Creative Methods in Disseminating Global Health Ideas

EXECUTIVE SUMMARY

The diffusion of health promotion and health ideas is as great a challenge as it is a necessity. It calls for a number of effective social marketing strategies as well as the incorporation of new communication tactics. The use of entertainment-education has been made a staple of social marketing and the dissemination of ideas but it requires constant updating to remain marketable to the public. The formation of new alliances and the adoption of new marketing strategies are also needed to keep pace in an ever-evolving world economy. This paper will seek to update current strategies in education-entertainment as well as provide reasons for the health sector to adopt new tactics and form partnerships with the private sector as a means to synergize the promotion of global health ideas.

BACKGROUND

Every new medium of entertainment inadvertently provides a potential new conduit for learning. Commercial interests often spearhead the greatest of technological advances, but these progresses can be utilized for far more than the for-profit sector. Lord John Reith, BBC’s first Director-General, wrote in 1924 “I think it will be admitted by all that to have exploited so great a scientific invention [broadcast radio] for the purpose and pursuit of entertainment alone would have been a prostitution of its power and an insult to the character and intelligence of the people.” (http://www.bbc.co.uk/heritage/story). The British Broadcasting Corporation (BBC) formed the objective to “inform, educate, and entertain” and did so with such radio productions as The Archers and later with television programs such as BBC Nature and BBC Knowledge. The predecessor to the BBC’s groundbreaking radio serial The Archers was The Australian Broadcasting Corporation’s (ABC) The Lawsons which pioneered the use the radio to educate its audience. These radio programs with an agenda that transcended the mere intention to just entertain were trailblazers for a new genre of communication broadcasting, the genre of entertainment-education.

As radio broadcasts filled the homes of millions in the middle of the twentieth-century, movie houses packed in crowds featuring movies, news, and animated shorts. The Walt Disney Company revolutionized the film and entertainment industry with their innovation of cartoon studio productions. Walt Disney used the medium of cartoons during World War II as a vehicle to promote pro-Ally and citizen support propaganda, and created an innovative forum to teach technical operations. With such productions as Donald’s Decision, The Winged Scourge, and Four Methods of Flush Riveting, Walt Disney utilized his media resources to influence audience behavior through social marketing and social merchandizing. The purpose of social marketing and social merchandizing is to sell not products but acceptance and awareness of social and health issues (Singhal et al, 2004). The ideas are presented in a commercial broadcast form such as by intercalating health ideas into television and movie plots and through endorsements by celebrity personalities.

The use of celebrity identification is crucial in promoting health ideas. Celebrities are powerful spokesmen that can increase consumer awareness and generate approving feelings towards the products they endorse (Singhal et al, 2004). But these celebrities can be equally as effective promoting social change and health ideas as they are in promoting goods and services. Celebrities may influence social attitudes and awareness through media advocacy. We see this with comedian Jerry Lewis’ advocacy for Muscular Dystrophy in yearly telethons, actor Christopher Reeves sponsorship of stem-cell research in press conferences and fundraisers, and Sally Struthers’ promotion of aid for child malnutrition in frequently ran television commercials. Sometimes the ill fate of a celebrity serves to raise awareness of health issues. When NBA draft pick Len Bias died by an accidental overdose of cocaine, youth use of the drug reportedly dropped off 75 percent over the next several years (http://www.npr.org/templates/story/story.php?storyId=9332383). A lot of times celebrities choose to take on a philanthropic role in promoting a health cause for personal reasons. Athlete Earvin “Magic” Johnson heavily promoted HIV/AIDS prevention as soon as he learned he acquired the disease (http://www.npr.org/templates/story/story.php?storyId=9332383), likewise actor Michael J. Fox became a spokesperson for Parkinson’s disease after coming out to the press that he had been fighting the disease for years. Even fictional characters often function as role models that can greatly influence public behavior. When an episode of Happy Days aired, actor Henry Wrinkler’s popular character Fonzi decides to get a library card. Libraries reported the next several days after that episode aired, they were flooded with requests for library cards by kids and teens that had watched the show and were influenced to follow in the footsteps of the Fonz (Brown, 1992).

The influence of the entertainment market is an allusive power that can be harnessed by the health industry just as well as it can be used by the for-profit sector. It just takes some imagination to do so.

CURRENT METHODOLOGY

The sophistication of media outlets has brought about new ways in which health ideas are delivered. In a day and age where consumers are over-saturated with information, goods and service companies and health professions alike have to find novel ways to capture the attention of the global audience. But sometimes the most state-of-the-art technology is not needed to reach a modern audience.

The Wonders of Radio

In 1996, a radio program entitled Tinka Tinka Sukh (Happiness Lies in Small Things) first aired on All India Radio (AIR). The program was in a soap opera format that advocated such causes as the elimination of dowries, family planning/population size, and opposition to child marriages. In December of 1996, an AIR station in New Delhi received a poster-sized letter signed by 184 villagers of Lutsaan. Amongst other comments it stated, “Listening to Tinka Tinka Sukh has benefited all listeners of our village, especially the women…Listeners of our village now actively oppose the practice of dowry-they neither give nor receive dowry.” The practice of dowry giving had become a health issue do to the social implications it involved. In the most extreme of cases, brides whose families had given inadequate payment were burned to death in a kitchen accident called a dowry death (Singhal et al, 1999). With such injurious traditions being practiced, the radio program sought to promote the elimination of these activities and with such a response by a faithful audience, was successful in doing so. Though radio in western culture is no longer the most popular format for receiving information and entertainment and is often seen as antiquated, it is a very appropriate medium to help shape social behavior in underdeveloped nations.

Television and Movies

Just as radio, television has provided the health industry a vast and powerful medium to diffuse public health ideas. A survey conducted by Porter Novelli HealthStyles in 2001 found over half of regular drama viewers reported they learned something about a disease and disease prevention from a television show, and one-third acted upon hearing about a health issue (http://www.learcenter.org/html/projects/?cm=hhs). Cable and satellite providers currently offer literally hundreds of channels for the consumer audience’s pleasure. With such a bevy of programming, health promoters have access to every type of target audience imaginable. Programs need only to be tailored to a respective audience to maximize the exposure of the intended message. Popular episodic television such as the medical drama E.R. and dramedy serial Sex and the City are often used to support some sort of health promotion message.

Such organizations as theUSCAnnenbergNormanLearCenteraid the entertainment industry in providing a health education message to their audience. Their Hollywood, Health, and Society (HH&S) project provides topical health ideas to entertainment writers and studios through tipsheets created with the Center for Disease Control (CDC) and the National Cancer Institute (NCI) and through a quarterly newsletter with health updates called “Real to Reel” (http://www.learcenter.org/html/projects/?cm=hhs). By facilitating the process of incorporating health ideas into mainstream television and movie markets, we enhance the exposure of such ideas. It is also a highly cost-effective method to social marketing. Instead of producing something that is marketable and costly, the health message can be “piggybacked” on an established television production with an already established viewer following.

Once again celebrity identification plays a substantial role in winning over audience acceptance of the health message in the television and movie market.

Perhaps the greatest modern testament to the power of celebrity identification can be seen with the influence held by talk show host Oprah Winfry. As stated by conservative pundit Bill O’ Reilly “I mean this is a woman that came from nothing to rise up to be the most powerful woman, I think, in the world. I think Oprah Winfrey is the most powerful woman in the world, not just inAmerica. That’s — anybody who goes on her program immediately benefits through the roof. I mean, she has a loyal following; she has credibility; she has talent; and she’s done it on her own to become fabulously wealthy and fabulously powerful.” Oprah has a rare ability to mobilize communities and disseminate information that produces almost instantaneous results in the American pubic. An episode of her talk show on the dangers of beef during the 1996 mad cow disease epidemic allegedly plummeted cattle prices and purportedly cost the beef industry $12 million (http://www.cnn.com/US/9801/ 21/oprah.beef). With such presence in the world psyche, celebrities like Oprah are essential powerhouses of influence to disseminate health ideas worldwide.

Print Media

Beyond video production, simple print media is also highly effective in diffusing health messages. The Starlight Starbright Children’s Foundation collaborated with Marvel Entertainment to produce an X-men comic book for teens and pre-teens recovering from burn injuries. The comic book entitled X-Men in: Life Lessons features a teenage superhero named T-Ray who suffers from burn injuries and saves the day by learning to overcome the adversity of his disfiguring wounds. The comic book seeks to teach kids social reintegration skills and coping strategies (http://www.starlight.org/site/c.fuLQK6MMIpG/b.1090075/k.702C/The_XMen_in_Life_Lessons.htm). Such print media is very affordable and with such globally recognized characters as Marvel superheroes, the comic book can easily be localized to cater to global markets by translating the text and adjusting to target culture. This medium is also useful when attempting to reach a target audience with a low literacy rate. Comic stripes that use very simple text and that act out the message can reach a larger audience especially in underdeveloped countries.

Digital Media

Like print media, digital media has proven to be an effective means in disseminating health messages. The Internet is a tool that has undoubtedly contributed to the spread of health ideas worldwide. Due to this innovation, information can be available all day, every day. Static web pages provide laymen and health professionals alike with up to date information that is only a few keystrokes away. Academic libraries share information, allowing individuals to access a breadth of information that would otherwise be inaccessible. Such sites as WebMD.com provide comprehensive health information to the general public. Forums and blogs allow patients and their families to communicate and share their life experiences on-line with others. They also allow patients of serious disease a way to communicate and develop a sense of community in a world they may feel alienated from. The Internet also allows for multimedia showcases to provide a level of interactivity that draws in the audience. The Starlight Starbright Children’s Foundation provides a number of interactive games tailored to kids to inform them of their respect disease and tips to help deal with the illness. Games like Sickle Cell Slime-O-Rama and Medical Imaging: Welcome to the Radiology Center give kids incentive to learn more about their illness and help prepare them for medical procedures (http://www.starlight.org/site/c.fuLQK6MMIpG/b.1075955/k.2732/What_We_Do.htm).

The Adoption of Business Marketing

Modern commercial marketing strategies are a lot more aggressive in order to vie in a very competitive and saturated market. Marketing firms such as Mr. Youth use tactics such as guerilla marketing, viral, and stunt/ambush marketing to capture the attention of the ever-fickle youth market. The VERB campaign was a youth social media campaign coordinated by the CDC that aimed to encourage people in their tweens (ages 9-13) to become physically active (http://www.cdc.gov/youthcampaign). Mr. Youth’s promotion of the Verb campaign used such techniques as national tours that went into schools and used activities that promoted physical activity, individuality, and sharing. They utilized yellow dodge balls to help spread the message and delivered them as a commodity to the tweens, getting them to perform their favorite verb in order for them to take one home with them. Each yellow ball was stamped with an access code that the tweens put into the verb website and allowed the tweens to develop a space where they got to communicate and share their ideas about the verb campaign. Sharing is the key to this type of marketing as word of mouth and peer acceptance allows for viral marketing to take affect.

FUTURE METHODOLOGY

The Need for Modernization

As sophisticated as our media systems currently are, we have just scraped the top of the proverbial iceberg. The Internet is an ever changing and ever evolving entity. It is changing from a read-only format produced by webmasters financially backed by large corporations to an interactive playground where ideas and opinions are delivered via top quality formats by multimedia hobbyists. Sites such as youtube.com and blogspot.com allow anyone to broadcast their thoughts and ideas through video or text. High speed Internet and the ability to compress video with such avenues as Flash allow the visual medium of video to achieve a level of accessibility never before seen. This allows for greater diffusion of global health ideas as there is no wait for video streaming, making the Internet just as instantaneous and even more convenient than the television.

These new breakthroughs make it possible to expand the scope of the audience as the technology that delivers the Internet has advanced as well. With satellites and broadband piping, individuals and communities that were previously located too far from metropolitan areas can now have access to a bevy of new services. If even a single Internet portal is established in a village headquarters, the whole community then has access to real-time video, news, and information. Environmental warnings can be delivered to help a community prepare for a natural disaster. Preventative medicine tactics can be shared to reduce the spread of disease epidemics. Primary care health staff can keep in more frequent contact with patients and community leaders to help provide better health solutions. Remote Internet based surgical procedures are also closer to reality and could allow patients who are too remotely located a chance to be operated on by a world-class surgeon thousands of miles away. Just as the radio was effective in promoting social change in the Indian village of Lutsaan, providing culturally sensitive media to a population via the Internet will help to change injurious social behavior but at a quicker rate and with a broader audience. And in turn, underdeveloped communities can give themselves a global presence by communicating with the outside world, perhaps even increasing their own foreign aid by advertising their need for assistance. But the technology has to be provided and it will not come easily. It is not reluctance to use such technology but the sheer cost of establishing the technological infrastructure that is the impediment to modernizing these underdeveloped communities. It will require the aid of non-governmental organizations and call for governmental partnerships with private businesses to shoulder the financial burden. But once it has been established it will help the lives of every member of the community just as previous technologies respectively have proven to be of great benefit.

But until such for-profit/non-profit/public sector alliances are made, more grass roots social marketing must lead by example. The BRAC organization, which has served as a testament to non-profit organization sustainability, has done wonders by providing easy to use health promotion tactics. It has trained armies of instructors to go to homes one-by-one to promote health behaviors such as oral rehydration therapy, a solution that is nothing more than a mixture of water, salt, and sugar, which has drastically decreased the deaths of dehydrated children (http://www.pbs.org/wgbh/rxforsurvival/series/video/c_faz_atl_bangladesh2_qt_h.html). BRAC has opened schools that have grown to constitute eleven percent of the primary schools in Bangladesh(http://www.brac.net/education.htm). It utilizes microfinance to give individuals a chance to create personal business and rejuvenate the economy. BRAC has also created its own bank system and food and agricultural industries to make it self-sustainable. (http://www.brac.net/economicdev.htm) By starting small and focusing on education and sustainability, BRAC has become the role model to how to develop healthy communities. Though the organization has done nothing new in terms of health promotion theory, it is unique in terms of its mindset and its success. By finding a solution that works at the community base and scaling it up so it is works at a larger level, BRAC has learned to franchise global aid in a way that mirrors private business strategy (http://www.pbs.org/wgbh/rxforsurvival/series/video/c_faz_atl_bangladesh2_qt_h.html).

The Power of Cyberspace

There are drastic differences in the strategies needed to promote health in first-world countries than in underdeveloped nations. More of a focus needs to be made on utilizing the available technologies that tend to be easier to access in richer economies. The content capability of the Internet, for instance, is extremely interactive, robust and available. Private-sector businesses such as the Walt Disney Company invest heavily in their Internet presence, and need to in order to stay afloat in a highly competitive entertainment market. Disney.com provides a veritable interactive playground that is just as exciting and entertaining as Disney’s commercial television channels and its theme parks. With high bit-rate video and highly polished interactive games visitors are welcomed by a lavish cyber treasure trove of Disney themed activities. It features online episodes from Disney channel programming, news about Disney characters and special events, and online games that target the child audience and revival home-console based games in terms of quality. In short, just like their theme parks it is a place you can literately spend an entire day visiting. They have also created measures to ensure return patronage. They invite visitors to join such Disney online communities as “Disney Blast” which keeps track of game points won and rewards you with game privileges for points that are collected.

If the Disney.com site is so fantastic, why does the health sector not have a site that is equally as impressive? Simply because to make a website that even comes close takes money, and a lot of it. To start from scratch, campaign agencies would have to develop character branding that is highly appealing to kids, they would have to effectively market said characters which tends to be expensive, create high quality web multimedia that is timely and costly, and all of this has to be financed for a cause that raises no venue. The Starlight Starbright Children’s Foundation have followed in the vain of the Disney on-line multimedia approach, but their quality of work in no way matches the polish of Disney’s, and for kids who are ever jaded by new technology their content is lackluster and antiquated in comparison. Because of this jaded-children factor the health and private sectors are in battle when it comes to providing viably marketable on-line edutainment.

But there is a solution to this multimedia problem. The Starlight Starbright Children’s Foundation was on to something when they collaborated with Marvel Entertainment. Had they tried to produce their own comic book it probably would not have come out nearly as effective as their production with Marvel. Marvel brought the world-renowned character branding and comic publishing expertise and the Starlight Starbright brought the scientific know-how. This type of partnership with the private sector is what needs to be done in first-world countries in order to deliver such highly effective health promotion in the twenty-first century. Instead of starting from scratch, the health sector can utilize character celebrity identification just as it has since the beginning of edutainment to help promote health concerns and curb production costs. The private sector would benefit as corporate philanthropic works provide good publicity for the corporation and further exposure of their product to the public. Also the public sector can provide a number of strategies to push the entertainment industry to be more corporate socially responsible, such as through facilitation as the Norman Lear Center HH&S project has and further strategic partnership with the public sector (Fox et al, 2002).

Home Entertainment and its Ability to Go Beyond the Home

The introduction of the Wiki and the Blog are new innovations that also yield usefulness to public health. These forums for personal expression and collaborative authoring allow individuals as collectives to help themselves. It facilitates in the spread of information and allows for databases of information to be made for the people, by the people. The Walt Disney Company is about to launch a parent wiki that allows parents to share advice and opinions about all aspects of child rearing (http://news.moneycentral.msn.com/provider/providerarticle.aspx?Feed=FT&Date=20070313&ID=6608704). A health-professional wiki would be just as useful for health professionals to share tips and personal lessons in addressing health challenges. It would also facilitate in helping health-professional “to-bes” and everyday laymen a glimpse and understanding at the problems that plague modern health care.

The incorporation of the Internet with the living room entertainment center presents a bevy of new mediums to intercalate public health ideas. Video games consoles are no longer stand-alone systems. They utilize Wi-Fi to access on-line databases they allow players to interact with other players, sometimes halfway around the world. This burgeoning interactive wonderland is a resource that needs to be utilized. By creating game story plots that feature topical health ideas the same way we currently influence the film industry, game content can be educational as much as entertaining. On-line game forums could generate buzz about health ideas if effectively marketed and implemented.

Innovative game systems such as Nintendo’s DS and Wii systems that target the novel and infrequent gamers have the capacity to create a new genre of highly marketable games. Nintendo’s DS system already carries a highly successful line of edutainment games called Brain-Age that are played to increase one’s brainpower (http://www.brainage.com). The Wii system controllers contains Mem chips that allow for groundbreaking interactive play that model real-life movement. The production of exercise-oriented software could easily be adopted by this system and can viably be a huge commercial success. By partnering the private-sector gaming industry with the public and non-profit health sectors, a new genre of entertainment can be created that reverses the negative impact of the sedentary lifestyle that video games up till now have promoted. The for-profit industry would be enticed by the new consumer market it would generate and the health sector would be satisfied by the prosocial and proactive messages these products would promote.

A different type of partnership between the Internet and television lies within digital cable. The navigability of digital cable and the proprietary feature of Video On Demand (VOD) create a cost-effective forum that has yet to be tapped by the health field. Video On Demand allows the viewer to choose what he or she wishes to view. A bevy of topical health programs can be created and showcased on this medium to capture the digital cable audience. Such website as Utube.com and Google Video currently house a wide array of health themed lectures, symposiums, and video works. Showcasing the same video on VOD in better video quality may possibly attract a larger audience.

Athletic Endorsements: The Other Type of Celebrity

Another type of celebrity besides the Hollywoodactor or actress is the professional athlete. Able to garner just as much influence as any other public figure, a professional athlete would seem just like any other celebrity, but there is one crucial difference. Unlike any other type of celebrity, athletes do not necessarily need to vocalize their endorsement because their equipment can do it for them. We see it with NASCAR drivers and racecars blanketed with corporate logos; we see it with professional surfers, skateboarders, and snowboarders with sponsor stickers littering on their boards. These logos define the sporting equipment and sport enthusiasts pay attention (http://www.usatoday.com/sports/motor/ nascar/2002-07-12-acov-sponsors.htm). Simply getting professional athletes to cover a small area of their equipment with a health promotion logo would generate an amazing amount of attention and requires virtually no work on the celebrity’s part. By this method, health professionals can brand health ideas with the use of logos and by symbolizing an idea, like the Verb campaign’s yellow dodge-ball, they can promote the health idea through this type of guerilla marketing. It is an opportunity for professional athletes to not only be sponsored by big business, but sponsored by good health as well.

Stakeholder Analysis

Table 1. Stakeholder Analysis

CONCLUSION

It is imperative the health sector adopt new methods to disseminate global health ideas. Current education-entertainment practices must be updated to remain competitive to other mediums of entertainment and the health industry can facilitate the efforts by partnering with the private business sector to do so. The health sector can also adopt private marketing tactics that have proven to be successful. By watching the private sector or joining corporations in health promotion ventures, we can reduce the risk of failures and aggrandize our health promotion campaigns. The use of such staple marketing tactics as celebrity endorsements has been proven effective, but social marketing must not stop there. New technologies must be adopted as well as distributed to communities worldwide. More impoverished communities may not be modernized enough to take full advantage of such promotions but new creative campaigns can be made to reach these communities as well. Though it is difficult to quantifiably verify how effective a health promotion may be, the private sector can verify their success through the profitability of their commercial venture. By following the private-sector in their proven successes hopefully we too can be as rich in health as they are in profits.

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