To improve public health you need to be an active participant, says health campaign expert Jane Asscher

While public health campaigns often try to change behaviours simply by delivering information, Jane Asscher from creative agency 23red says they need to go further.

“I first started working on public information campaigns such as for the Department for Transport Drinking and Driving campaign 20 years ago. The approach then was very much top down,” she says. “However, I have come to realise that to change behaviour you need to take a holistic view of your audience and deploy a broad range of tools and techniques within the marketing mix that support people at grassroots in changing behaviour. I want to deliver campaigns that make people do something.”

When planning a campaign, Asscher starts by asking what action she wants her audience to take, whether starting, stopping or continuing an action. “This helps to focus at the very beginning, then we try to understand why our audience is, or is not, doing the action and how we might motivate them,” she says. “We try to distil that thinking into a one-sentence proposition, which then goes into the creative brief.”

She cites smoking cessation as an example. “Research shows that it takes 13 attempts to successfully quit smoking on average, but if people stop for a month they are far more likely to quit for good, and that’s where the idea of Stoptober – a nationwide campaign to encourage people to give up smoking for October – comes from.”

Holistic thinking

The next step is to gain a holistic understanding of the target audience by “getting under their skin to understand what makes them tick”, says Asscher. “This includes everything from qualitative and quantitative research to less obvious techniques such as ethnography and mobile. We have to understand what the barriers are, why people are not changing their behaviours, and what the motivators are to help them to change.”

An example of this approach is the Department of Health’s (Public Health England) long-running Change4Life campaign, which focuses on childhood obesity. “We spent 18 months living with people from the intended audience to better understand the issues. We learnt that people see their children’s happiness as the most important thing, and that there is some confusion between being happy and being healthy,” says Asscher.

“It was shocking for parents to see that as a result of trying to make their children happy they could be shortening their lifespans. That was a really interesting piece of insight, although we had to be careful not to blame mums for the obesity epidemic.”

They needed to find a common enemy, she says, which ended up being convenience. “We focused on convenience in transportation and convenience in food. We were there to be supportive and explain the causes and outcomes of obesity, and to support parents in changing the eating behaviours of the family. We looked at how you can package those behaviours into bite-sized chunks that are easy for parents to understand and effect change, such as sugar swaps, five-a-day and cutting back on fat.”

Tip of the iceberg

Delivering a campaign’s messages to its audience requires a broad range of techniques, says Asscher, who points to her work in smoking cessation.

“Smoking is a really interesting area,” she says. “There is definitely a role for television advertising but to reach the really hardcore audience that still haven’t changed their habits, we have to use an eclectic mix of channels.”

Asscher uses what she calls ‘owned and earned’ channels; not only the things you buy, such as television or poster advertising, but also using organisations and brands that consumers trust to deliver the message. “We do a lot of work with pharmacy chains because they talk to our audiences day-in, day-out. Pharma companies have an equally important role to play,” she says. 

“We also work closely with local authorities; they are big providers of smoking cessation services and our goal is to make sure we’re really present in the community and support people to change behaviour. There’s an awful lot that sits below the tip of the iceberg that is television advertising.”

Ongoing considerations

When it comes to the timing of a campaign, a number of different factors need to be considered, says Asscher, including the public health agenda, policy initiatives sitting alongside the campaign and the timeframes of partner organisations.

“We also consider the best time of the year, day or week for the audience,” she says. “The retail calendar has an important role to play as well; for example in January we know that a lot of the retailers are focused on new year’s resolutions.”

For continuous campaigns like Change4life, it is important to regularly assess their impact on the audience. “We’ll use various data sources to tell us how we’re doing, from assessing awareness of Change4Life and the various health issues, to studying the behaviours we’re trying to change. We’ll also look at sales data in different categories; for example, looking at sales of sugary fizzy drinks is a good way to for us to see the impact the campaign is having. 

Unfortunately, Asscher’s approach is not an exact science and the landscape often changes dramatically, she says. “The process of continuously learning and evolving is very important. Factors like the proliferation of social media channels and the falling trust in governments and institutions have forced us to change the way we think about campaigns. Now, we have to be nimble, and respond to the results and the changes in the landscape.”

Nevertheless, there are emerging themes that inform all campaigns. “The importance of working in partnership and collaboration, supporting people in changing behaviours rather than just providing public health information and, of course, proactive prevention – these are what we must focus on.” 

Asscher concludes: “We have to recognise that we all have a responsibility in changing behaviours – at an individual level, in terms of the choices we make, at a corporate level, in terms of the choices we provide and at a local government level, in terms of the services we offer. Health behaviours are not somebody else’s problem anymore, nobody else is going to provide the solution.”

We have to understand why people are not changing their behaviours, and what the motivators are to help them to change.Jane Asscher is a founding partner and chief executive of creative agency 23red