'Social marketing recognises that, all things being equal, people will choose behaviours that keep them in good health. But all things are rarely equal; most people have to make choices and compromises'

To paraphrase Gerhard Wiebe, an early writer on social marketing,.can - or even should - health be sold like soap?

David Woodhead's recent opinion piece (see 'David Woodhead on social marketing') raises some challenging questions about the ethics and impact of social marketing techniques in reducing health inequalities and improving public health. In view of the current emphasis on.social marketing in the health service, these questions cannot be ignored.

Social marketing is about using a consumer-centred approach to promote behaviours that will help people stay healthy. The concepts of social marketing have been around for more than.50 years and the techniques have been applied in many countries.

Social marketing.is not simply about generating carefully crafted, individually focused messages to promote behavioural change. Successful social marketing strategies reflect a logical planning process, which can be used to promote behaviours at the individual level and/or to encourage policy-makers and organisations to make improvements to their policies, services and practices so it is easier for people to adopt and sustain healthy behaviours.

Over the last five to 10 years, the evidence base on social marketing has continued to develop, and increasingly demonstrates its potential for improving the impact and effectiveness of interventions..

But what does 'consumer-centred' mean in the context of public health? Typical health campaigns:

  • are driven by health service targets;
  • focus on specific behaviours such as smoking, excessive drinking, lack of exercise and poor diet;
  • employ generic, correctional 'stop doing that, it's bad for you' behaviour change messages;
  • rely on rational responses;
  • require a benchmark for healthy (or socially acceptable) behaviour.

Such campaigns need to be designed with considerable skill and sensitivity if they are to avoid pinning labels on their target audience. These labels can be explicit or implicit and, although intended as a marketing tool, can quickly become shorthand descriptions used by healthcare workers and the public. For some people, refusal to be labelled can become a barrier to accessing a service.

Overcoming obstacles

A consumer-centred approach, on the other hand, focuses on the public's needs, not health service targets. Social marketing recognises that, all things being equal, people will choose behaviours that keep them in good health. But all things are rarely equal; most people have to make choices and compromises.

By developing an in-depth understanding of the reasons for these choices, social marketing aims to engage people in a partnership to adopt a healthy lifestyle. This peer-to-peer, partnership approach can make a social marketing campaign highly effective. It also avoids negative.labels.

A particular strength of social marketing in this context is that it does not need to focus on a specific condition or behaviour. Rather, it recognises that many choices are interdependant and respects the reasons for the way people behave and the choices they make. By understanding those reasons, social marketing aims to provide an evidence-based platform that will identify the package of services and support needed to enable people to adopt a healthy lifestyle.

This approach lends itself to co-ordinated partnership working, where the partnership involves the public, those with responsibilities for improving public health and those with the means to remove the actual and perceived barriers people face in adopting a healthy lifestyle. To be fully effective, a partnership may need to involve organisations in voluntary, public and private sectors.

While this sounds attractive, the actual and perceived barriers people face in overcoming health inequalities may not be the same as those the health providers think they face or those addressed by existing services. As a result, there may be tensions between health providers being pressurised to meet their targets and having to relinquish some control to the service users

Long-term view

Is social marketing a cure-all for.health inequalities?.Perhaps uniquely, it supports the development of a consumer-centred comprehensive strategic framework. It is a powerful tool for achieving certain goals. Properly applied, it should help primary care trusts.and local authorities commission and deliver evidence-based services that will genuinely meet people's needs and reduce health inequalities..

However, true social marketing is not a short-term solution..Developing the right partnerships takes time and resources. Nor can social marketing be an intermittent activity. There needs to be commitment from all parties to make it work. Organising a focus group or gaining feedback through a questionnaire to inform a conventional health promotion campaign is a small step forward but falls well short of a fully engaged scenario.

Perhaps the real question is whether PCTs, local authorities, voluntary organisations and other actors are willing and able.to pursue a fully engaged scenario and delegate some of their responsibilities.

Dr Richard Morgan is a principal consultant at Momenta, a division of AEA Technology. Allison Thorpe is a policy manager at the National Social Marketing Centre.

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