Posts Tagged public health

What does behavior change have to do with True Blood?

In HBO’s True Blood you gotta bring the whole bag of tricks to protect yourself from vampires, werewolves, maenads, warlocks, faeries and who knows what else is comin’. According to social marketing expert Mike Newton-Ward, if you showed up in Bon Temps with only garlic or only a wooden stake, you’d be in a whole lotta trouble.

For many issues in life, you need more than one strategy to deal. Think about rationalizing with children – different personalities and ages may need different approaches. Strong negotiators have many tactics up their sleeves, ready to pull out as needed. Consumer products companies have endless marketing and sales strategies to get us to buy. Even justifying a new shoe purchase – many women know a variety of ways to do this. So why would we think it’s enough to apply one solution, one strategy, or one event to complex, vexing social issues and public health problems, and expect much change? Or, to apply the solution or strategy or communication only one time?

These problems haven’t gone away yet for a reason. For a good discussion about this, check out Mike’s social marketing blog and his post “Stop Looking for a Silver Bullet! We need Wooden Stakes and Garlic, too!” for a reminder of how the 4 P’s of marketing applied to social issues allows you to more effectively attack a problem from numerous angles. 

I also appreciate how he shares this quote: “Problems worthy of attack, prove their worth by hitting back.” It’s not bad if your prevention and behavior change efforts get push-back. Especially if you get major push-back from industry. Instead look at it this way — it means you are on the right track. It’s a sign of your effectiveness, and that’s a good thing.


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Selling what people don’t want to buy (part 2)

In Part 1, I noted that in public health we often do something that I’ve been guilty of doing too:

  • We tell people not to do things they want to do.
  • We tell people to do things they don’t want to do.

And then we expect people to “do the right thing” or “make the right choice” “for their own good.”  Then we’re surprised when things don’t change. Or we rely on satisfaction evaluation surveys — that people answered very nicely — to try to show that we made a difference.

Well, what if someone tried to sell something to you that:

  • May increase your appetite even though you want it to help you lose weight
  • Has zero nutritional value
  • May leech calcium from your bones
  • Has acidity level that can attack your teeth

Would you want to consume that? Millions of people do every day. And they pay for the privilege of doing this. In diet sodas (or pop, cola). More about drinks marketed as “healthy.”

Now set aside for a moment the fact that this could be bad for you, while in public health we try to sell the good for you. The point is, marketers are turning something that we wouldn’t want to buy and drink — when you think about what you are really drinking — into something that millions of people do want to buy and drink.

They don’t sell what the product actually is. They sell how it can make you feel. And, furthermore, they tell you what you will feel. And they choose feelings that people may want to feel: full of energy, fun, cool, fashionable, attractive, at the top of their game:

See lots of people having good times, living good lives in a lot of ways. And while drinking … what?

What they are actually selling, packaged in those cans and bottles, people would not want to buy.

Now, I understand if this example isn’t the most ideal example, because in public health we sell well-being. So how about looking at water? We would be in favor of drinking water, right? Can we imagine any scenario where people would not want cool, refreshing water? And most importantly, life-sustaining water because we cannot live for many days without it?

But what if water cost 10,000 times more than we’re used to paying for it? And most of the time, with no extra health benefit for this extra cost?  What if over 1.5 million barrels of oil were required each year to deliver water to our country? Would we want that cost? For those of us living near the Great Lakes, why import water from the other side of the planet? The well in my yard taps into an aquifer; why do I need water from anywhere else? Plus plastic production and plastic waste from 7 billion gallons each year? Are we OK with that cost?

As you can guess what’s coming, we already do pay 10,000 times more for water. We happily buy bottled water instead of turning on the tap. Why do we do this?

Youth. Purity.

And people are sold on the beauty and allure of water from Fiji. This poster even sells the green angle, when the manufacture and delivery for this industry is far from green.

So what does this mean for public health, and what we want people to “buy”? What can we do? More of this series coming soon …

Related posts:

Selling what people don’t want to buy (part 1)

Melinda Gates wonders about learning from Coca-Cola for social change too

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Selling what people don’t want to buy (part 1)

Type “yuck” into‘s search and you’ll see many totally unmotivated people, like this cutie who has bad thoughts about that salad. Where do kids get that attitude so young? At any rate, it’s a hard sell at this point to get this kid to eat his veggies. You’re selling something to him that he doesn’t wanna buy.

(I apologize, by choosing this photo, I just realized I’m adding to this attitude. But he’s so cute. And he gets the point across. And I don’t think 4-year-olds are reading this blog.)

What company would sell things that people don’t want to buy? How long would that company stay in business? But in public health, we do this a lot. Too often,

  • We tell people not to do things they want to do.
  • We tell people to do things they don’t want to do.

We tell them they should do this for their own good, in one way or another. And we expect that to change behavior.

Well you know what, that appeal isn’t good enough.

What if people had to pay for what we’re “selling” in public health? And yes, we are selling. We’re selling people on an idea, a belief, an attitude, a behavior. How many people would buy what you’re selling? Would enough people buy to keep the lights on in your office? To pay a salary that would cover your basic bills? To pay a salary that would pay basic bills plus your kids’ college tuition, nice vacations, new roof or kitchen re-do whenever you need or want it, ample retirement nest egg, etc.? Really think about this. Would enough people buy what you’re selling so you could “stay in business”?

Many public health professionals work in government and non-profits because the behaviors that we promote for the good of individuals and the public don’t involve an exchange of money, like consumer sales and business-to-business sales do. The private sector won’t take on our issues for a financial exchange. But I challenge that although there’s no exchange of money between us and our audience, we still must deliver the most effective appeal that our audience would buy. Because in our case, the “buy” is behavior change. When our audience buys in, they change. And we’re not selling another pair of fashionable winter boots, the latest hosta hybrids for a garden, or the most beautiful travertine tile for a new bathroom floor. Although I’ve bought all of those over the past few years, I’d say we’re selling something more critical than those things. We’re selling the well-being, health and safety of people.

And although most people would say they want to be well, healthy and safe, we know they don’t always “buy” the behaviors that deliver that. Selling what people don’t want to buy is not the best road to behavior change. We need to find ways to influence behavior change by using appeals that our audience does want to buy.

I don’t mean to leave you hanging, but more on this later. … (OK maybe I do mean to leave this for now, it’s a gorgeous weekend in October and we’re going up to Door County! You can’t make me buy more time indoors this weekend, no way!)

Related post:

Selling what people don’t want to buy (part 2)


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Got 2 1/2 hours? Watch Project Runway and On The Road with Austin & Santino … or …

Read Rework. It’s written so snappily, it’s just as entertaining as wacky reality TV personalities. When I needed a book to last a flight from Chicago to San Diego, this fast happy read lasted from O’Hare to Oklahoma. But that’s OK. That’s exactly what the book is about — more results, not more work and more hours. The authors wrote a book the way they believe business should be done. Now that’s acting on your beliefs!

If you want a jolt of evidence that work can be done differently, get this book. It’s a business book that’s relevant for public health too. It challenges you to think the opposite of conventional wisdom. A few gems …

Many of us in public health would like more resources, more people, more to have more. The authors wonder why organizations always want to grow. Instead, they use the advantages of a small organization:

Embrace the idea of having less mass. Right now, you’re the smallest, the leanest and the fastest you’ll ever be. From here on out, you’ll start accumulating mass. And the more massive an object, the more energy required to change its direction. It’s as true in the business world as it is in the physical world.

They argue you don’t need to be bigger to make big change, and in fact, constraints can make you better. Think about tiny organizations that can say what they mean. They can advocate. They can push buttons. They can act where larger organizations have barriers preventing this.

This next tip is a twist on “don’t sweat the small stuff” advice. A theme throughout this book is, don’t plan too much too soon. For public health professionals trained to have plans for everything, this is a mindbender. But I’m gonna break out the Sharpies and try this …

When we start designing something, we sketch out ideas with a big, thick Sharpie marker, instead of a ballpoint pen. … They encourage you to worry about things that you shouldn’t worry about yet, like perfecting the shading or whether to use a dotted or dashed line. You end up focusing on things that should still be out of focus. A Sharpie makes it impossible to drill down that deep. … The big picture is all you should be worrying about in the beginning.

So true. While we are making perfect straight lines we aren’t using creativity to solve problems. While we are planning perfect plans, we aren’t acting.

In public health we often seek to change culture:

Artificial culture is paint. Real culture is patina. You don’t create a culture. It happens. … Culture is the byproduct of consistent behavior.

This is a great visual analogy to remind us that we can’t force culture to grow. It must come from within.

It’s a fun read. My copy already looks used n’ abused, many page edges turned under, passages underlined, favorite parts starred. If I shared them all here, there’d be major copyright violation. Let’s just say the book challenges prevailing thought about many things we do daily:

  • learning from mistakes is overrated
  • throw less at the problem
  • meetings are toxic (I know they can be unproductive, but, toxic?)
  • good enough is fine
  • make tiny decisions
  • underdo your competition
  • don’t write it down

Huh? Believe it? Or not? Well I can say this — from Oklahoma to California, I started reading Switch: How to Change Things When Change is Hard. Its stories reaffirm points in Rework. More on that later when I finish Switch on the flight home …

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Is this driver really the only one responsible for his problem?

It was a murder mystery. That’s how New York Times journalist Matt Richtel, who won a Pulitzer Prize this year for his reporting on cell phones and distracted driving, described the series of articles. After reading his writings for over a year, we heard him speak and share background stories about the special series at a conference this week.

This murder mystery angle got me thinking about public health and injustice and personal responsibility. In public health we usually seek to reduce and erase injustices. However so many issues, such as car crashes, are incorrectly pegged as issues of only personal responsibility.

Matt’s investigation into how a fatal crash involving texting happened took him decades into the past when cell phones were first created as car phones. Then he traced a path through industry and government decisions to the present, where we now lose thousands of people a year in crashes involving cell phones. He showed how distracted driving could be a true public health issue of injustice.

For those who think the issue is only one of personal responsibility, you need to trace what led to people’s personal decisions about using cell phones in vehicles.

Cartoon from National Safety Council

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