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Case Study - Pakistan's Pink Ribbon Campaign

As a professional management function Public Relations is all too often categorized as managed media relations at best and a press relations activity as a default. Most of the measurement and evaluation metrics even professional practitioners use tend to re-enforce this narrow view obscuring a clear view of its role in creating mutual understanding between and engaging stakeholder groups. In public education and particularly public health education the totality of the public relations function can be seen to best effect. For the past 15 years the Pink Ribbon has become symbol of support for breast cancer awareness world wide or at least throughout the developed world. It has become an emblem of hope for breast cancer sufferers and for those working to fight this curable disease that still claims the lives of too many women in particular. The Pink Ribbon Campaign was brought to Pakistan in 2004 by the Pakistan Women"s Empowerment Group (WEG). It was their response to the chilling fact that Pakistan has the highest rate of breast cancer of any Asian population in the world. It is the commonest cancer observed in females, representing more than one third of female cancers and about one fourth of all malignancies. Approximately 35% of Pakistani women are likely to suffer from breast cancer at some point in their lives. Every fifth woman in Pakistan develops breast cancer after the age of 40. About 77 percent of invasive breast cancers occur in women over 50 years of age but the average age at diagnosis is 64. Advanced breast cancer accounts for 43.7% of cases, accounting for 40,000 deaths per year in Pakistan Cultural, religious and economic factors limit availability of public health education information on breast cancer and access to advice, early discovery, and treatment. In a first for Pakistan, and any Islamic country, the Women"s Empowerment Group addressed these issues head on

launching and establishing a nationwide Breast Cancer Awareness Campaign. The story of that campaign is an object lesson in role of public relations and communication management in overcoming cultural barriers to social development

Planning and Objectives

WEG had been established in 1999 by a group of young professionals from marketing, public relations, the law and medicine. With initial seed funding from USAID they established a reputation for their programmes taking women"s healthcare into rural communities. They took up the challenge to create awareness of breast cancer and in so doing, ran an enormous risk to the Group"s own reputation, possibly even violence against volunteers and staff by venturing into previously forbidden territory. Working with PIELLEVision the professional public relations firm headed by Omer Aftab, one of those behind the creation of WEG, the Group established Pink Ribbon Pakistan "" the National Breast Cancer Awareness Campaign. Its goal was to become a self funded, nationwide volunteer driven organisation charged with making breast cancer a premier public health concern in Pakistan. Its mission was to become the Centre of Excellence for Breast Cancer Care Information. Public relations objectives for the Breast Cancer Awareness Campaign were:

Make breast cancer an acceptable topic in the public domain in Pakistan Secure "leadership" support at the highest level Promote understanding and the practice of self-diagnosis among women. Evoke empathy in the right quarters to support the cause Motivate people to contribute funds for campaign execution

Build a long-term, sustainable platform for future Pink Ribbon campaigns and similar women"s health and well being programmes. Stimulate campaign and issue awareness in the Pakistani Diaspora and the wider world of Islam

Strategy and tactics

A clear overriding strategy was established and articulated clearly throughout the organisation and among all those associated with it: "create widespread awareness about breast cancer and all the key aspects for Pakistan. Its high incidence, its seriousness leading to fatality, its impact on the life of the sufferer and the whole family, Pakistan"s comparative regional and international position and leadership of breast cancer death rates, and importantly, the good news, that if detected early, breast cancer may be cured". This was no easy task in country with physical barriers, a very large population, many out of reach of modern media and against a background of cultural and social barriers on women"s issues and health in particular. The Pink Ribbon Campaign used multi-pronged strategies to address the needs of different stakeholders. Tactically, events and communication activities were planned to reflect the core relationships of the campaign. The diagram below shows the stakeholder areas that were and are the focus for discrete but integrated programmes during the campaign:

Media relations and press publicity, the traditional anchor for any public relations led campaign posed the greatest challenge. According to Pakistan"s Press Freedom Report 2001-2002... "under the present code of ethics, the difference between obscenity and education is a blur, for example a program on breast cancer is not an educational one but a vulgar programme."? Getting media, broadcast and print, to accept the Press Freedom Report"s criticism and recommendations for change was to become a secondary challenge. Establishing recognition of the high prevalence of breast cancer in Pakistan and the importance of creating awareness of the issue and the need for mass communication among editors and

journalists alike was the campaign"s greatest trial. The Pink Ribbon Campaign"s strategic approach made media realize the gravity of the issue and breast cancer became an integral part of the health programmes they broadcast. National media coverage and interviews with leaders of the campaign gave a boost to the campaign by bringing to the limelight different events organized at the National and Provincial levels. Similarly, various newspapers and magazines printed special articles on the situation of breast cancer in Pakistan and the services of Pink Ribbon Pakistan. Along with these special transmissions and publications, the media also gave coverage to various Pink Ribbon activities throughout the country. In 2006 Press Information Department (PID) aired Public Service ads for the first time ever on Breast Cancer, on all State run TV channels. These ads were aired in support of the campaign and the wife of the Prime Minister (Shukat Aziz) of Pakistan delivered the message. International media from the BBC to Voice of America, Yahoo News, Daily Mail, The Times, Khaleej Times, Oman Times, and Hindustan Times also gave momentous exposure to the campaign by giving significant coverage to different events, such as the visit of Jagjit Singh as cultural ambassador for the Indian Government through his peace concert for the campaign, and support from former Miss World Ashwariya Rai. Jaquit Singh For the BBC Fiona Bruce made a documentary on the visit of Cherie Blair to Pakistan as Patron of Breast Cancer Awareness UK. This 30 minute documentary showed the warm welcome and celebrations organized in honour of the wife of the UK Prime Minister. It showed the plight of a young girl, named Minahil, residing in one of the villages of Punjab and the impact on the family after the death of her mother from breast cancer. It was aired on all channels of BBC throughout the world for over a month.

Print, electronic and broadcast media were not the only communication tools used. WEG Pink Ribbon Publications, viral marketing and merchandising - Pink Ribbon pins, badges, wrist bands, nursery rhyme books and CDs - all played their part. Advertising and publicity were most effective for creating awareness, though the role and effectiveness of different advertising media varied as the campaign moved from one state to another. Electronic, outdoor media and newspaper articles were most effective in sustaining awareness and establishing comprehension about the issue among the target audience. Newspaper advertisement, brochures and mounted posters were developed to match religious strictures. Posters and leaflets were produced that went beyond cultural norms for display in the waiting rooms of different clinics. They all gave detailed information increasing knowledge about the issues and were most appropriate for disseminating detailed information and creating better understanding and comprehension. Seminars and conferences were used to effectively complement these efforts. Celebrity endorsement was used with those who had actually benefited from having the disease diagnosed and treated in its initial stages. They were portrayed as everyday heroes to re-enforce the message "that life after cancer was not only possible but is worth living".

Results, reviewing progress

In the four years since WEG committed itself to establishing a national Breast Cancer Awareness campaign it has achieved its goal of a self funded, nationwide volunteer driven organisation. Breast cancer is now a premier public health concern in Pakistan and mission for Pink Ribbon Pakistan to be the Centre of Excellence for Breast Cancer Care Information is a work in progress . Since October 2004 WEG has:

Distributed explanatory brochures in easy to understand language to millions of women across the country through various means utility bills, bank statements, handouts in girls" colleges managed a communication campaign through the media including press releases, articles and interviews in the print media and investigative news stories and interviews in the electronic media. established a bi-lingual interactive website that enables women to seek and exchange information, ideas and views with each other. Prompted and promoted live discussion programs on FM radio and national television. Established Volunteer Support Groups nation wide. Staged seminars and workshops in various cities and focused presentations to targeted audiences like college girls or members of women"s organisations. Advanced the campaign objectives through quantifiable incremental progress with Every one of its stakeholder groups

A subject which was taboo and very sensitive for an Islamic country like Pakistan is now part of the national agenda for women. Continuing active public support from the first Lady and the Cherie Blair has encouraged the commitment of national and international business in Pakistan. Women, including those in the rural communities have been involved in creating awareness, providing public education materials, and promoting women"s action to reduce the incidence of breast cancer. Empathy with the campaign has been established and generated both personal and financial support vital for success and sustainability. International Aid Agencies "" GTZ (Germany), USAID, UNDP and UNESCO have funded WEG campaigns run with PIELLEVision communication expertise on women"s health and issues. In 2008, through the involvement of Cherie Blair, the Pakistan Pink Ribbon Campaign Group will join with Breast Cancer Care UK to reach out to the British Pakistani, and British South Asian communities.

"Women are beautiful and survivors of breast cancer are even more beautiful because of the journey they went through."? Mrs. Cherie Blair--- on her visit to Pakistan 2005. Peter L. Walker FCIPR was President of the Chartered Institute of Public Relations in 1998 its Golden Jubilee year. He is Chairman of the PIELLE Consulting