Look ahead/Look back

Mass communication and socialmarketing strategies toimprove men’s healthPeter D. Rumm

Introduction

This paper discusses how communication

strategies in public health, especially a

technique known as social marketing,

might be applied to men’s health with

the specific aim of reducing health dispa-

rities between men and women as well as

other health disparities such as those

between American African and White

men in the US.

Effective communications of health

messages are increasingly playing a critical

role in public health. This is not new

‘‘news’’. For example, about a decade

ago, a major US public health consensus

panel derived the term ten ‘‘Essential

Public Health Services’’ and highlighted

among these a specific charge for public

health leaders to inform, educate, and

empower people about health issues [1].

Recently, the World Health Organi-

zation (WHO) and the US Centers for

Disease Control and Prevention (CDC)

have begun to embrace mass communi-

cation techniques for health promotion

and prevention of disease. The commit-

ment to health marketing and commu-

nication by two leading public bodies is

reflected in the US by the increased use

of these techniques at the state and local

level by public health departments and

in community health programs in the

field.

Commercial firms have heavily pro-

moted the techniques to public health

professionals with coursework and semi-

nars on mass communications to meet

demand for specialists trained in health

� 2004 WPMH GmbH. Published by Elsevier Ireland Ltd.

education and health communication.

Research in health communication has

also been published.

In the US millions of dollars have been

spent on health communication strategies

related to the bioterrorism efforts, strate-

gies which have included the building of

large information networks (nationally

called the Health Alert Network), web-

based education and health messaging,

robust emergency response communica-

tion tools, and provision of training risk

communication and other communication

expertise [2].

On a global level, over the past 2 years

the WHO has applied a concept called

‘‘COMBI: Communication for Behavioral

Impact’’ in the design and implementa-

tion of behaviorally focused social mobi-

lization and communication programs.

COMBI, which draws on consumer com-

munication experience, begins with the

‘‘people’’ (clients, patients, beneficiaries,

consumers) and their health needs and

desires, and has a sharp focus on the

behavioral result expected in relation to

these needs and desires. The blend of

communication actions include advocacy

and public relations, administrative/man-

agerial mobilization, community mobili-

zation, sustained appropriate advertising,

interpersonal communication/ counsel-

ing/ personal selling, and point-of- service

promotion [3]. The COMBI typically uses

jargon and language of the market place to

‘‘market’’ health programs; using a term

called ‘‘cause-related marketing’’ [4].

The CDC have used strategies that

focus on social marketing, i.e., the adap-

tation of commercial techniques and

health promotion strategies to target

health status improvement. The CDC

identifies social marketing as a practice

allied with Health Education and Health

Promotion. The Office of Communica-

tion encourages CDC/ATSDR (Agency

for Toxic Substance & Disease Registries)

programs to apply the principles of social

marketing to public health problems to

increase the effectiveness of interventions

[5]. This technique will be highlighted

below after a review of why it might be

needed most for men’s health.

The importance of suchstrategies for men

Despite emphasis on women’s health pro-

grams it is on average men who are increas-

ingly falling behind the health of women in

almost all disease categories. This is true

for most conditions related to disease and

health in both developed and undeveloped

countries. In fact, according to the WHO,

studies have shown consistently that even

as countries get richer, male mortality

tends to decline less than female mortality.

A recent large study by the WHO sub-

stantiates this. Based on an indicator devel-

oped by WHO scientists, Disability

Adjusted Life Expectancy (DALE) men

have much worse health indicators than

women worldwide [6]. DALE summarizes

the expected number of years to be lived in

what might be termed the equivalent of

‘‘full health.’’ A multi-country WHO

study showed that the same patterns hold

Vol. 2, No. 1, pp. 121–123, March 2005 121

Look ahead/Look back

for healthy life expectancies. Importantly,

in the early 1900s, the gap between female

and male life expectancy was 2-3 years in

richer countries around the world. By

1999, women were living on average 7-8

years more than men in those same coun-

tries.

Why is this gap increasing? According

to the WHO, women are generally more

health conscious coupled, in rising econo-

mies, with men’s higher smoking rates

and less exercise. Women live longer

and healthier lives in richer countries

basically because they have always

smoked less than men. Men in richer

countries also tend to have poorer diets

than women do, and men exercise much

less than did their grandfathers. Men are

also far less likely to visit health care

clinics and hospitals than women, seem

less likely to be involved in their health

decisions and may be harder to reach

through health education strategies. In

poorer countries, men are victims of more

disabling injuries than women. They also

get more diseases than women, for a

variety of unexplained reasons. Other

reasons for the gap include poorly under-

stood genetic aspects [6,7].

Focusing in on the strategyof social marketing

Social marketing, the use of marketing to

design and implement programs to pro-

mote socially beneficial behavior change,

has grown in popularity and use within

the public health community. Most of the

work in this field has come out of the

public health sectors of infectious disease

(HIV, TB, and malaria) although it is

increasingly being used by the CDC

and others in chronic diseases (oral

health, tobacco, cardiovascular disease,

breast cancer etc.). Despite this growth,

many public health professionals have an

incomplete understanding of the field [8].

Recently, the CDC in addition to an

annual course in social marketing it holds

in Florida for public health professionals,

created a web site specific to the topic.

The following reviews key information

on that site.

122 Vol. 2, No. 1, pp. 121–123, March 2005

Several decades ago standard marketing

principles were pointed out as applicable to

promote ideas, attitudes and behaviors that

benefit target audiences and society [9].

Andreason, a recognized leader in this

specialty in the US, stated that social mar-

keting is the ‘‘application of commercial

marketing technologies to the analysis,

planning, execution, and evaluation of pro-

grams designed to influence the voluntary

behavior of target audiences in order to

improve their personal welfare and that of

their society’’ [10]. Such experts as well as

the CDC commonly quote the ‘‘4Ps’’ of

marketing:

� Product: what the consumer is asked

to ‘‘buy’’

� Price: the actual cost or something the

consumer must give up/do in order to

obtain the product,

� Place: how and where the product

reaches the consumer, and

� Promotion: how information is disse-

minated.

These characteristics are promoted

to consumers with persuasive messages

sent through ‘‘channels of information’’

that are popular with the target audience.

The ‘‘marketing mix’’ is continually

refined on the basis of consumer feedback

[11].

Two experts in the field of health

promotion, Drs. Levebre and Flora from

Rhode Island, USA, recently described in

more detail several essential aspects of an

effective social marketing process as the

use of

� a consumer orientation to develop and

market intervention techniques

� exchange theory as a model from which

to conceptualize service delivery and

program participation, audience analy-

sis and segmentation strategies

� formative research in program design

and pre-testing of intervention materi-

als, channel analysis for devising dis-

tribution systems and promotional

campaigns

� ‘‘marketing mix’’ concept in interven-

tion planning and implementation,

� a process tracking system

� a management process of problem ana-

lysis, planning, implementation, feed-

back and control functions.

Most importantly, according to these

social marketing experts, attention to such

variables could result in more cost-effec-

tive programs that reach larger numbers

of the target audience [12].

Social marketing and men

There is little doubt that effective social

marketing strategies that hone in on tar-

geted populations and disease states can be

effective. Yet a review of recent medical

literature (performed through searching

related terminology on PubMed and Med-

line) found that less than 20 references

specifically linked terminology for social

marketing, mass communication cam-

paigns and men within the last 20 years.

Moreover, most of those listed are fairly

recent and not focused on men’s health.

That being said, there do appear to be

several notable campaigns in this area,

some of which undoubtedly have not been

published, e.g. the City of Philadelphia

will soon be beginning a health campaign

aimed at men and stroke with a particular

focus on minority men (personal commu-

nication). Possibly this is in response to

the calls for effective communication to

men in the arena of stroke prevention [13].

Social marketing is also being used to

get men involved as a vehicle for improving

women and family health [14]. Work has

been done to reduce childhood deaths by

appealing to men as leaders of the family

and as husbands in the safe motherhood

SUAMI SIAGA campaign in Indonesia

through social marketing [15].

Interestingly targeting men as audiences

for the critical behavioral risk factors of

physical inactivity and tobacco has been

more successful than interventions with

female audiences [16]. The use of advanced

technologies such as web-based learning

coupled with social marketing techniques

could be effective in many segmented

populations but need to be tailored to

the resources of the community of interest

in a culturally specific manner [17].

Look ahead/Look back

Discussion

Social marketing and other mass commu-

nication strategies are an important part of

effective public health practice and should

be included in all approaches by govern-

ment or health systems to provide better

prevention. The techniques have been

refined and improved and are now a part

of day-to-day public health practice in the

US and internationally. They should also

become part of the growing regimen to

attack the disparities in men’s health in an

effective manner.

The techniques of social marketing

adopted from the commercial world can

focus on specific educational levels and be

tailored in such a way to be culturally

of Health and Human Services, available

at: http: //www.cdc.gov/hiv/projects/pmi.

sensitive and specific. Therefore, it is to

be hoped that many more campaigns in

the media will promote men’s health and

be published so that others in world-wide

communities can learn important lessons

to improve the health of men and there-

fore, that of those they love and the

communities they interact in, as well.

Acknowledgements

The author has no commercial conflict of

interest with this publication: Dr. Rumm

does serve as a volunteer scientific advisor

to the U.S. Men’s Health Network and on

the volunteer U.S. board of directors of

the American Association of Public

Health Physicians and as volunteer mem-

ber of the Residency Review Committee

for Public Health and Occupational Phy-

sicians, U.S. ACGME. None of these

entities has a commercial interest in social

marketing or health communications.

Peter D. Rumm, MD

MPH Associate Professor,

Department of Community Health

and Prevention,

Director, Center for Public Health

Readiness

and Communication,

Drexel University School of

Public Health, Philadelphia,

Pennsylvania, USA

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