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Marketing public health
  1. Central Sydney Area Health Service
  2. University of Sydney
  3. Locked Mail Bag No 8
  4. Newtown NSW 2042 Australia;
  5. criss{at}

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    Marketing public health—strategies to promote social change. Michael Siegel, Lynne Doner. Gaithersburg, Maryland: Aspen Publishers, 1998, ISBN 0-8342-1071-1, pp 530.

    This is a somewhat unusual book about social marketing. Not only does it present the traditional marketing paradigm with lots of “how to” lists, the authors argue well that considerable marketing of the concept of public health is itself needed. More than other US marketing or advocacy texts, this book looks at why the current health issues exist, and presents a good case for why we need to think differently about public health marketing than we have.

    The book is divided into two parts. Part 1 deals with why marketing in public health is different from commercial marketing, and that the concept of public health itself needs to be promoted as a way of making the policy climate for public health interventions more receptive. Siegel and Doner document well the various barriers public health practitioners face with regard to marketing, including: limited resources; negative or no demand (from consumers) for some public health recommendations (for example, less alcohol consumption); a hostile/competitive environment in which social change is being marketed; limited marketing and advocacy skills training of many public health practitioners; and limited ability to assess impact.

    With both authors from the United States, the book has an obvious US focus, and all the examples and discussion of the political problems facing the public health infrastructure and social environment relate to the US, which may not always apply to other countries. Many of the problems prevention and public health services face are indeed all too familiar, however, and the difficulties in marketing public health concerns also apply around the world.

    Part 2 comprehensively covers the “how to” of public health marketing, including the planning process, message framing and communication, and monitoring and evaluation. A fifth P is added to the usual 4 Ps (product, price, place and promotion). The fifth P represents “partners”, although the authors have not drawn on the growing literature on coalitions and intersectoral strategies in health promotion to elaborate on how best to enhance this aspect.

    Michael Siegel has a strong background in tobacco control. Readers ofTobacco Control will appreciate the many tobacco examples, and how “big tobacco” has successfully appealed to what the authors see as core US values of freedom, independence, autonomy, control, fairness, democracy and free enterprise, and public health advocates have been less successful with framing their appeals to “health”. The authors helpfully propose alternative messages that can be expected to have greater impact. One line that resonated well for encouraging the reframing of messages was: “People don't buy products, they buy expectations of benefits” (p 319).

    A consistent theme throughout the book is the need for public health marketers to pitch their messages better to address these core consumer values. “The public health practitioner must be able to offer programs with a benefit that the audience appreciates and demands, to back up this offer, and to communicate an image of public health programs or the public health institution that reinforces core values of the target audience” (p 117). Of course, other core values may be applied.

    The authors also describe the successful application of marketing principles to tobacco control policy initiatives, such as the defeat of proposition 188 in California (which was sponsored by Phillip Morris), and a case study of the campaigns in five US states for a state tobacco excise tax.

    The book contains loads of specific suggestions and suggested steps for working through the various stages of planning, implementing, and evaluating marketing campaigns, such as how to conduct formative research. There are many “real life” examples with innovative suggestions for conceptualising issues, such as appendices examining difference between advocacy and lobbying in the US context, and a framework for categorising social change objectives and strategies (developed by Kasturi Rangan and others at Harvard) along two dimensions of low cost to high cost to the target audience and tangible, personal benefits to intangible, societal benefits, and the corresponding marketing problems and solutions.

    Overall, the book is a great resource, comprehensively drawing on the history of social change marketing, as well as recognising the social and environmental determinants of health. I recommend it for public health students, and am sure it will provide fresh insights into framing messages for experienced practitioners.