Social marketing for health has become a core component of UK government strategies to improving wellbeing and tackle inequalities amongst diverse populations, including men. Social marketing strategies adopt the methods of commercial marketing to promote social good through encouraging behavioural change in individuals. These methods have been employed with men in the UK as part of a wider movement to improve male health. Drawing on original empirical data collected with 50 unemployed men in the UK, this paper and considers men's responses to social marketing strategies and their own understandings of health, its determinants and personal responsibility. Data presented illuminates men's critical stance towards social marketing for health and its imperatives for behavioural change in the face of wider societal determinants of wellbeing which shape both their health behaviours and experiences. Critical discussions of the use of such strategies as part of neo-liberal models of health governance are offered.
Keywords: social marketing, men's health, determinants of health, responsibility, neo-liberalism
Our public health problems are not, strictly speaking, public health questions at all. They are questions of individual lifestyle--obesity, smoking, alcohol abuse, diabetes, sexually transmitted disease. (Tony Blair, 2006)
Social marketing is: the systematic application of marketing, alongside other concepts and techniques, to achieve specific behavioural goals, for a social good. (French & Blair Stevens, 2005)
Your asking the wrong people who are on benefits aren't you really? You can't afford choice. (Research participant)
In the above quote, UK Prime Minister (1997-2007) Tony Blair neatly summarises what have become, in the UK and beyond, prevailing neo-liberal ideologies which position responsibility for health and its management with the individual. These ideologies have infiltrated recent public health work, promoting individual responsibility for the management of health and wellbeing and focusing upon what has been described as the "politics of behaviour" (Furedi, 2006). Where once, the aim of public health was to improve environments, strengthen communities or tackle inequalities (Ashton & Seymour, 1988), newer strategies emphasise the role of the individual in determining their own health (Rose, 2001), typically focusing upon the promotion of behavioural change. Perhaps nowhere else are these imperatives so apparent than in social marketing strategies which have recently become a key aspect of UK government public health policy at national and local levels (French, 2009). These strategies are indicative of newer forms of health governance which move beyond the provision of services to integrate health as a core aspect of the lives of individuals and communities and elevate it to a core goal of self actualisation within late modern western "health societies" (Kickbusch, 2007).
Social marketing aims to promote "social good" (National Social Marketing Centre (NSMC, 2007) using the methods of commercial marketing. These methods include: a customer/consumer orientation, setting of behavioural goals for a social good, use of a marketing mix to achieve those goals, audience segmentation to target customers effectively, and use of the concepts of "exchange" and of "competition" (Robinson & Robertson, 2010). Social marketing for health typically targets individuals and communities (the sick, but more often, and most significantly for this research and discussion, the "worried well"), with the aim of encouraging behavioural change, often with populations deemed to be "at risk"; for example (male) smokers (see Figure 1).
These objectives are achieved through a complex "mix" of methods which includes recognising the relationship between product, price, place and promotion characteristics in intervention planning and organisation (Lefebvre and Flora, 1988). This mix is operationalised by beginning with specific target audiences as the basis of campaigns, gaining full understanding of how audiences construct the product, considering the costs and benefits of behaviour change and understanding the place or settings in which both audiences will be targeted and in which changes will take place. How these elements are combined, and which are given precedence varies according to the social goal of the given intervention or campaign (Lefebvre, 1992).
The adoption of social marketing as a strategy is driven by the observation that many of the health challenges facing Western societies have significant behavioural elements including obesity, alcohol misuse, infection control, recycling, saving for retirement and crime (French, 2010, p. 1). These challenges are coupled, French (2010) argues, with growing resistance to state paternalism and its perceived propensity to breed dependency (ibid). The combination of these factors opens the door, so it is argued, for methods which position the citizen/consumer centrally in the delivery of interventions. Social marketing, with its emphasis on understanding people as the starting point (French, 2010, p. 2) is proposed as a potentially powerful methods for achieving this. Thus it works with consumers as its starting point, guided by the nostrum (supported by the UK Kings Fund (2004) which states that: 89% of people agree that individuals are responsible for their own health) that under the right guidance and with appropriate "nudges" (Thaler & Sunstein, 2009), individuals can and should be able to take responsibility for wellbeing. To achieve this, social marketing typically uses advertising and other forms of media to encourage behavioural change, alongside interventions. For example, the recent UK Change4Life campaign combines advice and encouragement to engage in more physical activity (advertisements on public transport ask "why not get off one stop earlier") with events which are free to access, for example, offering free dance classes around the UK in Spring 2010. In this way strategies use a "marketing mix" (Lefebvre, 1988) to most effectively target populations.
We argue that these approaches represent a rupture from more established public health strategies, whether classical interventionism (Rosen, 1993) or more recent new public health approaches which have emphasised enabling environments and social change (Ashton & Seymour, 1988). Social marketing for health, although ostensibly intended to bring about "social good," rather, eschews the social in favour of an individualisation of responsibility for the management of the body, health and self. Such strategies assume a rational, active individual capable of monitoring their own wellbeing, and that of their families, and who is able to moderate and "improve" behaviours where appropriate. As noted, this reflects prevailing neo-liberal approaches to health governance wherein the individual becomes central to the management of their own wellbeing.
Despite reiteration that "Social marketing really works--but only if it is done properly" (Andreasen, 1995), there is still limited evidence that this is the case (Stead et al., 2007). In a recent systematic review, Stead et al. (2007) analysed fifty four interventions, finding significant positive effects in the short term but not the medium and longer term. Further, of these fifty four, forty eight relied heavily on face to face methods like counseling and peer support. Stead et al. (2007) thus argue that the marketing elements of these were less effective than direct intervention with populations and the individual. As already hinted, perhaps the most significant problem with the "touting" (Herrick, 2007) of these strategies as a panacea for health improvement is the continued overwhelming evidence of the structural determinants of health. Research into health inequalities has long identified the material basis of the distribution of morbidity and mortality amongst populations (Black, 1980). Thirty years of subsequent research has documented how the Western industrialised nations continue to …