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Technical Paper 1:
Obesity in Australia: a need for urgent action

4.5.1 - Social marketing

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An effective and coordinated long-term public education campaign is needed to increase physical activity levels and improve eating habits. The campaign should include evidence-based media advertising and targeted education for priority population groups. National campaign messages and resources should be integrated with advice on healthy weight, healthy eating and physical activity within the community setting, in order to establish healthy social norms.

The best evidence on the effectiveness of mass media campaigns, such as that derived from tobacco control, indicates that long-term, well-funded, sustained, hard-hitting campaigns are necessary to achieve behaviour change. For example, a recent study found a significant reduction in smoking prevalence associated with a televised antismoking advertising campaign.[91]

It should be noted that, unlike campaigns to stimulate smoking cessation behaviour that are implemented in an environment in which tobacco advertising had been banned, healthy eating campaigns will need to compete and achieve cut-through (i.e. awareness and exposure) in an environment that is dominated by food advertising.

Considered in a social marketing framework, advertising for energy-dense, nutrient-poor products generally promotes behaviours that compete with public health recommendations and services, and strengthens potentially negative or challenging behaviours.[92, 93] The advertising supports behaviours that are typically more appealing to the target audience than the behaviour that is the focus of the intervention (in this case, increased intake of fresh fruit and vegetables, and decreased consumption of unhealthy food options).

Potential competing factors therefore need to be considered in the development of interventions, and sustained strategies to recognise and remove or minimise the potential impact of such competition must be incorporated into the program design.[94, 95]

The effectiveness of social marketing in improving health behaviours

There is increasing evidence that social marketing can substantially enhance the impact and effectiveness of public health and health promotion interventions.[92-94, 160, 161] A study examining 17 European health campaigns concluded that the campaign effects, while small, were positive.[92] A meta-analysis examining 48 health promotion campaigns in the US estimated there was an average 9% level of behaviour change associated with the campaigns.[96] Even small estimates of behavioural change associated with health programs can translate into significant impacts at the population level.[92] It is important to note that funding for these health campaigns was very limited and this probably explains the limited campaign outcomes.

A recent report on a series of three systematic reviews selected only interventions that applied six key social marketing features in their design.[95] All interventions were aimed at improving healthy eating behaviour, increasing physical activity or targeting substance abuse. The review concluded that social marketing interventions can be effective in these three areas: in nutrition and substance use the evidence was reasonably strong, while in physical activity the results were more mixed. In addition, the interventions were successful among different target groups and in diverse settings, from family- and community-based settings to clinical practice and the workplace.
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Evidence from other health-related campaigns indicates that appropriately targeted investment in social marketing can provide health and economic gains; compelling evidence is available from areas including tobacco control, drink-driving/road safety, immunisation, sun protection and HIV/AIDS, as well as the commercial sector.[162-165] Lessons from these areas are transferable to obesity management and prevention.

Tailoring key campaign messages and interventions to specific target audiences will enhance campaign effectiveness.[92-95, 160] Key elements of social marketing include:

• Identifying the target audience and tailoring interventions and key messages accordingly
• Using market research to identify and segment target audiences, to develop effective messages (including comprehensive pilot-testing) and determine dissemination channels.

The need for a campaign in Australia

Social marketing campaigns involving public education and the engagement of healthcare professionals can help to raise community awareness about relatively fundamental issues, such as what constitutes healthy weight for adults and for children, as well as providing information and resources about healthy eating and activity. This is important in addressing misperceptions about healthy levels of weight in the Australian population. For example, with the increasing prevalence of overweight and obesity nationwide, it appears that Australians may perceive being overweight as ‘normal’ and hence many overweight people may not consider that they have a problem. Only around one-third of Australian adults in the 2004–2005 National Health Survey considered themselves to be overweight (32% of males and 37% of females).[45]

This was substantially lower than the actual rates based on BMI calculated from self-reported height and weight: 62% of males and 45% of females in the survey were classified as overweight or obese. Trends also suggest that this is becoming increasingly likely: the proportion of overweight or obese Australians who perceived themselves as having an acceptable weight increased from 37% in 1995 to 41% in 2001 and 44% in 2004–2005.[5]

International initiatives

Initiatives can be simple and cost-effective. For example, French schemes to tackle obesity have included posters suggesting that metro train passengers use stairs instead of escalators, and advisories prominently displayed on advertisements for fast foods telling people to eat at least five fruits and vegetables a day.[62]

The UK ‘Healthy Weight, Healthy Lives’ strategy seeks to reverse the increasing rates of obesity and overweight in the population through ‘enabling everyone to achieve and maintain a healthy weight’.[40] This is reflected in the strategy’s approach to a social marketing campaign that aims to ‘recruit’ people to change the lives of themselves, their children and their families. It is based on research that indicated that people want help to live healthier lives and want to be broadly supported to do this, including by government and commercial organisations.
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The social marketing aim is therefore ‘to act as a catalyst for a societal shift in English lifestyles, helping bring about fundamental changes in those behaviours that lead to people becoming overweight and obese’. Rather than merely telling people what to do through an education campaign, the strategy aims to motivate them to participate in a supportive social movement designed to make lives healthier. The aim is to engage stakeholders from the public and commercial sectors, and create a practical healthy living campaign driven by ordinary people.[40]

Several international models of community engagement are using large-scale sporting events in specific cities to create a focus for improving community health. In Canada, the province of British Columbia is hosting the 2010 Olympic and Paralympic Winter Games and is using the preparation in promoting their aim to be the healthiest region ever to host these events. Similarly, in the UK, the upcoming 2012 Olympic Games and Paralympic Games in London are being used as an opportunity (via the national strategy to tackle obesity) to develop a range of physical activity initiatives inspiring people to be more active in the 
lead-up to the games and beyond.[35]

Develop effective, adequately funded and long term media advertising and public education campaigns to improve eating habits and levels of physical activity, with specific media advertising and targeted public education for priority population groups.

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