What is the social change approach in health promotion,the ways to get success in our life quotes,the secret circle initiation free ebook sites - Videos Download

17.12.2013
In other words, the theory you use – whether old, new or personal – frames the way you look at a problem, try to understand it, go about solving it and attempt to measure it (for example, not one epidemiological survey has ever give me a clue about HOW to change risk behaviors, only that it needed to be done for certain population groups).I was recently called into a family planning project at the beginning (thankfully) to help develop an overall approach and strategy.
Research should target practices, social factors and behaviors that fuel HIV epidemics across populations and settings.
Work with Community-Based Organizations (CBOs) and Health Departments (HDs) to determine how best to focus and tailor these responses in their particular communities.
Research should focus on the process of dissemination that emphasizes studies of training procedures, end-user response to guidance, implementation strategies, contract manager effectiveness, enhancers and barriers to scale up, evidence in the real world for effectiveness, and capacity building.
CDC should undertake a community-driven research agenda that takes advantage of its unique relationships with CBOs and HDs and encourages their input in the identification of emerging issues and potentially effective practice-based interventions. Social marketing has a central role to play in scaling up interventions and in research-to-practice strategies. Audiences need to be broadened from at-risk populations and service providers to include DOH and CBO implementation agents (for example, Learning from the Community: What Community-Based Organizations Say About Factors that Affect HIV Prevention Programs -pdf). Theoretical models that drive program development, implementation and evaluation do not reflect a unified conceptualization of behavior change.
After a number of posts about the need for more radical behavioral research in HIV prevention and to scale up demonstrably effective programs for HIV prevention, it was an honor and privilege to serve on the DHAP review team and to part of a very knowledgeable, dedicated and fun panel. Gaining insight into why programs achieve scale or not is not sufficient for change at any level of society. The Bringing HIV Prevention to Scale report also examined how the successful national efforts of Brazil, Senegal, Thailand and Uganda scaled up their national HIV prevention activities.
The report also highlights that truly comprehensive HIV prevention programs need to focus on (1) preventing sexual transmission, (2) preventing blood-bourne transmission (including through blood transfusions and sharing injection equipment), (3) preventing mother-to-child transmission, and (4) social strategies and supportive policies. Reading these reviews I have to ask if this problem of scale is really a call for better social marketing - creating and managing markets and resources more strategically? Then again, I guess we could be talking about marketing through social network sites and blogs?
About the image: This map shows the distribution of all people between ages of 15 and 49 with HIV. Scaling up programs that have been shown to be effective in promoting health and other social causes in pilot and demonstration projects or larger efficacy and effectiveness trials should be a major focus of social marketers. Though numerous examples abound to support this conclusion, I will focus on one: HIV prevention programs.
Despite the extraordinary potential of available prevention strategies, most people at risk of HIV infection have little or no access to basic prevention tools.
Among the factors the Working Group identifies as fueling the failure to scale HIV prevention efforts are:Inadequate Financing. Our challenge, whether it be in HIV prevention or the prevention of childhood obesity, it to apply the evidence-base of diffusion research through social marketing programs. In developing countries, social marketers have been trying to get more people to use condoms.
Since 2003, according to a PSI survey, young men and women in Kenya with multiple partners increased their use of condoms from 33 to 47 percent. Blog that publishes text and some graphics on topics related to social marketing and social change issues. The Better Care Fund has placed partnership working at the very heart of health and social care policy in England.
The reality of real money moving around the system has given the policy teeth, and given Health and Wellbeing Boards the tools to move beyond the talking shop phase of their existence. We have been working on the integration agenda with service users, health and social care practitioners and leaders, and community and voluntary services since 2009. All this enables you to construct your strategies and plans around the people you serve, co-designed by your greatest asset – your staff . The Tricordant ApproachOur approach has developed through gathering a body of transformation expertise in organisation design and development. The Tricord™The Tricord describes the aspects of an organisation that need to be aligned and in balance for the whole to be healthy. Person-Centred Health and Care PathwayIntegration of services is the Holy Grail for the NHS and Local Authorities where they have common service users and populations.We believe passionately that the single most important organising principle for integration is the individual citizen. The King's Fund calls for more innovation in public health approaches that have tended to focus only information and communication campaigns (the 5% solution) or just offering financial incentives. Social determinants of health are becoming a dominant way of thinking about public health issues and their solution. Today I want to make the case for social marketing becoming a core part of the public policy-making arsenal was the beginning of a speech Getting the balance right: the role of soft power and hard power in social change by Rt Hon Alan Milburn, MP, the former British Secretary of State for Health, at the World Social Marketing Conference in Brighton last week. The total weight of evidence - from multiple types of studies, conducted by investigators from different disciplines, and using data from many countries -  demonstrates a causal relationship between tobacco advertising and promotion and increased tobacco use. Targeting various population groups - including men, women, youth and young adults, specific racial and ethnic populations, religious groups, the working class, and gay and lesbian populations - has been strategically important to the tobacco industry.
Substantial evidence exists from the United States and several other countries that tobacco companies typically respond to partial advertising bans in ways that undermine the ban’s effectiveness. Corporate sponsorship of events and social causes represents a key public relations strategy for major tobacco companies, which spent more than $360 million on these efforts in 2003.
Corporate image campaigns by tobacco companies have highlighted their charitable work in the community and have promoted their youth smoking prevention programs; at times, corporate spending on these campaigns has vastly exceeded the amount actually given to the charities. Strong and consistent evidence from longitudinal studies indicates that exposure to cigarette advertising influences nonsmoking adolescents to initiate smoking and to move toward regular smoking.
The studies of tobacco advertising bans in various countries show that comprehensive bans reduce tobacco consumption. News coverage that supports tobacco control has been shown to set the agenda for further change at the community, state, and national levels.
Experimental studies show that images of cigarette smoking in film can influence adolescent and adult viewers’ beliefs about social norms for smoking, beliefs about the function and consequences of smoking, and their personal intentions to smoke.
The total weight of evidence from cross-sectional, longitudinal, and experimental studies, combined with the high theoretical plausibility from the perspective of social influences, indicates a causal relationship between exposure to movie smoking depictions and youth smoking initiation. Numerous studies have shown consistently that advertising carrying strong negative messages about health consequences performs better in affecting target audience appraisals and indicators of message processing (such as recall of the advertisement, thinking more about it, discussing it) compared with other forms of advertising, such as humorous or emotionally neutral advertisements. Population-based studies of antitobacco mass media campaigns that were only one component of multicomponent tobacco control programs provide considerable evidence for reduced use of tobacco by youth and adults. Increasing consumer awareness of tobacco industry activities to counteract public-health-sponsored campaigns designed to reduce tobacco use can be an important component of effective media interventions.
The tobacco industry consistently has used several primary themes to defeat state tobacco tax increase initiatives.
The point here is with a research base that is probably the most extensive with respect to the role of the media and a health behavior (well, with the exception of the portrayal of aggression on television and violent behaviors which we have known about since the early 1960s), you have to think about media in the broadest possible way – including new media, movies, news coverage, editorial pages and the public policies that govern them.
With the presidential nomination process claiming most of the news holes in the US, the authors of Greater Good: How Good Marketing Makes for Better Democracy are interviewed at the Harvard Business School Working Knowledge site.
Health promotion programs often lack a clearly specified theoretical foundation or are based on narrowly conceived conceptual models. The social-ecological model for health promotion focuses attention on both individual and social environmental factors as targets for health promotion interventions (McLeroy, 1988). While learning about the theories was repetitive, I felt like I learned a more useful way to apply them to interventions.
While I cannot predict what the final report might look like, or how CDC may choose to implement the recommendations of our panel and from the other four, hopefully you will find a new idea or inspiration in these recommendations to improve your ability to design public health change. Learning how programs successfully achieve scale (what some might call observational learning), imitating them (a form of flattery that many are loathe to practice unfortunately) and monitoring performance (through relevant program outputs and behavioral outcomes to feed back to planners what is working and what needs to be adapted to local circumstances) are the components of turning lessons learned into action (note I deliberately left out epidemiological endpoints. These countries have demonstrated that it is feasible to reduce the incidence and prevalence of HIV, slow down the rate of predicted increases in prevalence and keep HIV infection rates at low levels.
These authors also note that expanding access to key HIV prevention services including HIV counseling and testing, expanding condom distribution and use, and targeting of high risk and vulnerable groups - injection drug users, sex workers and men who have sex with men - are all necessary for scaled up programs to succeed. Or has the international health community gotten to the point where social marketing is being marginalized as a term reserved only for the promotion and distribution of subsidized commodities through commercial sector channels? I say 'should be' for while we talk about population-based or social change, the fact is that few evidence-based practices ever achieve the scale necessary to make their promise or vision reality for the thousands or millions of people who could benefit from them. The Global HIV Prevention Working Group has just released a report on the 'failure to scale' (my words, not theirs). Although necessary coverage levels vary depending on national circumstances, current coverage levels for essential prevention strategies are woefully inadequate for any national epidemic. Only 9% of risky sex acts worldwide are undertaken while using a condom, and the global supply of condoms is millions short of what is needed. In the most heavily affected countries of sub-Saharan Africa, only 12% of men and 10% of women know their HIV status.
It is estimated that fewer than 20% of people with a sexually transmitted infection are able to obtain treatment, even though untreated STIs increase the risk of HIV acquisition and transmission by several orders of magnitude. Years after clinical trials demonstrated that a brief, inexpensive antiretroviral regimen could reduce the risk of mother-to-child HIV transmission by 50% (5), only 11% of HIV-infected pregnant women in low- and middle-income countries receive antiretroviral prophylaxis. Prevention services reach only 9% of men who have sex with men, 8% of injection drug users, and under 20% of sex workers. An estimated 6 million units of unscreened blood are transfused yearly in developing countries, and 40% of injections administered in health care settings are unsafe. While financing for HIV has increased dramatically in recent years, available funding is only slightly more than half of amounts needed to support a comprehensive, scaled-up response. Several impediments stand in the way of doing so, not the least of which is the overwhelming (at least to me) lack of understanding among health professionals and policy makers of what this research offers health and social programs (other than fleeting references to The Tipping Point). But the United Nations Development Program says that breaks down to about 10 condoms a year for every man in Africa — and that is not enough.


Problem is that two of the four major networks (CBS and FOX) rejected the TV ads for not focusing on preventing diseases (which diseases do the ED drugs prevent again?).
So our approach is based on years of experience and has benefitted hugely from the insight and skill of stakeholders in the field.
We know how to engage them appropriately at different levels, including through large and small-scale, facilitated events. It is their experience of public services as integrated (or not) that really counts.Our pathway model is the basic building block to analyse and redesign the health and care system. We work across all types of organisation enabling people to work to their full potential, through the creation of whole work. This was, for me, the highlight of the meeting: a politician who clearly understood and spoke knowledgeably about social marketing and its implications within the broader social change context we are all working in. In most instances, the perception among public health advocates is that this impact is primarily negative (such as tobacco use, obesity, violence).
Key targets included sporting events, antihunger organizations, and arts and minority organizations. These campaigns have reduced perceptions among adolescents and adults that tobacco companies are dishonest and culpable for adolescent smoking, and among adults, have increased perceptions of responsible marketing practices and favorable ratings for the individual companies. Noncomprehensive restrictions generally induce an increase in expenditures for advertising in “nonbanned” media and for other marketing activities, which offset the effect of the partial ban so that any net change in consumption is minimal or undetectable. Despite this, organized media advocacy efforts on behalf of tobacco control issues remain an underutilized area of activity within public health. Some of these negative advertisements also portray deception on the part of the tobacco industry.
The antitobacco mass media campaign and the other program components together may have reduced smoking more than did any single component alone.
These include suggestions that the measures would impose unfair taxes and that tax revenues would not be spent on health care or tobacco control programs as intended. It was timed to coincide with the CDC Leaders-to-Leaders conference that I was attending [webcasts of the event are available here].The Healthiest Nation Alliance aspires to help create an America where an integrated national system values health, prioritizes prevention, and protects from emerging threats. I'll note here that the original document concerns ALL public services and not just health, though these are the focus of what I extracted.
For example, lifestyle modification programs typically emphasize individually focused behavior change strategies, while neglecting the environmental underpinnings of health and illness. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors (McLeroy, 1988).
This is, what the student above referred to, as theory from the 1950s (well, not quite that long ago, but you get the idea). The total DHAP budget in FY2009 was $853 million, of which $28 million (that’s 3.2%!) was for behavioral intervention research. The second is that very few social marketers seem to know how to transform programs focused on individual behavior change to ones scaled for population impact.
Rather than comment on what he said, with the permission of the conference organizers who kindly sent me his text, you can read excerpts I selected (and have added emphasis to in some places) on his vision for the potential role of social marketing in the new politics of empowerment, conversation, social capacity building and engagement:From its beginnings in government public information campaigns and through its development since the 1970s into a formal discipline, social marketing is today a life-changing movement.
In a few other cases, the media framing of a health problem is less contentious; what is debated is how to harness the media for improving public health.
These efforts have been used, in certain cases, to influence opinion leaders who benefit from such sponsorship.
Advertisements for smoking cessation products and tobacco-industry sponsored smoking prevention advertising have been shown to elicit significantly poorer target audience appraisals than do advertisements based on negative health consequences.
The relative contributions of various components to program effectiveness are difficult to determine, but some of the controlled field experiments showed a dose-response relationship between reduced smoking and an increased number of program components. Secondary themes used consistently over an 18-year time span include that the measures would increase “big government” and wasteful spending, discriminate against smokers, and increase crime and smuggling.
I am particularly pleased to see that research in this area is also finding that it is the exposures to multiple channels, rather than the magic bullet, that is most likely to lead to behavior change.
Even though a number of possible explanations for these disparities have been identified, two key social determinants, race and ethnicity and socioeconomic position (SEP), have stood out, and have influence that spans the disease prevention and health promotion continuum. The Alliance exists to provide leadership and foster actions by organizations and individuals that encourage or sustain health.Panel presentations and group breakouts covered the usual territory when it comes to health promotion and disease promotion gaggles. The promises of social marketing and applications of new media are not restricted to just health issues! However, there are many individual, social, and environmental factors that can either contribute or detract someone from adopting a healthier lifestyle. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes (McLeroy, 1988).
It is the canon for behavior change academics, one that must (?) be passed down to the graduate students of today for it’s historical importance – although, unfortunately, most of those instructors I expect still believe it to be operational.
It proved to be a daunting task, especially since the last full programmatic review was in 1993.
What impressed me (and others on the panel) was how this limited budget was spent on mimicking a drug R&D process of uncovering the most effective elements of HIV prevention programs, testing them, packaging them and then promoting their availability to the community.
In part due to the weakness of HIV information systems, many countries do not target limited funds where they would have the greatest impact. Even fewer researchers and their funders seem to get that developing and testing programs meant to achieve scale need to be designed that way to begin with and not focused on reductionistic minutiae that - again - focuses on individuals, not people. We have used our unique concept of Significant Events with service users and professionals to co-design a lean and simple person-centred pathway that captures the key points where professional support or intervention may be required. It is essential that governments, civil society, WHO, and other global organizations now come together in taking action to improve the lives of the world’s citizens.
Here in the UK the National Social Marketing Centre has become a repository of good practice and real support to those leading a legion of local efforts to reduce teenage pregnancy rates, tackle alcohol abuse and support sustainable living. In the past year, I have heard repeatedly from international HIV prevention experts that what we need to do is launch the same type of media campaigns to change social norms that the tobacco control community has done. Other, less frequent themes were that the measures would be a tax cut for the rich, impede economic growth, fail to solve state budget problems, restrict personal choice, and violate antitrust laws.
However, the specific mechanisms and processes that connect these social determinants to individual and population health remain unclear. What was clear throughout the discussions was a shared commitment by most participants to a social determinants model to frame the issue - a model that social marketers who adhere to the individual behavior change paradigm may find perplexing in its focus on upstream determinants.
There was limited attention to what one panel member referred to as ‘the science of the street’ or learning from what is working in communities.
Misallocation of limited resources by donors and affected countries also often occurs as a result of ideological, non-scientific restrictions imposed by donors on how HIV prevention assistance may be used.Capacity Limitations. And finally, as the Working Group makes clear, and as an old saying goes (thanks to Thomas Friedman): A vision without resources is just an hallucination.
The six stages start with the equilibrium of stable health, moving through to end of life care.
Achieving health equity within a generation is achievable, it is the right thing to do, and now is the right time to do it.At a 2008 meeting convened by the Prevention Institute and Trust for America’s Health, a group of government officials, community advocates, and researchers discussed the US government’s role in addressing underlying determinants of health. Led by the Department of Health, the UK Government has recognised the potency of social marketing in bringing about desirable changes in society. Unfortunately, this call is then followed by a riff on the need for ‘hard-hitting, fear-arousal’-types of efforts. We propose that the connection between social determinants and disparities in health outcomes might be traced to disparities in information and communications, and that communications is a central thread that could link social determinants of class and race to health disparities. When I have done research into what theories people use in public health programs, practitioners can describe (maybe) one or two, and academics describe their own (developing your own theory must be a prerequisite for tenure now). However, among the practitioners I have worked with, they find it a very useful and comprehensible road map for thinking about a variety of public health problems. Indeed, these activities were labeled ‘homegrown’ solutions and had little weight or prominence in the Diffusion of Effective Behavioral Interventions (DEBI) model. Due to inadequate human capacity, countries often have difficulty programming substantial infusions of new funding.Service Fragmentation.
What is unfortunate is that these experts do not appreciate the multiplicity of media efforts that have gone into developing tobacco control media activities – they have not simply been emotional television ads.The National Cancer Institute has published the monograph The role of the media in preventing and reducing tobacco use (media release).
Communication inequalities are differences among social groups in accessing, seeking, processing and using health information. Seems like we are asking a lot or organizations and people to invest time and resources in overlapping efforts. That some authors want to impose a single theory on social marketers borders on malpractice.People in the advertising and public relations worlds who work on social marketing projects don’t even know what a theory is – unless they have been in the game for a while. The integrative theory incorporates elements of 3 widely used theories in behavior change and communication interventions: the health belief model, social cognitive theory and theory of reasoned action. The panel concurred that focusing such a small budget on the full spectrum of R&D activities was not practical or effective.
HIV prevention has frequently not been integrated into schools, workplaces, and other institutions, and HIV efforts are insufficiently linked with other health-related service systems, such as TB or sexual and reproductive health.Stigma and Discrimination.
Resources in both health and social care are increasingly being targeted at stage 0, but rarely in a coordinated way. Establish high-level leadership in the federal departments and at the White House to serve as a focal point for prevention strategy and to ensure collaboration between government agencies to enhance underlying determinants of health.2.
It should be required reading for anyone using, or considering using, the mass media in any of its forms to address public health issues from obesity to mental illness to climate change. Communication inequalities may act as a significant deterrent to obtaining and processing information, in using the information to make prevention, treatment and survivorship-related decisions, and in establishing relationships with providers - all of which impact prevention and treatment outcomes. They want you to believe that their past ‘experiences’ give them a better feel for what will work with an audience than any textbook.


In this model, whether a specific behavior is performed depends upon (1) if one intends to engage in that behavior - which you can see depends on a whole lot of things, (2) if they have the requisite skills and abilities to perform the behavior, and (3) if there are no environmental constraints (broadly defined) to performing the behavior. Rather, we suggested more of the CDC behavioral research endeavor should focus on the improving the science at the ends of the spectrum – innovation (often gleaned from communities) and dissemination (how to achieve scale for effective programs). The stigma associated with HIV and with membership in a vulnerable group deters many at-risk people from seeking HIV prevention services or learning their HIV status and also discourages the kind of political leadership required to implement a robust and evidence-based HIV prevention effort. Engage key federal sectors and agencies that shape the conditions that determine health in collaborative efforts.3.
The monograph is a collection of chapters reviewing the empirical evidence on the role of mass media on tobacco use including industry marketing and promotion practices (often the playbook for other industries), tobacco portrayal in news and entertainment media, tobacco control media interventions, and the use of the media by the industry to weaken tobacco control efforts (pay attention to this one too). Communication inequalities are a disturbing, yet potentially modifiable, counterpart to health disparities and, may have a profound and invidious impact on health outcomes. What they often fail to intuit is that these ‘experiences’ form their own naive or folk psychological theories. We threw around phrases such as ‘community-driven research’ and ‘community-to-science’ to reinforce our point.
Here’s a sampling of some of the conclusions, pulled from the Executive Summary (pdf file), to start your thinking (my emphasis is added).
We have articulated a framework, The Structural influence Model (SIM) of Health Communication, that identifies how communication inequalities may influence health disparities.
Among the constraints identified in the audience research are the few facilities available in rural counties, busy clinic staff that makes local outreach and promotion efforts difficult, making time in their busy schedules for setting clinic appointments, and difficulties using the centralized referral service.Second, we need to assess if the person has the necessary skills to access and effectively use family planning methods over time. We asked: How about establishing an Innovations Lab for behavioral change research for HIV prevention to respond to emerging needs through formative research and Phase 1 studies and leave Phase 2 and 3 work to other agencies (NIH, HRSA, SAMHSA) to fund?
Implement a system of accountability that establishes clear responsibilities and incentives for contributing to improved population health.5. The key in reading this list, and the monograph, is to make the inference to your own issue and the players and practice that you face. Our model posits that disparities in health outcomes at least in part be explained by understanding how (a) social determinants (e.g.
About several dozen to several thousand research studies validating them (and some will still argue ‘what do the researchers know! Establish a data and evaluation system to monitor progress and focus public attention on the importance of determinants of health.6. I write this remembering a nutrition professional who after listening to me talk about tobacco advertising and promotion practices and their influence on tobacco use raised her hand and innocently asked: could the food industry do the same thing to encourage excessive consumption, and therefore obesity? Among the determinants of these intentions we found that conservative community values can play an important role in reducing conversations and public education activities around family planning.
Looking at the CDC as an institution, we were also asking ourselves quite often: What are the rewards and incentives for staff who conduct innovative behavioral research and dissemination of practices?
Establish a strong system of training and skill building for staff at all levels of government to engage in determinants of health work.7.
We did not hear much about women believing they were not susceptible to becoming pregnant (though other research informs us that this is the most common reason from women to discontinue using contraceptives).
But before we all get carried away it’s important to recognise the limitations as well as the opportunities inherent in what Robert Cialdini calls “the new science of persuasion”.
There was also evidence that women do talk with each other about birth control, though no common times or places were discovered that might guide communication strategy. The point is that social determinants are rapidly becoming the lingua franca for the new public health (maybe 30 years later than originally envisioned, but OK).Shifting the perspective of public health policy-makers, researchers and practitioners will be one set of challenges. Now some people will ask ‘what about…?’ And if you think that’s an important variable to consider, first make sure your audience does too.
An equally important group of questions will focus on how to communicate about social determinants with the public in ways that make it relevant to them and offer opportunities to improve their own health. While I am not going to defend this particular theory as all-encompassing (that is why there will be a second installment to this topic), what you can take away from this is: the theory you use helps you to focus in thinking about the issue, asking relevant questions of your audience and forming program strategies that are both theoretically- and research-driven. After decades of public health messages that have focused on individual knowledge, attitudes and behaviors, this will be no easy task. That is what made this study on message design strategies to raise public awareness of social determinants of health interesting for me. FINDINGS: Although few studies have directly tested message strategies for raising awareness of SDH and health disparities, the accumulated evidence from other domains suggests that population health advocates should frame messages to acknowledge a role for individual decisions about behavior but emphasize SDH. This is where I believe those on the Right of politics are making such a fundamental strategic error. These messages might use narratives to provide examples of individuals facing structural barriers (unsafe working conditions, neighborhood safety concerns, lack of civic opportunities) in efforts to avoid poverty, unemployment, racial discrimination, and other social determinants. By rejecting the role of the State they have drawn the wrong conclusion from the modern world.
Evocative visual images that invite generalizations, suggest causal interpretations, highlight contrasts, and create analogies could accompany these narratives. To meet today’s policy challenges requires a new balance between what I will call soft power and hard power. Improving health, beating crime, regenerating communities cannot happen if society has to choose between either having an active state or having active citizens. So I will make the case for a politics of change that has at its core the empowerment of individual citizens and their local communities. During my time as health secretary I championed an expert patients programme to give people, mostly those with chronic conditions, the tools to better manage their own care.
By putting the individual patient in charge of managing their conditions - the food they ate, the exercise they took, the medicine they used - the programme succeeded in reducing physiotherapy visits by 9%, hospital outpatient visits by 10% and accident and emergency visits by 16%. And as we seek to increase the proportion of spending on public health from a miserly 5% across the developed world - by focusing on preventing not just treating illness as I believe we should - the way to do that is not by preaching at people but by empowering them.
Giving people, through our unrivalled UK primary care network of pharmacies, GP surgeries and community services, the practical help they need - blood pressure monitors, testing kits, food co-ops - to improve their own health. To do that we need to convert patients from being passive recipients of care in a system that denies them both power and responsibility to being in charge and more responsible for their own health.
That will require a new focus on providing accessible information and proper support to empower individual citizens.
And, given that different people have different starting points, it will require a national drive to grow social capacity so that across all communities, and not just some, people can make the choices that are right for them. It is here that your expertise and insight about what drives change is so sorely needed……when it comes to social change it is surely inconceivable that poverty or disadvantage can be overcome without the State or politics playing its part. So it is no more acceptable for today’s Conservatives to blame poor people for failing to live healthier lives and urging them to get on their exercise bikes than it was for a previous generation of Conservatives to blame people for being out of work and urging them to get on their push bikes.
There is a danger of a new naivete: that the science of persuasion can replace the art of public policy-making when it comes to tackling what are deep and complex social problems. Over many years campaigns that exhorted people to stop smoking and warnings about the consequences of doing so undoubtedly helped many smokers quit. And in the process these social marketing techniques helped create a permissive climate for political action. In turn that political action, in the form of tax rises on tobacco and smoking cessation on the NHS, helped shift the climate of public opinion still further in favour of tougher action culminating in a legal ban on smoking in public places.
The smoking ban could not be nudged into existence: State action had to bring it into existence…The challenges of the modern world call for the State to play its part but also to know its place. It is only the State that can equalise opportunities throughout life and empower its citizens.
Equally only citizens can seize those opportunities and realise their own aspirations to progress. So just as the Right is wrong to reject the State’s role, the Left must avoid the trap of countering an argument about less state by making a case for more State. In foreign policy circles the contemporary debate following the West’s interventions in Iraq and Afghanistan is about the necessary balance between hard power and soft power. Hard power is expressed through military force and economic sanction; soft power through careful diplomacy and economic or cultural engagement. Some argue a preponderance of one approach to the other, but the lesson of history is surely that a mix of both approaches is necessary. In the Cold War mutual assured nuclear destruction and NATO may have provided deterrence and safety, but the fall of the Berlin Wall owed at least as much to the attractions of a dynamic mixed economy, blue jeans, the Beatles, the Voice of America and the BBC World Service.Similarly I think the concepts of soft and hard power can be used to delineate the various instruments that are needed to bring about desirable behaviour and social change in a complex modern society. By “hard power” I mean the use of laws, regulations and formal incentives to reinforce social norms.
By “soft power”, I mean the array of community engagement and social marketing tools that you are so versed in. In my view getting the right balance between soft and hard power is the key to unlocking social progress and opening the way to a modern relationship between state and citizen. I welcome the fact that the National Social Marketing Centre is taking a leading role in this debate through its own reviews and the growing recognition within the social marketing profession of the need to achieve the right balance.
So that those officials engaged in community regeneration, for example, would have their focus as much on hearts and minds as bricks and mortar…In 1945 the new idea was for power to be vested in the central state and its policy expression was nationalisation. In 1979 the new idea was for power to be vested in the free market and its policy expression was privatisation. In 1997 the new idea was for power to be vested in reformed institutions and its policy expression was modernisation.




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