Chapter1

ADVOCACY IN HEALTH PROMOTION

Structure

1.0 Objectives

At the end of the chapter, you will be able to:

i. describe the meaning and scope of advocacy;

ii. ascertain the aim of advocacy in promotion of health;
iii. describe different form of advocacy
iv. describe effective advocacy component;
v. design advocacy plan for the districts; and
vi. describe salient features of a successful advocacy.

1.1 Key Term

Advocacy: Seeks to increase the power of people and groups and to make institutions
more responsive to human needs. It attempts to enlarge the range of choices that
people can have by increasing their power to define problems and solutions and
participate in broader social and policy arena.

Health Advocacy: encompasses direct service to the individual or family as well as

activities that promote health and access to health care in communities and the larger
public. Advocates support and promote the rights of the patient in the health care
arena, help build capacity to improve community health and enhance health policy
initiatives focused on available, safe and quality care.

1.2 Introduction

Health advocacy includes a variety of different actions aimed at changing the major
structural and attitudinal barriers to achieving positive health outcomes in
populations. Families subsequently, consumers developed organizations enabling
their voices to be heard. They were joined and supported by a range of
nongovernmental organizations, many health workers and their associations, and some
governments. More recently, the concept of advocacy has been broadened to
include the needs and rights of the general population.

1
 Actions typically associated with advocacy include the raising of awareness, the
dissemination of information, education, training, mutual help, counselling,
mediating, defending and denouncing.

1.3 What is Advocacy?

Advocacy is a key health promotion activity for overcoming major barriers to public
health and occupational health.

1. It is an ongoing process aiming at change of attitudes, actions, policies and

laws by influencing people and organizations with power, systems and
structures at different levels for the betterment of people affected by the issue.
2. It is an action directed at changing the policies, positions and programs of any
type of institution.
3. It is lobbying for ultimate benefit for the health of the populations

Advocacy includes many activities such as:

 Media campaigns
 Public speaking,
 Commissioning and publishing research
 Poll
 Lobbying

1.4 Goals of Advocacy

There are two main goals underpinning health advocacy; that of protecting peoples
who are vulnerable or discriminated against; and that of empowering people who need
a stronger voice by enabling them to express their needs and make their own
decisions.
 The first goal involves advocacy on behalf of (involving protection)
 The second goal involves advocacy with (emphasising strategic partnerships,
facilitation roles, capacity building).
Public health advocacy is often used to refer to the process of overcoming major
structural (as opposed to individual or behavioural) barriers to public health goals.

1.5 Targets of Advocacy

 The policies and practices of government and large institutions whose actions
affect the lives of many people

2
  Laws and government regulations
 Commercial marketing practices of industries
 Activities of counter-health lobby groups who if successful in their aims can
delay or obstruct the implementation of public health strategies such as
universal health insurance, immunisation, seat belt wearing or speed limits.
 Breaking down public and political inertia and apathy about an issue.

1.6 Forms of Advocacy

There are several forms of advocacy, each of which addresses different issues in the
way change is brought into society.

 Budget advocacy: It enables citizens and social action groups to compel the
government to be more alert to the needs and aspirations of people in general
and the deprived sections of the community. It’s another aspect is to ensure
proactive engagement of Civil Society Organizations with the government
budget to make the government more accountable to the people and promote
transparency.

 Bureaucratic advocacy: Bureaucracy is a system in which we work and make

it moving to achieve desired goals. The experts have better chances to succeed
at presenting public health issues to convince its contribution for overall socio-
economic development to the decision-makers for appropriate policy/decision
making.

 Ideological advocacy: in this approach, groups fight, sometimes during

protests, to advance their ideas in the decision-making circles. For eg women
groups arguing against introduction of injectable contraceptives under national
family welfare programme.
.
 Legislative advocacy: is the “reliance on the state or federal legislative
process” as part of a strategy to create change e.g. banning of sale of non-
iodized salt

Mass advocacy: is any type of action taken by large groups. (petitions-Public

Interest Litigations, demonstrations, etc.) Legal challenges related to Section-4
of the Tobacco Control Act, ‘Prohibition on smoking in public places’ in
India”. For example:

3
  K. Ramakrishnan Vs State of Kerala and Others reported in AIR
1999 Kere 385 has held that “Public smoking of tobacco in any form
is illegal, unconstitutional and violation of Article 21 of the
constitution of India.” Held, Public Smoking comes within the
definition of Public Nuisance under IPC.
 In Murli Deora V/s. Union of India 2001 8 SCC 765, Hon`ble
Supreme Court has held that public smoking violates the non-smoker’s
Fundamental Right to Life under Article 21 of the Constitution of
India.

 Media advocacy: is “the strategic use of the mass media as a resource to

advance a social or public policy initiative”. For example NDTV India
recently take up the health issue relate to Bihar some district were it was
reported that quantity of Arsenic is high in the under ground water and people
are getting infection because of that.

Patient representatives, ombudsmen, educators, care managers, patient navigators

and health advisers are health advocates who work in direct patient care
environments, including hospitals, community health centers, long term care
facilities or patient services programs of non-profit organizations. They
collaborate with other health care providers to mediate conflict and facilitate
positive change, and as educators and health information specialists, advocates
work to empower others.

1.7 Key elements of Advocacy

1. Speaking out, acting or writing for people

Advocacy involves doing something, may be speaking out, writing letters to

politicians, media and raising issues of concern to organizations or services. Being
with a person confronted with situations finding it difficult to cope or being with
victimized person or fighting for a person's right to live a more fulfilling life.

2. Conflict of interest

In every situation there will be more than one person's or group's interests that will be
in conflict or in competition with the interest of a person with a disability. When you
are in an advocacy role, you need to be clear as to how your interests and needs may
be in conflict with the person for whom you are advocating. Advocacy efforts must
identify and attempt to minimize any conflicts of an interest.

4
A typical example is that of health issues of the children and women engaged in
tobacco production. Here, on one hand, the health department may communicate and
focus on adverse impact of tobacco production through various messages but the
women and children who are engaged do not give importance as they are dependent
on it as is the source of their livelihood.

3. Perceived interests

Advocacy does not just speak up for what a person may want or may be interested in,
but will make decision and advocate for the group. For example: advocacy for
handicapped persons instead of addressing individual problem, advocates for better
life for differently abled population.

Vigour of action. It requires:

 Fervor and depth of feeling in advancing the cause or interest of another,

 Taking a lead, initiating,
 Sense of urgency,
 Doing more than what is done routinely,
 Challenging the community,
 Costs

1.8 Role of Advocacy in Health Promotion

Health promotion aims at making political, economic, social, cultural, environmental,

behavioural conditions and biological factors can all favour health or be harmful to
good health favourable through advocacy for health. Advocacy has a key role in
building and maintaining occupational health programmes and is essential to shape
the social and political climate (WHO).

5
 To acknowledge
people as the
main health
resource

For healthy
Consensus
policy
building
formulation

Role of
Advocacy

For
To focus
appropriate
attention on
investment in
public health
health
issues
promotion

1.9 Barriers in Advocacy

 Political philosophies that devalue health and quality of health at the expense
of economic outcomes
 Political and bureaucratic opposition or inertia to health promoting legislation,
regulation and policies
 Opposition to participation of consumers in health care planning
 Marketing of unsafe and unhealthy products often by transnational
corporations of immense influence and wealth
 The pervasiveness of racism and sexism, expressed through institutional
values, personal attitudes and behaviours.
 Limited understanding about advocacy, lack of advocacy skills.

6
1.10 How to design Advocacy Strategies

Step First: Defining the Situation

Defining the current status of problem and health promotion efforts is the first step
in developing and understanding of the need of advocacy in the context of
comprehensive and integrated approach to health promotion.

Ask Questions

A. What is the current health problem?

B. What health promotion policies and programs currently exist? Are they
comprehensive, integrated and of good quality? Are they being funded and
implemented?
C. What is the level of awareness about health problem and risk factors in the
population?
D. Among the Government officials, influential people organizations and the
public in general, what is the level of understanding of, and commitment
towards the health promotion?
E. What advocacy, lobbying or communications activities are currently being
undertaken, and which organizations and individuals are involved?
F. What are their goals, objectives and target audiences?
G. What resources do they have and what has been the impact of their
advocacy efforts to date?
H. What are the barriers to, and opportunities for, comprehensive health
promotion work?

Define the needs for advocacy

Advocacy for effective health promotion planning and implementation

may be needed to:

1. Increase awareness and reduce the barriers to health promotion

2. Promote the comprehensive health promotion framework as the most
effective approach
3. For translating health promotion knowledge into action
4. Develop a comprehensive health promotion plan where health promotion
is recognized as an important sector
5. Update an existing plan that has become outdated
6. Revise an existing plan that is not achieving desired outcomes, is
inefficient, limited in scope, insufficiently funded or unsatisfactory
7. Secure political will and the public support necessary to implement or
sustain an existing health promotion plan

7
 8. Reinforce specific components of comprehensive health promotion plan
that are being neglected
9. Mobilize and allocate the necessary resources

Step Second : Setting Goals and Objectives

Clear goals and specific, measurable, achievable, realistic, and time-bound (SMART)
objectives need to be formulated at the beginning of any advocacy work. These
should be based on the analysis of the present situation and the availability of
resources. A well-planned and well-executed advocacy plan will play a key role in
achieving this goal by driving forward the necessary policy and programmatic
changes. A good advocacy plan responds to identified needs, builds on opportunities
and overcomes barriers.

The following are examples of short- and medium-term advocacy objectives that can
act as incremental steps in the overall development and implementation of a
comprehensive health promotion plan:

 To increase awareness among influential groups and the public

 To engage and mobilize key stakeholders
 To progressively expand advocacy groups, including community volunteers
and cover all the regions or provinces of the country
 To promote the value and the need for developing policies and programmes
for health promotion
 To launch a simplified version of the health promotion plan and disseminate it
widely to the media and the lay public using attractive messages
 To promote the effective and equitable implementation of key priority (core)
interventions
 To mobilize resources to support the implementation of key priority (core)
interventions;
 To maintain the involvement of decision-makers and the public profile by
disseminating information on achievements to date and future challenges

Step Third : Defining the Target Audiences

The main target audiences for advocacy work will usually be decision-makers and
influencers:

Decision-makers are the primary audience – These are the individuals or groups
who can take decisions in relation to health promotion policies and programmes.
The primary audience may include the president, the prime minister, the cabinet,
health or deputy health ministers, parliamentarians, funding agencies and
community leaders.

8
 Influencers are the secondary audience - These are the individuals or groups who
have access to the decision makers and who may be able to influence them.
Influencers may become partners in the advocacy plan. The secondary audience
typically includes associations, organizations, medical associations, experts and
other health-care professionals, faith based groups, opinion leaders, the media,
international leaders, entertainment and sports personalities, teachers, professors
and researchers.

When drawing up a list of potential targets for advocacy, it is helpful to consider

the current political climate and ask:

i. How important is health promotion to the general public? Is there adequate

understanding and of the various components of health promotion?
ii. Does the government need to be convinced that there is a popular demand
to give health promotion a higher priority?
iii. Are there other influential municipal or national government departments
– parks and recreation, education, environment, industry and innovation –
who share the concerns of advocates for health promotion?
iv. Do you need to convince other influential groups, such as professional and
national medical associations or corporate leaders who have at-risk
employees, of the value of health promotion?
v. What influence might the media have through the Internet, radio,
television and print?
vi. Does the private sector play an influential role in the issue of health
promotion?

The process of selecting specific target audiences may be assisted by working through
the following:

i. Firstly, for each objective in the advocacy plan define your target audience. To
do this, you will need an adequate understanding of the decision-making
system. Once the decision making process is clear, it may become evident that
a key target decision-maker is not directly accessible. In such cases, it may be
necessary to work through others to reach the key decision-maker.

ii. Secondly, for each target, identify individuals or groups (i.e. influencers) who
can deliver the message to that target. The messenger needs to be a good
communicator, eloquent, convincing and genuine. For example, in many
settings, a prestigious oncologist is likely to have the greatest influence on a
minister of health. On the other hand, a national economist who is able to
argue convincingly for the economic benefits of comprehensive health
promotion may be more effective in influencing a minister of finance. Pairing

9
 the medical or other professional will bring the collective leverage of a
personal, professional and policy perspective to the political front.

iii. Thirdly, understand the target audience(s). Consider their motivation and
interests, and the nature and format of information needed to persuade them.
Note that targets may be either in favour of the change, undecided, or even
opposed to Mobilizing Support

Step 4: Mobilizing Support

The most effective way to mobilize support for health promotion is to inform the
parties involved about the problem and ask them to be part of the solution. This
creates strong commitment and fosters coalition building and social mobilization
based on common goals. Coalition building, patient involvement and social
mobilization are critical to the success of advocacy efforts.

Coalition building

Coalition building strengthens advocacy. Coalitions with organizations that are

working on public health issues that share the same risk factors – heart disease,
diabetes, tobacco control, healthy diet and active lifestyles – can be strengthened to
the mutual benefit of both parties.

The elements of effective coalition building include:

i. Encouraging all coalition partners to participate actively

ii. Planning events incorporating credible speakers from different partner
organizations
iii. Developing a schedule and sequence of activities for maximum positive
impact
iv. Delegating responsibilities to coalition members, and monitoring specific
events and activities
v. Networking to enlarge coalitions and to keep them together organizing
training and practice in advocacy, using the framework model proposed in this
module, to allow participants to deepen their understanding of advocacy while
simultaneously creating new partnerships and alliances
vi. Presenting information in a brief, dramatic and memorable fashion.
vii. Social mobilization - Today, success in planning and implementing
sustainable and comprehensive plan depends very much on whether society
can be mobilized to increase its expectations of health promotion excellence in
all aspects of cancer control. Social mobilization reinforces political coalition
building and community action (UNICEF, 1993; Wallack, 1989). Successful
social mobilization is based on mutual benefit for partners and a non-
hierarchical structure.

10
Step 5: Developing key Messages

The process of designing messages should always take into account the objectives
of the planned advocacy campaign, the target audience(s) and also the availability
of resources. Below mentioned are the requirements for successful advocacy

i. Have a clear definition of health promotion plan that can be explained

simply and in a way that will resonate with the public as well as
policy-makers.
ii. Be prepared to answer specific questions such as: What difference will
the health promotion programme make? What difference have similar
programmes made in other counties? How much will the programme
cost? How long will it take?
iii. Demonstrate concretely what is being accomplished with optimization
of resources and what will be addressed if additional resources are
provided in the future.
iv. Be specific about outcomes and results when explaining the planning
of new priority programmes, and emphasize how these actions will
reduce the health problem.
v. Have a unified message that crosses regional and programmatic
boundaries, brings together disparate stakeholders, and tells a
nationwide story in addition to the local one.
vi. Define measure and deliver tangible results to show how
comprehensive health promotion program is making a real difference.

Consider your audiences

A. What will motivate them to act?

B. What benefits will action on health problems bring them?
C. What attitudes will prevent them from acting?
D. Messages should always be tailored to the target audience’s level of
understanding and awareness. Consider also cultural and political feelings
and sensitivities: it is important to connect to your audience’s values and
political views.
E. Try to reframe the issue with information that will gain their interest.

Develop your messages - Messages will determine how your target audience
perceives you and your arguments for developing or reinforcing a health
promotion plan. These messages need to demonstrate both the problem and an
evidence-based solution. Above all, messages need to be:

i. Rationale, morale and appealing to hearts and mind

ii. Credible, clear, compelling, concise, consistent, convincing

11
 iii. Simple, persuasive, incorporating a direct call to action
iv. Consistent in visual style
v. Repetitive and reinforced

The generally recommended approach is to have one primary message

supported by two or three secondary messages. The primary message is the
main message. It is broad, appealing to all audiences, simple and direct. It is
the theme that holds the whole advocacy campaign together.

Step 6: Selecting Methods of Advocacy

There are two main methods of advocacy:

1. Lobbying or direct communication: Involves influencing through direct,

private communications with decision-makers. Lobbying, particularly
through personal meetings with decision-makers, can be a powerful and
cost-effective advocacy tool.

2. Campaigning: Involves speaking publicly on an issue with a view to

generating a response from the wider public and using a variety of
techniques such as:

• Chain e-mail or letter

• Opinion pieces and letters to the editor in newspapers
• Newsletters
• Celebrity endorsements
• Media partnerships with newspapers, journalists and film-makers
• Web-based bulletins and online discussions
• Public events
• Large-scale advertising campaigns.

The choice of method will very much depend on the target audience, the message
to be conveyed, the resources available, and the cultural and socioeconomic
context.

Step 7: Developing and Implementing Advocacy Plan

An advocacy plan should factor in all the elements described in the previous
sections – goals and objectives, target groups and the specific activities to be
undertaken, as well as set out stakeholder roles and responsibilities, time frames,
expected short-term and long-term outcomes, and available and needed resources.

Step 8: Monitoring and Evaluation

12
 Monitoring is the measurement of progress towards the achievement of set
objectives, noting which activities are going well and which are not. Evaluation is
about judging the quality and impact of activities. Evaluation asks why some
actions went well and others did not, and why some activities had the desired
impact while others did not.

There are numerous ways of monitoring and evaluating advocacy work. Methods
can be:

1. Qualitative (e.g. case studies, stories, opinions, survey questionnaires); and

2. Quantitative (e.g. statistics or trends that indicate a change over time).

Monitoring methods should be chosen according to the indicators that you have
selected to evaluate the impact of your work. Monitoring methods may include:

1. Keeping records of meetings, correspondence or conversations with target

audiences and the responses elicited;
2. Tracking when your key messages or briefing notes are used by elected
officials, other key influencers or the media;
3. Carrying out surveys and interviews to determine the impact your actions
have had and the recognition they have received; and
4. Monitoring the media and keeping track of coverage of your topic in the
media.

Evaluation should be based on the goals and objectives that were set at the outset
of the advocacy planning process. Questions that you might ask in order to
evaluate the impact of your work are as follows:

1. Have you achieved your objectives?

2. How many meetings have you had with key target decision-makers and
what were the outcomes of those meetings?
3. What actions were taken by these target decision-makers?
4. Is the situation better than before? By how much?
5. If there is no change, how might you change your advocacy methods?
6. What would you do differently next time?
7. Are the people involved with the advocacy effort happy with the results
and the way the work was implemented? Are they still involved?

1.11 Advocacy for Healthy Public Policy

Advocacy includes actions that bring about social change through a focus on policy
and legislation. It aims to create an enabling environment which advances and
protects health and development and within which people are more able to make
healthy choices for themselves, their families and their communities. Creating an

13
enabling environment means removing the structural barriers to health such as
poverty and inequality.

Promoting healthy public policy is one of the key pillars of Health Promotion as
articulated in the World Health Organisation’s Ottawa Charter. The modern use of the
term advocacy gained momentum from the Ottawa Charter, it defined health
promotion as “political, economic, social, cultural, environmental, behavioural and
biological factors that favour health or be harmful to good health. Health promotion
aims at making these conditions favourable through advocacy for health”.

Advocacy for healthy public policy is a vital tool in the struggle for health equity and
human rights. This can be achieved by using a range of advocacy tools, including
research, media, lobbying and social mobilisation

Policy advocacy in health promotion is not just a question of identifying and acting
upon the more clearly visible and direct determinants of morbidity, but also of
advancing the healthy society which creates the conditions both for reduced morbidity
and enhanced well-being. Advocacy for healthy public policy does seek to alter
policies in order to achieve identified health and well-being outcomes. But it is also
about changing the means by which policy is made, in particular by:

 advancing democratic values

 empowering people as participants in the polity
 facilitating the capacities of communities and vulnerable populations to make
their needs and interests known
 increasing peoples participation more substantively in processes allocating
societal resources and values among its members.

Many countries like Thailand, Bangladesh, Canada, Tunisia etc are advocating
implementation of healthy policies through healthy city project. India is also
advocating healthy policies by enforcing the ban of smoking in public. As per the
government, no one is allowed to smoke in public places including public
transportation and public offices etc.

1.12 Resource Mobilization for Health Promotion Networking

Resource mobilization is a comprehensive process involving strategic planning for

program funding, close communication and effective negotiation with donors, sound
management of resources, improving image and credibility of the Organization and
ensuring good coordination among all partners, etc. It primarily involves promotion,

14
advocacy, coordination and policy and strategy development on resource mobilization
through external cooperation and partnerships.

Networking for Promoting Health

Networking is simply a process for initiating and maintaining contact with individuals
and organizations that share or support common goals and agree to work together to
achieve those goals. Through advocacy, networks can engage in high-level dialogue
with policymakers and other influential leaders on broad policy issues and national
policies. For example for family planning and reproductive health, networks might
identify issues for advocacy campaigns that focus on such goals as the elimination of
tariffs on imported contraceptives or the enactment of a national population policy.

Advocacy includes both single-issue, time-limited campaigns and ongoing work

undertaken by a network around a range of issues conducted at the national, regional,
or local level. By generating public support for reproductive health issues and linking
them to other important social and economic topics under consideration by
policymakers such as poverty alleviation and job creation a network can help change
the knowledge, attitudes, and practices of major decision makers. At the same time, a
network can help ensure that more appropriate and representative policies and
resource allocations are in place.

Networks are invaluable in policy advocacy because they create structures for
organizations and individuals to share ownership of common goals. In the area of
reproductive health, a network’s membership usually will include representatives of
NGOs, women’s groups, community organizations, and professional associations
made up of nurses, midwives, physicians, or lawyers. Local, religious and traditional
leaders are potential members whose perspective and influence could be invaluable in
achieving the network’s objectives.

To be successful advocates, networks need to be well organized and operate

efficiently. Their founding members have to bring together the resources, time,
energy, and talents of many different people and organizations and then skilfully take
advantage of opportunities to influence the policy process on behalf of their goals and
objectives. When they succeed, networks help create a supportive and self-sustaining
environment for reproductive health.

Case Study

Advocacy Networks at Work

15
Most toilets built in 20th century India were dry latrines with a water-fed flushing
system, due to the expense of pour-flush systems and the scarcity of water. In
addition, many did not have formal sanitation. In 2003, the Indian Ministry for Social
Justice and Empowerment recorded 676,000 scavengers in the country—people,
mainly women, who lift human excreta for a living. Since 1970, Bindheshwar
Pathak’s Sulabh International has worked to liberate India’s scavengers by employing
low-cost, safe sanitation technology. Over the course of three decades Sulabh has built
a commercially viable business model—with a significant development impact.
Sulabh has developed 26 toilet designs for varying budgets and locations, training
19,000 masons to build low-cost twin-pit toilets using locally available material. It has
also installed more than 1.4 million household toilets, and it maintains more than
6,500 public pay-per-use facilities. Its technology has freed 60,000 people from life as
a scavenger, offering programmes to reintegrate them into society.

The Sulabh conducted workshops to sharpen advocacy skills of public health experts
to inspire country level stakeholders to increase support, awareness and efforts to
environmental sanitation and build more toilets.

The advocacy campaign sought the following objectives:

 To increase awareness of environmental sanitation among the health workers

and citizen’s of India’s.
 Increases the installation of household toilets and maintains public pay per-
uses toilets.
 Increases the uses of household toilets and maintains public pay per- uses
toilets.

Activities

 By 2006, Sulabh had liberated about 60,000 scavengers out of the official
estimate of 700,000 (or 1.2 million according to unofficial estimates).
 By 2006, Sulabh had installed 1.4 million household toilets and also maintains
6,500 public pay per- use toilets. An estimated ten million people used its
facilities across the country.
 Sulabh also trained 19,000 masons who could build low-cost, twin-pit toilets
using locally available materials. Sulabh paid specific attention to women as
they trained them in food processing. Sulabh also successfully marketed their

16
 products and found buyers that became repeat customers. Of the 11,000 people
provided with vocational training, 5,000 were women.
 Sulabh employs over 50,000 associates and presently operates in 26 states.
 Sulabh also offered a plethora of value-added services that ranged from public
health advocacy to adult literacy and technology solutions such as fax
machines, copiers, telephones, etc. Sulabh used internal and external resources
to start a successful English medium school and a variety of training and
business incubators targeted at the erstwhile scavengers, and the company also
devised programs to get them accepted by the mainstream in a politically
sensitive way.

Key Strategies

 Adapt products and processes: Sulabh developed an initial pilot project and
demonstrated popularity of pay-per-use toilet facilities in urban Bihar and
pioneered low-cost toilet to be installed in poor residential areas.
 Invest in removing constraints: Sulabh constructed a museum and planned for
a sanitation university.
 Combine resources and capabilities: Sulabh took its own designs and trained
other NGOs.
 Engage in policy dialogue with governments: Sulabh influenced the central
government and over 100,000 public toilets will be constructed in addition to
local government's provision of toilet related loans and subsidies.

Outcomes

An increased awareness of environmental sanitation among public. The establishment

of a working alliance between the sulabh and State governments, critical to building
awareness and support for further action to prevent from unhealthy environment and
build and run public toilets.

1.13 Social Marketing of Ideas and Products

The application of marketing philosophy and methodology to social causes including

public health has emerged as a separate discipline as social marketing. Marketing
practitioners and professional agencies are increasingly involved in designing and
implementing social change programmes and their potential could be utilised by the
Central and State Governments to enhance the effectiveness of the health
programmes.

17
Social marketing involves using marketing principles to sell products to consumers
which could be used to "sell" ideas, attitudes and behaviors. social marketing has been
defined as "differing from other areas of marketing only with respect to the objectives
of the marketer and his or her organization. Social marketing seeks to influence social
behaviors not to benefit the marketer, but to benefit the target audience and the
general society." This technique has been used extensively in international health
programs, especially for contraceptives and oral rehydration therapy (ORT).

Social marketing is described as a powerful approach to social change. It offers a

logical planning process, involving consumer-oriented research, marketing analysis,
market segmentation, objective setting and identification of strategies and approaches.
It is based on the voluntary exchange of costs and benefits between two or more
parties. Consumer orientation is the key element in the marketing process. Instead of
focusing on selling and product-driven approaches, in social marketing, the consumer
assumes greater importance and participates in the change process. The social
marketer seeks to build a relationship with the target consumers over time and their
feedback is sought at all stages in the process of development and implementation of
the programme. Social marketing offers a proven and time-tested method of
influencing group behaviour through a variety of steps such as:

 –Analysis of the social marketing environment

 – Research and selection of the target population
 – Definition of the social marketing objective
 – Design of social marketing strategy
 – Implementation, monitoring and evaluation of the social marketing programme

The planning process takes this consumer focus into account by addressing the
elements of the "marketing mix." This refers to decisions about 1) the conception of a
Product, 2) Price, 3) distribution (Place), and 4) Promotion. These are often called the
"Four Ps" of marketing.

Product

The social marketing "product" is not necessarily a physical offering. A continuum of

products exists, ranging from tangible, physical products (e.g., condoms), to services
(e.g., medical exams), practices (e.g., breastfeeding, ORT or eating a heart-healthy
diet) and finally, more intangible ideas (e.g., environmental protection). In order to
have a viable product, people must first perceive that they have a genuine problem,
and that the product offering is a good solution for that problem. The role of research

18
here is to discover the consumers' perceptions of the problem and the product, and to
determine how important they feel it is to take action against the problem.

Price

"Price" refers to what the consumer must do in order to obtain the social marketing
product. This cost may be monetary, or it may instead require the consumer to give up
intangibles, such as time or effort, or to risk embarrassment and disapproval. If the
costs outweigh the benefits for an individual, the perceived value of the offering will
be low and it will be unlikely to be adopted. However, if the benefits are perceived as
greater than their costs, chances of trial and adoption of the product is much greater.

In setting the price, particularly for a physical product, such as contraceptives, there
are many issues to consider. If the product is priced too low, or provided free of
charge, the consumer may perceive it as being low in quality. On the other hand, if the
price is too high, some will not be able to afford it. Social marketers must balance
these considerations, and often end up charging at least a nominal fee to increase
perceptions of quality and to confer a sense of "dignity" to the transaction. These
perceptions of costs and benefits can be determined through research, and used in
positioning the product.

Place

"Place" describes the way that the product reaches the consumer. For a tangible
product, this refers to the distribution system--including the warehouse, trucks, sales
force, retail outlets where it is sold, or places where it is given out for free. For an
intangible product, place is less clear-cut, but refers to decisions about the channels
through which consumers are reached with information or training. This may include
doctors' offices, shopping malls, mass media vehicles or in-home demonstrations.
Another element of place is deciding how to ensure accessibility of the offering and
quality of the service delivery. By determining the activities and habits of the target
audience, as well as their experience and satisfaction with the existing delivery
system, researchers can pinpoint the most ideal means of distribution for the offering.

Promotion

Finally, the last "P" is promotion. Because of its visibility, this element is often
mistakenly thought of as comprising the whole of social marketing. However, as can
be seen by the previous discussion, it is only one piece. Promotion consists of the
integrated use of advertising, public relations, promotions, media advocacy, personal
selling and entertainment vehicles. The focus is on creating and sustaining demand for

19
the product. Public service announcements or paid ads are one way, but there are other
methods such as coupons, media events, editorials.

Some other P’s of social marketing are:

Partnership

The social marketing organization can enhance its programme effectiveness by

teaming up with other organizations pursuing similar goals. Often, the underlying
causes of a social problem go beyond one specific issue. The educational and
economic levels of the beneficiaries are some of the factors determining the
effectiveness of programmes pertaining to health and ecological conservation. This
needs to be carried out in a holistic manner.

Policy

Certain policy changes are essential to ensure an environment conducive for

sustaining social change in the long run. Tax exemptions allowed for donations to
voluntary organisations, prohibiting smoking in public places and providing special
increments for undergoing tubectomy or vasectomy, are supportive of social change.
Hence, social marketers use lobbying and media advocacy to effect such legislation.

Politics

The social marketer often has to deal with groups other than the target audience,
mobilize support and pre-empt resistance. Religious leaders and organizations, village
heads or community leaders may be permission-granting groups whose approval is
necessary. Further, their participation enhances the pace with which the required
critical mass is influenced in order to trigger social change faster.

A number of social marketing programmes for health have been undertaken in the
developed and developing countries. The issues include promoting the usage of
contraceptives, immunisation, family planning and better nutrition.

One of the earliest and least successful programmes undertaken by the Government of
India is the family planning is the family planning programme. It has been pointed out
that, “Family planning is not a medical problem but a marketing problem”.

Marketing practitioners and professional agencies are increasingly involved in

designing and implementing social change programmes and their potential may be
utilized by the central and state governments to enhance the effectiveness of the health
programmes.

20
Summing up


Advocacy for health promotion is needed in order to influence policy and urge
decision makers to create an environment for health promotion. Advocacy is
an effort to influence people, primarily decision-makers to create change, in
the context of health promotion so as to develop comprehensive policies and
effective programme implementation, through various forms of persuasive
communication.

A combination of individual and social actions designed to gain political
commitment, policy support, social acceptance and systems support for a
particular health goal or programme.

Advocacy has also been defined as the use of tools and activities that can draw
attention to an issue, gain support for it, build consensus about it, and provide
arguments that will sway decision makers and public opinion to back it?
(Rice, 1999, cited in Nathan et al, 2002).

The role of advocacy here is best categorized as facilitation rather than
representational—providing individuals and communities with the skills to
tackle and redress inequalities in health.

Alternatively, advocacy may operate as a conduit or channel, mediating and
negotiating between opposing forces in the interests of positive health,
abandoning adversarial positions in order to develop a common agenda and
find mutually achievable goals (Nutbeam, 1993).

Advocacy may also have a capacity building function, providing support for
disadvantaged individuals and/or communities to gain control over and
improve their own health by becoming effective policy advocates (Schwartz et
al., 1995).

WHO notes that health professionals have a major responsibility to act as
advocates for health at all levels in society? It can be done by Lobbying,
Social Marketing, Social Mobilization

Self-Assessment

1. Consider your own set-up where you are working and answer the
following:

i. Target groups for advocacy among youth

21
 _________________________________________________________
_________________________________________________________
_________________________________________________________

ii. Sources for advocacy for that group

_________________________________________________________
_________________________________________________________
_________________________________________________________

iii. Select what methods will you select and why for that group?
_________________________________________________________
_________________________________________________________
_________________________________________________________

iv. How will you determine the effectiveness of the messages?

_________________________________________________________
_________________________________________________________
_________________________________________________________

2. Review an advertisement related to health in the local news paper or T.V

and analyze the following:

i. Who is the primary target audience?

_________________________________________________________
_________________________________________________________
_________________________________________________________

ii. What is the objective of the advertisement? What is it trying to

accomplish?
_________________________________________________________
_________________________________________________________
_________________________________________________________

iii. What is the key promise or main message?

22
 _________________________________________________________
_________________________________________________________
_________________________________________________________

iv. What (if any) are the supporting points?

_________________________________________________________
_________________________________________________________
_________________________________________________________

v. What is the “call to action”?

_________________________________________________________
_________________________________________________________
_________________________________________________________

3. You have to meet the Cabinet secretary to express the concerns regarding
tobacco consumption among the adolescents in the schools.

i. What reasoning would you give?

______________________________________________________________
______________________________________________________________
______________________________________________________________
_________________________________________________________

ii. What is the basis of your reasoning?

______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
_________________________________________________________

iii. What evidence would you provide?

______________________________________________________________
______________________________________________________________
______________________________________________________________

23
Bibliography

1. Advocacy skills-building workshop for HIV/AIDS, International HIV/AIDS

Alliance, Zimbabwe, July 2001.
2. Advocacy skills-building workshop, India HIV/AIDS Alliance, India,
November 2002.
3. An Introduction to Advocacy, Training Guide, SARA Project.
4. An Introduction to Advocacy, Training Guide, SARA Project.
5. A Waka for Change. Health Education and Behaviour, Vol 27 (3):339-350
6. Advocacy Institute Washington DC http://www.advocacy.org
7. Canadian Pubic Health Association (1996) Action Statement on health
promotion in Canada, Ottawa.
8. Carlisle, S. (2000) Health promotion, advocacy and health inequalities: A
conceptual framework, Health Promotion International, 15, 369-376.
9. Chapman, S and Lupton D (1994) The fight for public health: Principles and
practice of media advocacy. London: BMJ.
10. Chapman and Lupton, 1994, Chapman and Wakefield, 2001
11. Chapman, S and Wakefield, M (2001) Tobacco Control Advocacy in Australia:
Reflections on 30 Years of Progress, Health Education and Behaviour, Vol
28(3): 274-289.
12. Chapman, S and Wakefield, M (2001) Tobacco Control Advocacy in Australia:
Reflections on 30 Years of Progress, Health Education and Behaviour, Vol
28(3):274-289.
13. Chapman, S. Lupton, D. (1994), The Fight for Public Health: Principles and
Practice of Media Advocacy, BMJ Publishing Group, London.
14. Christoffel, KK (2000) Public health advocacy: Process and product,
American Journal of Public Health, 90, 722-726.
15. Conway, K. Tunks, M., Henwood, W. Casswell, S. (2000) Te Whanau Cadillac
16. Deidre Kent (1998) The Joy of Lobbying: Campaigning to Influence
Government Decisions and Public Attitudes, Gateway Lobbyskills.
17. Fear, H, Barnett, P. (2003) Holding fast: the experience of collaboration in a
competitive environment. Health Promotion International, Vol 18(1), pp 5-14.
18. Ganju ADM, Ramprasad R. Marketing For Public Health Programmes. The
Journal of Family Welfare 2004; 50 (1).
19. McCubbin, Labonte and Dallaire, 2001 p10.
20. McCubbin, M. Labonte, R., Dallaire, B. (2001) Advocacy for healthy public
policy as a health promotion technology. Centre for Health Promotion (online
archives). Available http: http://www.utoronto.ca/chp/symposium.htm.
21. Nathan, S. Rotem, A and Ritchie J (2002). Closing the gap: building the
capacity of non-government organisations as advocates for health equity.
Health Promotion International, Vol 17(1),pp 69-79.

24
22. Rice, M (1999) Advocacy and reproductive health: Successes and challenges
(letter). Promotion and Education, 6(2), 2-3.
23. Stead, M Hastings, G. Eadie, D. (2002) The challenge of evaluating complex
interventions: a framework for evaluating media advocacy. Health Education
Research, Vol 17 (3), pp 351-364.
24. Wallack, L. Dorfman, L. Jernigan, D and Themba(1993) Media advocacy and
public health: Power for prevention, London: Sage.
25. Wallack, L. Dorfman, L. Jernigan, D and Themba(1993) Media advocacy and
public health: Power for prevention, London.
26. WHO Guide for Effective Programs, Policy and Advocacy, Cancer Control,
Knowledge into Action.
27. Yeatman, H. (2003) Food and nutrition policy at the local level: key factors
that influence the policy development process. Critical Public Health, Vol
13(2) pp 125-128.

25