however, was around how these economic and potentially urgent stakeholders perceive campaigns and has identified a wide diversity in how far people believe the alcohol campaign work should go. The first research question asks: “What is the public's perception of such a campaign (nanny state/necessary intervention?)” While the secondary data sample showed considerable evidence of resentment of the campaign, the people in the author’s own sample seemed more in favour. In the former, 63 per cent of people appeared to be against intervention, and a common theme seemed to be the idea that they felt it represented what they saw as a pointless intrusion into their lives, administered by a government that had no right to tell them what to do. Indeed, the suggestion that there is one rule for people in charge and another for the general populace came across in several comments which referred to subsidised drinking in the Houses of Parliament – both in the BBC website and the letters to the editor. This theme is echoed in the literature review, where Phelan (2012, Thaler and Sunstein (2008) and French et al (2009) discuss the distrust and resentment that the governed can feel when they believe the governors are interfering too much in their lives. The literature review points out that many people ignore health warnings because they hold an underlying view that they are immune or somehow exempt from the consequences of poor habits. The information underpinning the government’s campaign states that: “More than 9 million drinkers in England are potentially putting their health at risk by regularly drinking above the recommended guidelines.” The adult population of England is 40m, according to the Office of National Statistics – so this would suggest nearly 25 per cent of people are at risk.

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In the author’s own alcohol survey, nine per cent of people felt they were affected by the campaign because they drink over the recommended amount, while 29 per cent felt they drank but not enough to be worried. Comments in the secondary data stating the research is somehow faulty or contradicts previous research, may suggest people are in denial about their own habits and may support the suggestion that drinkers don’t want to know about the consequences of their drinking. There was great richness in the secondary data that does not exist in author’s sample – this is partly due to the closed nature of the questions in the latter. Respondents did have the opportunity to make comments but these were very often around the fact that people were not aware of the campaign. Another factor could be that people who answered the questionnaire were either unaware or only subliminally aware of the campaign, while those who responded in the media had evidently just read an article about it. The author would also suggest this was because those who responded to the BBC website – or felt driven to write to a newspaper editor, did so because they felt passionately about the subject, while those who responded to the questionnaire, did not feel strongly and saw the task as a chore that needed to be completed quickly. Nevertheless, this richness conveys a huge strength of feeling about the subject. As has been noted, the contributors who responded to the media are a self-selected sample of the wider population, while the author’s own sample, who demonstrate significantly milder feelings towards the campaign, may also be unrepresentative of the population at large. The use of data and information In terms of information strategy, there are two key points that can be made about the alcohol campaign. The first is around the use of research data to publicise a campaign and the second is around the vast amount of data that has been generated in response to it. The second point will be dealt with in more detail in the section about two-way communications. In the secondary data, several people commented on the research. It was described as “inadequate”, a “waste of money”, “anecdotal” and “dreamt up”. Others described statistics as “useless” and “simplistic.” Another comment warned: “Back off on these studies” and yet another pointed out that previous studies have suggested that: “People who drank 21-30 units per week lived longer than those who drank less” - in other words, research is seen as contradictory. Only a handful of people said they welcomed the information provided through

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research. For example, it was pointed out that facts need to be stated repeatedly, as: “Changing a cultural habit is difficult.” It can be deduced from the website comments that people do not find this research particularly convincing. This could be due to the “information overload” referred to in the review. There are so many references to research of various kinds in current media that people begin to see contradictions, as well as becoming disillusioned with what is served up. They become cynical because there is so much information and begin to doubt the authenticity of what is presented. This contradictory nature of statistics was borne out in the author’s own research for the literature review - she found two hugely different figures on the costs to society of alcohol. One article in The Guardian (2012) cited a recent report which predicts that binge drinking will cost the NHS £3.8bn by 2015 and result in 1.5m A&E admissions a year. Another document, on the government’s alcohol strategy suggests alcohol-related harm is now estimated to cost society £21 billion annually (Home Office, 2012. p3). There is a huge discrepancy between these figures and while if they are considered closely, it becomes clear that the much higher figures includes costs of policing, damage to property and the long term illness caused by poor drinking habits including binge drinking; an interested lay person perusing this figures in the media, might be forgiven for picking them up as being a measure of the same phenomenon. In providing information about drinking, governments could do well to use more planning about the huge amount of information – looking at a holistic picture over a period of years, not simply individual campaigns – and incorporating this into its overall information strategy. Integrated Marketing and Communication If research is part of the “planned and coordinated strategy” which French et al (2009, p.12) suggest is key to IMC, the author’s own questionnaire provides clear evidence that many people are unable to distinguish this campaign from previous drink campaigns. To reiterate, the campaign is aimed at: “people who drink just a little bit more than they should.” (Department of Health, 2012). The fact that up to 31 per cent of people were unaware of any campaign at all, 75 per cent of people were unable to correctly pick out the slogan from a choice of five offered, only 32 per cent of people could identify the main key message and 11 per cent the secondary message, yet 55 per cent of people think it is a campaign about the long term effects of alcohol; indicate that it may not really be hitting the target audience of people who may be drinking just over the recommended daily amounts. One of the comments offered in the author’s own research was: “It doesn't touch on eg middle class, middle age over drinking”. The author would suggest that this demographic is one of the key target 42

groups in the people who the campaign is aimed at. Another said: “Binge drinking results in excessive strains on A and E” – again this campaign is not actually about binge drinking. In other words, people are seeing it as just another alcohol campaign and the message is not hitting home that they may be affected by it. This campaign has failed to break through Cornelissen’s “clutter” (2008, p.24), it’s not “customer driven” as suggested by Fill (2009, p.65), because people are showing themselves to be exasperated by the notion of the “same old“ messages. While the author’s own questionnaire group broadly agree that the government should be doing something, reading between the lines, they are not paying attention to the messages and do not believe the campaign applies to them. So, the campaign is only meeting the “needs of the bureaucracy” as explained by French et al (2009, p.4) and is driven by Scriven’s “need to be seen doing something (2010, p.153).” Two-way communications The BBC website yielded a number of people who by their very act of responding to the story felt themselves to be engaged in this issue. There did not appear to be any evidence that the Department of Health campaigners were engaging with these people, however. Behind the scenes, it will no doubt have engaged with the alcohol awareness lobby as well as drinks suppliers and retailers. It could be argued that this constitutes: “an active consultation of stakeholders and incorporation of stakeholders into the organisation’s decision making”, which Cornelissen defines as “dialogue” or “two-way symmetrical model of communication (2008, p.55). The government’s Change4Life and NHS Choices websites and Facebook page give the key public stakeholders a limited opportunity to feed back – so there is evidence of a degree of dialogue with the definitive stakeholders. Clinicians will also be advising individual stakeholder in face to face meetings. There is also evidence from the author’s sample that people don’t necessarily feel a strong urge to feed back. However, there were some very strong feelings of resentment shown by many people who replied to the website and this author argues that the government could do well to find some way of tapping into that and indeed feeding it into its information strategy mentioned earlier. Branding As part of the IMC mix, it is worth examining branding aspects of the campaign. In terms of the corporate brand identity model, it could be argued that the closest the UK government comes to the theory is through a collection of endorsed brand identities – in other words the government is the parent and the various departments are the individual brands within this collective. (Equally, it 43

could be argued that the UK government is not a brand and that the departments themselves are the brand). Within the various departments, such as the Department of Health, there are a number of other brands, most notably one of the most established and the most flaunted of all – the NHS. However, the programme under the magnifying glass is not run under the branding of the NHS – it is run under the Change4Life banner, a distinctive “campaign” which was launched by the Department of Health in 2009, and which is arguably a brand in its own right. The author’s survey found that only 7 per cent of people were aware of the branding aspects of the campaign. In terms of the extent of the Change4Life reach, however, a useful measure of awareness could be the number of ‘likes’ on its Facebook page – which total 110,000. A random check found this to be a reasonably respectable number compared with the NHS Choices health information page (5,000), the British Heart Foundation (135,000), Diabetes UK (39,000) and Cancer Research UK (261,000) (Facebook.com 2012). But compared to beauty company Dove which has 8m likes, there is scope for improvement and the author suggests that the development and impact of the Change4Life brand could be investigated. Minimum pricing The “need to be seen doing something” mentioned earlier could also be underpinning the proposed moves to a minimum price for alcohol. The move is seen as the natural extension of the current campaign and the Scottish Government has already announced plans to charge a minimum of 50p per unit, while in England the current campaign is seen as a way to “set the agenda” for similar moves south of the border – although the mooted price here is expected to be 40p per unit. There appears to be some confusion among the secondary data sample about how this would be implemented – the government proposal is that retailers should benefit from the extra cost – and as the point behind the move is to cut consumption and therefore sales of alcohol, this is not necessarily good news for retailers. However, more cynical commentators were under the impression that the move was just another way to fill government coffers with increased taxes. The move to minimum pricing would affect a much larger section of the population than the few who drink slightly over the recommended amounts who are the targets of the existing campaign, so once again this jars from an IMC point of view. It could be argued that this lack of streamlining doesn’t really matter as long as the ground is prepared and the public are ready; on the other hand if our cohort of people who show resentment about being preached at are those who really need to be the targets of the campaign, this could serve to exacerbate their resentment.

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Whether the money goes to the government or to retailers, it would appear once again that there is a much more vociferous cohort of people against this proposal in the secondary data sample than in the questionnaire sample, which serves to reinforce the suggestion that they may in fact be the people who need the most attention. The findings from this research suggest that if there is indeed a need for governments to be overseeing and reviewing the health needs of a population, as is confirmed by the literature review, as well as some of the comments in the website research, and the answers to the author’s own questionnaire, there is substantial scope for this to be done in a more targeted, co-ordinated and considered way.

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6.CONCLUSION
One of the respondents to the author’s survey said: “I am sorry I haven’t seen the campaign – perhaps this tells its own tale!” Is this tale one of so much boredom with the messages that are coming through that people are not paying attention, or is it a tale of a campaign that had been done for the sake of “doing something” which for that reason has been unfocussed, untargeted or simply too obscure for people to differentiate it from the many similar campaigns that are launched every year?

The findings of this research show that one cohort of people were clearly getting very agitated about the messages that were being handed over and another cohort, although generally in favour of public health messages, were often unaware of the particular programme itself, so that all the work that has been done over the years has blurred into one campaign and people have been unable to see it as separate from any other. The author’s literature review points out that people are exposed to 13,000 messages in a lifetime and that integrated communications campaigns are needed in order to gain attention.

There is a fine balancing act to be made between the obligations of the government as part of its “corporate social responsibility” remit and its need to ensure re-election through engaging with its key stakeholders. Many of these stakeholders are those who would like to see the burden of healthcare and social costs due to the consequences of excess alcohol to be reduced – yet they may resent the lessons on how to behave that are coming through from the government. In order to ensure more successful campaigning, the author makes the following recommendations as a result of this work.

The government should carry out a comprehensive review of all of its alcohol campaigns over a long period of time – perhaps 20 years – to identify a clear picture of:      All the key messages Target groups All stakeholders and at what times they have been most active (eg close to an election) Use of statistics Branding

It should use this material to inform the planning of this campaign and any subsequent campaigns to ensure that each campaign is focussed carefully in terms of how it uses all the above tactics. A long term strategy should be in place which would be planned around the needs of the predicted target 46

groups, and ensure that all the messages are finally honed and informed by relevant and accurate statistics. Each campaign should be carefully rehearsed with a number of sample groups so that the implementers are confident there are no misunderstandings about who should be receiving which messages. As part of its two-way communications strategy, it should also monitor and respond to comments on websites such as the BBC’s and the major newspapers. This should become part of a genuine conversation, not an attempt to patronise or preach to people.

(16,450 words)

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7. BIBLIOGRAPHY
BBC (2012) http://www.bbc.co.uk/news/health-16869618 (2012) [Online]. [ Accessed 29 February 2012] Blacker, T. (2012) I'm not taking a daily pill if I'm not sick (Independent.co.uk ) 18 March 2012 [Online] Available at: http://www.independent.co.uk/opinion/commentators/terenceblacker/terence-blacker-im-not-taking-a-daily-pill-if-im-not-sick-7763792.html Friday 18 May 2012 viewed 17 June 2012 British Society of Gastroenterology (2012). Booze taxes; Letters to the Editor The Times 28 March 2012, p21. Available at: http://www.proquest.com/ [Accessed 23 June, 2012] Cartnell, M. (2008) Public sector flunks communication poll, PR Week UK, Thursday, 26 June 2008 ([Online] Available at: http://www.prweek.com/uk/news/823291/Public-sector-flunkscommunication-poll/?DCMP=ILC-SEARCH. [Accessed 23 June 2012] Cheng, H. Kotler, P and Lee NR. (2010) Social Marketing for Public Health: Global Trends and Success Stories. Jones and Bartlett Publishers Clarke, K. (2012) Any Questions BBC Radio 4, 14 April 2012 Colorado State University (2012) http://writing.colostate.edu/guides/research/content/com3b8.cfm (2012) [Online] [Accessed 23 June 2012] Cornelissen, J. ( 2008) Corporate Communication a guide to theory and practice. Sage Publications Darzi, A. (2008) High quality healthcare for all: NHS next stage review final report (Online) Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D H_085825 [Online] [Accessed 23 June 2012] Department of Health http://mediacentre.dh.gov.uk/2012/02/05/dont-let-drink-sneak-up-on-you/ [Online] [Accessed 23 June 2012] Donnelly, L. (2010) Taxpayer should fund ‘bribes’ for obese and smokers www.telegraph.co.uk 26 September 2010 [Online] Available at: http://www.telegraph.co.uk/health/healthnews/8025014/Taxpayer-should-fund-bribes-for-obeseand-smokers.html [Accessed 17 June 2012]

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Fill, C. (2009) Marketing Communications. Pearson Education French, J. Blair-Stevens, C. McVey, D. and Merritt, R. (2009) Social Marketing and Public Health: Theory and Practice. Jones and Bartlett Publishers Glenny, L. (2008). Perspectives of communication in the Australian public sector. Journal of Communication Management 12, no. 2, (June 1): 152-168. [Online]. Available at: http://www.proquest.com/ [Accessed February 26, 2012] Hawkins, J. Bulmer, S. and Eagle, L. (2011) Evidence of IMC in social marketing. Journal of Social Marketing 1, no. 3, (September 1): 228-239 [Online] Available at: http://www.proquest.com/ [Accessed March 17, 2012] Home Office (2012) http://www.homeoffice.gov.uk/publications/alcohol-drugs/alcohol/alcoholstrategy?view=Binary [Online] [Accessed 17 June 2012] Liu, B. and Horsley, J. (2007) 'The Government Communication Decision Wheel: Toward a Public Relations Model for the Public Sector'. Journal Of Public Relations Research, 19, 4, pp. 377-393, Communication and Mass Media Complete, [Online]. Available at EBSCO host. [Accessed 20 February 2012] Luker, K. (2008) Salsa Dancing into the Social Sciences. Harvard University Press Meriläinen, N. and Vos, M. (2011) Human rights organizations and online agenda setting. Corporate Communications 16, no. 4, (October 1): 293-310. [Online] Available at http://www.proquest.com/ [Accessed March 22, 2012] Marmot, M. (2010) Fair Society Healthy Lives [Online]. Available at: http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review [Accessed 22 February 2012] Neuberger, J. (2011) [Online]. Available at: http://www.parliament.uk/business/committees/committees-a-z/lords-select/science-andtechnology-committee/news/behaviour-change-published/ [Accessed 29 February2012]

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Phelan, D. (2012) How Allen Carr saved my lungs Independent.co.uk 13 March 2012 [Online] Available at: http://www.independent.co.uk/life-style/health-and-families/features/how-allen-carrsaved-my-lungs-7562758.html [Accessed 23 June 2012] Phillis, B (2004), An Independent Review of Government Communications [Online] Available at: http://ics-www.leeds.ac.uk/papers/pmt/exhibits/1967/Phillis.pdf. [ Accessed 17 June 2012] Rogers, D (2012) Alcohol issues need more than good comms PR Week 23 February 2012 Sandel, M.[2012] The Public Philosopher BBC Radio 4, 17 April 2012 Saunders, M. Lewis, P. and Thornhill, A. (2007). Research Methods for Business Studies Pearson Education Schultz, DE. (2012) IMC: Who’s Doing it Right? Marketing News 46, 2, p.14, [Online] Available at Business Source Premier EBSCO host [Accessed 25 June 2012] Scriven, A. (2010) Promoting Health A Practical Guide Balliere Tindall Elsevier Sunstein, CR and Thaler, RH. (2008) Nudge, improving decisions about health, wealth and happiness Yale University Press Survey Monkey (2012) www.surveymonkey.com [Accessed 23 June 2012] Tench, R. and Yeomans, L. (2006) Exploring Public Relations Pearson Education The Economist (2012) A national service. Economist.com August 4 2011 [Online] Available at: http://www.economist.com/blogs/blighty/2011/08/public-information-campaigns [Accessed 17 June 2012] The Guardian (2012) Two glasses a day triples mouth cancer risk. Guardian.co.uk 05 February 2012 (Online) Available at: http://www.guardian.co.uk/society/2012/feb/05/wine-triples-mouth-cancer-risk [Accessed 17 June 2012] Tones, K. and Tilford, S. (2001) Health Promotion effectiveness, efficiency and equity Nelson Thornes

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APPENDIX A Pilot test questions 1. Governments frequently present campaigns to try and improve the nation’s health. What do you think of such campaigns?      People have the right to decide how they live their lives and the government should keep out of it. If people smoke less, drink less and eat more healthily, the government will save money in the long term It’s the government’s duty to protect the health of its people These campaigns cost an awful lot of money which could be better spent on other things Other (please specify)

2. What do you think the key messages of the government's latest alcohol campaign are? Tick one or more boxes       Drinking too much alcohol puts you at risk of violent attacks Drinking too much alcohol can give you cancer Drinking just a little over the guidelines can harm your long term health Drinking too much alcohol leads to anti-social behaviour Young female binge drinkers can get liver disease Other (please specify)

3. Who do you think the government's latest alcohol campaign is aimed at? Tick one or more boxes      16-25 year olds Middle aged drinkers who drink heavily Anyone who drinks slightly more than the recommended amount on a daily basis Binge drinkers Other (please specify)

4. What is the catchphrase of the campaign?      Alcohol gave me wings and then took away my sky Don’t let drink sneak up on you Think, no drink Don’t turn a night out into a nightmare Make your night last

5. What parts of the campaign have you noticed? Please tick one or more boxes.    TV advertising Leaflets Branding (ie slogan and Change4Life colours and logo) 51

   

Press coverage Alcohol pages on Change4Life website Social media (eg Change4Life Facebook page) Other (please specify)

6. How much attention does the public pay to health education campaigns like this one, in your opinion? Please rate      None at all Very little Not sure Some attention A lot of attention

7. Would you like to be able to give comments and feedback to the organisers of this campaign and if so, how?        Not interested in giving feedback Through Facebook/Twitter page Comments box on website Freephone line Meeting in your area Prepaid comment card Other (please specify)

8. What is your reaction to the campaign? (Tick one or more boxes)        I don’t like being preached to It’s made me think a bit more carefully about what I drink There are too many campaigns like this Excess alcohol is a serious problem and we need to do all we can to deal with it It doesn’t affect me because I don’t drink I sometimes drink just a little bit over recommended amounts so it affects me Other (please specify)

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9. The government wants to introduce minimum pricing which means that one unit of alcohol will cost at least 40p per unit. Will this proposal help? Please rate      It will definitely help It's unlikely to help It may help Not sure It won't help at all

10. Which of the following comments do you agree with about the proposed changes to the price of alcohol? (You may tick more than one box)       It may stop people from ‘filling up’ with supermarket drinks before they go out It won’t make any difference – people who want to drink will continue It penalises ‘responsible’ drinkers This move will penalise heavy drinkers more and as they ‘cost’ the country more, it’s fair they should pay more The government should not interfere in this way Other (please specify)

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APPENDIX B
Final questionnaire 1. Governments frequently present campaigns to try and improve the nation’s health. What do you think of such campaigns? Please rate each statement on the following scale     Strongly agree Agree Disagree Strongly disagree

   

If people smoke less, drink less and eat more healthily, the government will save money in the long term It’s the government’s duty to advise its people on health issues These campaigns cost an awful lot of money which could be better spent on other things People have the right to decide how they live their lives and the government should keep out of it.

2. What do you think the key messages of the government's latest alcohol campaign are? Tick one or more boxes        Drinking just a little over the recommended amounts of alcohol can harm your long term health Young female binge drinkers can get liver disease Drinking too much alcohol leads to anti-social behaviour Drinking too much alcohol can give you cancer Drinking too much alcohol puts you at risk of violent attacks Drinking too much alcohol is bad for your long term health Other (please specify)

3. Who do you think the government's latest alcohol campaign is aimed at? Tick one or more boxes      16-25 year olds Middle aged drinkers who drink heavily Anyone who drinks slightly more than the recommended amount on a daily basis Binge drinkers Other (please specify)

4. What is the catchphrase of the campaign?    Alcohol gave me wings and then took away my sky Don’t let drink sneak up on you Think, no drink 54

 

Don’t turn a night out into a nightmare Make your night last

5. What parts of the campaign have you noticed? Please tick one or more boxes.         Press coverage Social media (eg Change4Life Facebook page) Alcohol pages on Change4Life website Branding (ie slogan and Change4Life colours and logo) Leaflets Posters TV advertising Other (please specify)

6. How much attention does the public pay to health education campaigns like this one, in your opinion? Please rate      None at all Very little Not sure Some attention A lot of attention

7. The government wants to introduce minimum pricing which means that one unit of alcohol will cost at least 40p per unit. Will this proposal help? Please rate      It will definitely help It's unlikely to help It may help Not sure It won't help at all

8. Which of the following comments do you agree with about the proposed changes to the price of alcohol? (You may tick more than one box)       It may stop people from ‘filling up’ with supermarket drinks before they go out It won’t make any difference – people who want to drink will continue It penalises ‘responsible’ drinkers This move will penalise heavy drinkers more and as they ‘cost’ the country more, it’s fair they should pay more The government should not interfere in this way Other (please specify)

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9. What is your reaction to the campaign? (Tick one or more boxes)          I sometimes drink just a little bit over recommended amounts so it affects me It doesn’t affect me because I don’t drink If these campaigns can do some good, they're worth it I don’t like being preached to Excess alcohol is a serious problem and we need to do all we can to deal with it It’s made me think a bit more carefully about what I drink I do drink but not enough to be worried about it There are too many campaigns like this Other (please specify)

10. Would you like to be able to give comments and feedback to the organisers of this campaign and if so, how?        Not interested in giving feedback Through Facebook/Twitter page Comments box on website Freephone line Meeting in your area Prepaid comment card Other (please specify)

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