“Should we start a hashtag?” Eight tests for a local public heath campaign
This is my my favourite new image from Sport England’s This Girl Can campaign. The entire campaign is superb. It breaks down negative stereotypes about femininity and exercise, promotes positive practical ways for women to be involved physical activity and gives a platform to the women who are rarely featured in gleaming gym ads or the Instagram stories of fitness brands.
But what if you don’t have £10 million to build a campaign? What if you’re a local authority, a NHS trust or a local charity that has identified a local health issue and are wondering whether some carefully crafted local messages and branding could go some way to making things better?
The public certainly sees well-executed public health campaigns as an important part of improving health — they are almost exclusively thinking of campaigns aimed at changing individual behaviour. Public health experts, however, hold mixed views as to the effectiveness of population-wide and targeted health promotion campaigns. It’s also worth looking at Public Health England’s three-year approach to social marketing.
My perspective is that it is possible to do an effective, equity-promoting, health creating campaign, but it’s much harder and more complex than I used to think. Having been involved in a few local campaigns in public health and other sectors, including some really well-thought through ones created by the great team in Hertfordshire, I’ve been reflecting on how to sift through:
· campaign ideas that could go on to improve health equitably
· campaign ideas that should take another form
· campaign ideas which should remain on the flipchart paper of their conception.
I’ve refined my thoughts down to eight tests. I’m not a communications professional or academic so very much appreciate any thoughts, additions or critiques of these ideas. Another disclaimer — as a nation we need to address the structural and societal causes of ill health, and tackling these will have a far greater impact on health than the slickest, most health equity-informed campaign Saatchi & Saatchi and Michael Marmot could produce together (just imagine!). Nevertheless, structural levers of power are not always available locally and whilst we need to keep advocating for change, campaigns can sometimes be useful tools.
Behind these eight tests are two principles:
· Public health communications campaigns from scratch are never free. Even if an in-house communications team produces the all materials and free channels are used to get the message out, it will take substantial paid time to design, prototype, project manage, iterate, monitor and evaluate a campaign. This ratchets up opportunity cost; there will have been a thousand different things the people working on the campaign could have put their time and skills towards instead.
· Public health communications campaigns can be harmful. If your campaign creates a sense of helplessness and shame, if it reinforces negative stereotypes or, perhaps less of an issue in 2019, it promotes cigarettes as a balm for asthma, wellbeing can suffer as a result.
So here are eight tests for whether to run a local public health campaign. They assume we’ve done the campaign basics right; defining and understanding the issue at hand and setting clear objectives.
- It will reduce health inequities.
If our call to action requires individuals to use significant cognitive effort, cost or time, we’ll only reach those who are already in a good position to maximise their health, and the health gap may grow. For example, if for a workplace wellbeing initiative, our campaign focuses on preparing healthy lunches at home, who in our area would have the financial, educational and social resources to follow this advice? Probably not those in the worst health.
2. No other publicly available campaign exists to meet our objectives.
I noticed whilst working alongside the police service that across the country nearly every force designed their own generic anti-burglary campaigns and generic drink-driving campaigns, replete with their own straplines and logos. Services also refreshed their campaigns every two or three years. Branding relies on establishing consistency, familiarity and repetition — there’s a reason Coca-Cola UK doesn’t sub-divide its soft drinks into 40 geographically-based brands, even if its ads use sophisticated targeting for different demographics.
So, if our message is already targeted and delivered well by Public Health England, the Samaritans or another local organisation (even if it’s our neighbouring authority, trust or charity working in our area), let’s ask for permission to use it and tailor it to our local audiences. This is a big test that I think would screen out at least 75% of campaigns.
3.We want something tangible to change.
The case is often made for “awareness-raising” campaigns. It is hard to see how this can ever be the central campaign goal in itself; if more people become aware locally that 84 men week take their own lives but nothing else changes, how can this be classified as a success? Every one of our campaigns should include goals where something actually happens. We can debate whether that should include behaviour change, policy change, health outcome change or community change — but it must be more than awareness.
4. You have the resources to do proper user engagement and prototyping of your ideas with end users.
This is vital. Otherwise, we end up with a campaign that is designed by public/third sector professionals, for public/third sector professionals featuring a broken website. Showing our posters to the team across the office doesn’t count. Taking a further step and empowering communities to design and lead their own campaigns is even better. If we don’t have the time to do UX, it’s probably best to work on something else.
5. Local partners are excited about this idea and feel they have ownership. Building on test 4, each local organisation and community group can only reach specific subsets of the local community. It’s not enough to pop a couple of JPEGs across to partners the day before the launch; we should be working openly with both communities and other partners from as early as possible in the process.
6. What’s marketed is of sufficient quality.
Drawing on Wilson-Junger’s screening criteria, we should be fairly confident that what we lead people towards works well and has capacity to meet demand. For example, if we want to launch a public campaign on the value of green space to mental health, but most of our local parks are overgrown and inaccessible, we’re probably going to be doing more harm than good when people realise they can’t get the benefits of green space that others in the country are.
7.It’s accessible to people from different backgrounds, including those with disabilities.
Sometimes a public health campaign will focus on a particular group of people, which is perfectly legitimate. However, we should always make sure, using the best UX accessibility techniques available to us, that our messages and imagery are accessible to the whole population.
8. Evaluation is planned from the beginning
The concept of public health evaluation is in a state of flux. Traditional linear forms of evaluation are being challenged by researchers like Harry Rutter and his colleagues, who advocate a complex systems form of evaluation. Whichever way we decide to approach our evaluation, it needs to form part of our campaign design from the very beginning.
There are many other things to consider — what would make your list? Or would you do away with public health campaigns entirely?
