NHS Birmingham East and North and Dr Foster Intelligence are currently working in partnership on exploiting the joint capabilities and networks available to both organisations to tackle health inequalities in the local community.

As part of the Programme for Relationships, Intelligence, Metrics and Equality (PRIME), an in-depth segmentation of the population in the east and north of Birmingham was completed, providing a holistic view of the population and associated segments. This segmentation maps at an output area level and utilises a combination of health, socio-economic and ethnicity data, grouping people based on the degree of association between them.

A unique health typology map has been created, with each segment’s attributes fully described, including their media and communication preferences. This ensures that NHS Birmingham East and North and DFI are able to effectively identify health inequalities and tackle them successfully, through targeted social marketing activity.

Director of public health, Nicola Benge, explains: “The health typologies that Dr Foster created have made a significant impact on our ability to tackle inequalities by enabling us to focus on those that need our support the most.”

Tackling smoking prevalence

Smoking prevalence in the East and North of Birmingham in 2009, stood at 28 per cent, significantly above the national average and equating to 84,000 smokers. Smoking remains the primary cause of health inequalities between the rich and poor in England and, as such, tackling smoking prevalence plays a key part in PRIME.

DFI’s data analysis showed that the ‘red’ typology group experience the greatest health needs linked to smoking related conditions, with smoking prevalence in excess of 30 per cent in this audience, making them the primary focus of our activity.

The data showed that this group, particularly white males aged 35 – 55, were most at risk from conditions such as cancer and chronic obstructive pulmonary disease.

In order to effect behavioral change in the audience, it was necessary to fully understand what their motivation was for smoking and the barriers that stopped them from quitting. Through focus groups and one-to-one interviews a key piece of insight was generated, that many of the audience resented the control that smoking held over them.                                                                 

The challenge was to generate a creative idea that would convince the target audience that they could regain this control by quitting smoking. Four creative routes were tested, with one striking a clear chord. That campaign was Fight Back.

Fight Back confronted the audience with a graphic metaphor for the damage that smoking does by enabling them to “see it”, but was also empathetic in acknowledging that successful quitting is a real fight.

The campaign challenged the audience to fight back, regain control and beat cigarettes. Both DFI and NHS Birmingham East and North were aware that the campaign contained some challenging imagery and it was an approach that caused some controversy but, importantly, it resonated with the target audience and the evidence shows that it has made a difference to the number of people quitting smoking.

The Fight Back campaign was delivered over an eight week period in two phases. Phase One, running for four weeks, focused on launching the campaign through six sheet posters, mobile ad vans and PR to establish it with the audience. Phase Two, in the final four weeks of the campaign period, “amplified” the message taking the Fight Back message directly to the audience. On-street ambassadors frequented the areas where the audience lived and worked, using experiential elements such as lung age testing machines, to engage with people and explain the benefits of quitting.

The ultimate goal of this interaction was to refer smokers to their local pharmacy smoking cessation service. Primary research indicated that this service best met the needs of the target audience, in terms of flexibility and accessibility.

During the campaign period there was an 87 per cent increase in the number of Quit Dates Set and a 65 per cent increase in Four Week Quits at local pharmacies versus the same two month period in the previous year.

The campaign was also shown to resonate disproportionately the target audience, a group which, historically, has accessed smoking cessation services in low numbers. A second phase of activity was delivered in May 2010, building on the knowledge and success of Phase One to further tackle health inequalities linked to smoking within this audience.