The announcement last month by health minister Caroline Flint of the launch of a social marketing strategy for obesity next year highlights the importance of social marketing in delivering results that more traditional approaches fail to achieve.

One of the most memorable recent examples is in an NHS anti-smoking campaign, which featured a burning cigarette end between two 'fingerlegs' as a metaphor for a penis, with the tagline: 'Does smoking make you hard? Not if it means you can't get it up.'

By showing the impact of smoking on impotence and erectile dysfunction, the campaign specifically targets young men. It then encourages them to consider quitting smoking voluntarily, by offering them an incentive in the form of an improved sex life.

Social marketing covers a range of techniques - from highly targeted advertising campaigns to the use of market research and population data analysis to make direct contact with particular groups.

It is being used increasingly by the Department of Health and marks a departure from traditional campaigns which, although informative, were found to be ineffective at reaching those who smoke, take little exercise, eat poorly and drink too much.

The approach is being used for anything from drug and alcohol misuse to nutrition and physical activity.

Once a target audience is selected, its members are researched to provide an insight into the reality of their daily lives and experiences. By understanding their existing behaviour, key influences and influencers, a social marketing strategy can be developed to offer appropriate incentives to achieve measurable impacts.

Improving lives

'Social marketing is marketing which improves people's lives,' says Clive Blair-Stevens, deputy director of the National Social Marketing Centre.

'It's better than traditional campaigns, on which a great deal of time and money is spent trying to communicate messages to customers. It's really important to understand our customers first. It's not about messages but about where people are. If we know where people are, the message will take care of itself.'

John Bromley, head of the social marketing development unit at the DoH, told delegates at NHS Networks' social marketing conference in England in September that the government decided to develop a National Social Marketing Strategy for England in response to the Choosing Health white paper and an independent national review of public health promotion, which showed that existing methods were unlikely to deliver particular behaviours.

'Social marketing has been proved to be the most effective way of achieving behavioural change in a wide range of countries, which is why we want to adopt it more comprehensively in England,' said Mr Bromley. 'However, we are the first to use social marketing in public health for an entire country.'

The North East is one of the places actively using social marketing techniques. Newcastle University senior lecturer in public health Dr Ray Lowry said: 'Chief medical officer Professor Sir Liam Donaldson was instrumental in introducing it into the NHS in the 1990s. Since then the region has been at the forefront of developing it for public health in the UK.'

Dr Lowry ran a stop smoking campaign for pregnant mothers in Sunderland, which was so successful that it won 'best practice' recognition from the DoH last year. It was also described as one of the top three beacon services in England.

International marketing expert professor Alan Andreason of Georgetown University in the US stressed to delegates at the conference the importance of considering other influences. 'We have a role to play not just as a downstream focus but upstream, too,' he said.

'Take childhood obesity. Should we just focus on the kids? To really attack the problem, a lot of other people upstream also need to act, such as parents, news media and government regulators.

Also, the goal for many campaigns is not behaviour change but to stop people doing things in the first place. For example, smoking, drugs, or smacking children.

'We belong in earlier stages of social change but are brought in towards the end. That needs to change.'

Fun factor

National Social Marketing Centre director Dr Jeff French said that making social marketing entertaining is also important. 'The challenge is to make social marketing easy, fun and popular. Too often we have been the anti-fun police. The challenge is also to reach out to people in a way they appreciate.

'We have to find out what will motivate them, not what we think will,' he added. 'We need to let them lead us in this area. Our key job is to actively listen and understand them, rather than tell them what to do. Telling people what to do doesn't work.'

But a drooping cigarette end between two 'fingerlegs' might do the trick - if the target cares enough about whether he 'can get it up' to quit smoking for good.


Sunderland success

The success of the stop smoking campaign for pregnant mothers in Sunderland hinged on a series of focus groups that increased understanding among health professionals of the women they were targeting, says Newcastle University senior lecturer in public health Dr Ray Lowry.

'We found that these women already felt awful. They had low self esteem and knew they shouldn't smoke, so they didn't want to be made to feel worse.

'They felt the NHS saw them not as a woman with a baby inside but a pregnancy with a woman attached. The lack of enthusiasm among health professionals also made the women feel unwanted and unwelcome, so they did not see the point of going [to smoking-cessation services].'

Dr Lowry set up intervention strategies to overcome these barriers. Women were visited at home. A magazine in the style of women's chat magazine Talk! featured catalogue-style advertisements showing what women could afford to buy if they gave up smoking. It also provided a space where pregnant smokers could speak out.

Recruitment of pregnant smokers to the redeveloped smoking-cessation service increased tenfold during the intervention phase, and over a three-month period 26 per cent said they had hit the four-week quit period.

The campaign worked because it was designed to suit the needs of its target group, says Dr Lowry.