'It is naive to suggest that the effectiveness of interventions alone is the only issue we face in seeking to change behaviour. There are wider challenges in terms of respecting diversity and ensuring our work is culturally appropriate'
Ditch the fags. Cut down on the booze. Eat well. Increase activity. Breast feed. Have safe sex. Look left and right before you cross the road. The messages are familiar, yet our health remains poor and wide-ranging differences between communities remain. After years of trying to change the nation's behaviour, progress has been limited. And the reasons are unclear. Might it be the one-size-fits-all approach we have adopted?
Consequently, there is an interest in new techniques, including the potential of social marketing to make the nation healthy. Its proponents argue that marketing techniques allow us to focus activities on the poor, the vulnerable and those who routinely face discrimination. Carefully crafted messages and interventions, aimed at specific segments of society, will reap dividends. Social marketers argue that they have solutions which have eluded others.
However, at its core, social marketing assumes that it can change behaviour and influence individuals' choices. Criticisms of strategies based on individuals making different choices are well established: choice is seldom something we all have. People with money and opportunities often find healthy choices easier. Such arguments are widespread; as a result some colleagues suggest recent policies based on 'choice' will fail. Whether social marketing will avoid these pitfalls, and produce reductions in health inequalities, has yet to be seen.
It is naive to suggest the effectiveness of interventions is the only issue we face in seeking to change behaviour. There are wider challenges in terms of respecting diversity and ensuring our work is culturally appropriate. And there remain unanswered questions about the potential negative nature of supposed simple and benign health promotion messages.
Almost 10 years ago, I completed a piece of research which sought to understand the relationship between the advice colleagues gave about sexual health and the effects it had on the communities they worked in. I focused on the impact of HIV prevention advice for gay men..
I was not explicitly interested in the effectiveness of messages to help gay men protect themselves and their partners from infection, but in the broader social effects of those messages.
How did the technical language of risk, infection and protection affect the way gay men saw themselves and others? How did such concepts change the way they made sense of their identities? How did sexual health messages inform the terms upon which they built intimate relationships?
I argued that it was right and proper that health services should strive to improve sexual health. But it was clear that sexual health messages were not simply informing health-related behaviour. The ideas contained within them, and the language they used, deeply affected the ways in which gay men made sense of the world, the legitimacy of their relationships and their self worth. The logic contained within the messages became a road map through which they organised their desires, sexual activities and identities. The reach of sexual health messages is deep and goes to the core of who we are, I concluded. Sinister stuff.
A decade later, I stand by my conclusions, although I shudder slightly at their boldness. When we evaluate the effects of social marketing, we should not simply assess resultant behaviour change, but take a broader view of what constitutes success. We should reflect on how far health messages fundamentally alter the ways we see ourselves and erode the differences that make us unique.