Several of us have been working many months to have 1 or more objectives related to social marketing in the Healthy People 2020 - the US national health objectives for the next decade. With them, social marketing becomes part of a touchstone document for national policy related to health promotion and disease prevention. Without one, we watch the band go by - for example, one for Risk Communication has already received preliminary approval (see the complete list of officially proposed HP2020 Health Communication and Health IT objectives here). Our difficulties in getting a social marketing objective accepted are (1) we are not getting the type of support from stakeholders like you to make an impact on the Federal Interagency Work Group that is vetting HP2020 objectives, and (2) we need to have a funded mechanism - or commitment to do so - to evaluate progress towards the objective. The objectives we are proposing are:

Increase the number of programs that use evidence-based social marketing for health promotion and disease prevention.
a. Increase undergraduate/graduate training in schools of public health
b. Increase continuing education for public health practitioners
c. Increase evidence-based research in prevention research centers and schools of public health, business and other related disciplines.


We need to do 2 things:
1. Send in public comments as individuals AND organizations supporting the inclusion of social marketing objectives (see below). The public comment period opens on October 30th, 2009.
2. As importantly, we need to demonstrate commitment by one or more organizations to collect the data needed to document progress towards the objectives as well.

***Here's what we need you to do: ***

(1) Please write a letter supporting a new objective for social marketing in HP2020. If possible, tell them how you or your organization has used social marketing in your work (for example, we use social marketing extensively in our planning of chronic disease prevention programs, understanding our audiences for HIV prevention, establishing priorities for resource allocations). Be sure to include the language of the objective above (in bold).
(2) Submit your letter through the official comment website: http://www.healthypeople.gov/hp2020/comments/ after 30 October 2009. Only comments submitted through this website will become part of the official record and considered by the Healthy People work groups.
(3) Make a note at the end of this page to help us monitor the response.

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Added 30 October 2009 - Specific Directions for Using the Public Comment Form

Several people mentioned having difficulty submitting a comment about the social marketing in HP2020. Here’s some advice from my several tries at doing it.

First, I have already submitted a proposed OBJECTIVE for social marketing; so you only need to submit a COMMENT on a topic area. Here’s how…..

Go to http://www.healthypeople.gov/hp2020/Comments/

Log In (if you already haven’t)

On the Proposed Healthy People 2020 Objectives—List for Public Comment; go down the list and click on Health Communication and Health IT

On the near top of the next page, click on the “Submit a Topic Area Comment” (Do NOT go down the page and click on “Propose a New Objective”) unless you intend to type in a totally new objective….

That will take you to the page where you can type (or paste) a comment about our proposed objective. (You will see comments already posted there.)

Remember to hit “SUBMIT” to send in your comment.
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Here is the complete document we are working from -
To: Director, Office of Disease Prevention and Health Promotion

From:
R. Craig Lefebvre, PhD, George Washington University School of Public Health and Health Services
Robert J. Marshall PhD, Rhode Island Department of Health

Date: October 14, 2009 (DRAFT)

Re: Proposed New Objective for Healthy People 2020
Proposed New Healthy People 2020 Objective
Increase the number of programs that use evidence-based social marketing for health promotion and disease prevention.
a. Increase undergraduate/graduate training in schools of public health
b. Increase continuing education for public health practitioners
c. Increase evidence-based research in prevention research centers and schools of public health, business and other related disciplines.

Justification for New Objective
Public health research shows that about one-half of the leading causes of deaths in the US are related to underlying voluntary risk behaviors, such as tobacco use, poor diet, lack of physical activity, drug and alcohol use, intentional injury (firearms), risky sexual behavior and failure to use seatbelts and other safety devices (McGinnis and Foege, 1993; Mokdad et.al. 2004), In addition, the number of these “preventable” deaths due to poor diet and lack of physical activity alone increased by about one-third from 1990 to 2000.

Success in reversing some of these trends, and improving the Nation’s health, requires a transformative strategy that optimizes the health of the entire population by influencing behaviors that lead to preventable conditions responsible for a majority of premature deaths. Some of the most important preventable risks for poor health involve consumer wants and needs - voluntary behaviors rooted in ignorance, deliberate personal preference, convenience, etc. – that occur within the larger contexts of economic forces, changes in technology, peer and social network influences and social and cultural trends that confront the individual with often arbitrary and conflicting choices. For those interested in promoting population health, the interaction of these multiple influences on consumer behavior creates a difficult dilemma of drawing a line of intervention that crosses between individual freedom of choice and the iron hand of public policy. Fortunately the social marketing approach provides many options for promoting population health by influencing individual behaviors using strategies based on consumer choice.

The use of marketing principles and practices in the private sector provides one of the most compelling demonstrations of solving the core business problem of achieving organizational success (improving public health in this instance) through satisfying consumer wants and needs. Marketing goes beyond advertising and sales. When applied as intended, it becomes a systematic way for management to structure its relationships with consumers and stakeholders from the products and experiences it offers, the structure of the incentives and costs associated with them, and their accessibility to various population groups (segments), to how they are promoted in the marketplace with an ever expanding palette of communication tools. This same marketing management approach can be applied to the analysis, planning, implementation and sustainability of public health programs aimed at promoting healthy behaviors.

Definitions of social marketing evolved over the more than three decades since its first description by Kotler & Zaltman (1971). One of the more commonly used definitions says

Social marketing is a process that applies marketing principles and techniques to create, communicate, and deliver value in order to influence target audience behaviors that benefit society (public health, safety, the environment and communities) as well as the target audience (Kotler, Lee & Rothschild, 2007).

More to the point: Social Marketing is a systematic approach to changing behavior that offers the tools to translate theory into practice and to scale up proven intervention approaches. By using a systematic process the public health practitioner will be able to: select an appropriate priority audience, understand the determinants of their current behavior, establish realistic objectives, develop an integrated strategy to facilitate the adoption of healthier behaviors (or maintain current ones) and measure the degree of successful performance. Indeed, when we examine some of the more well-known and successful public health programs over the past three decades, the principles of social marketing are being applied by the US Agency for International Development, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, and in public and professional education programs of the National Institutes of Health to name just a few.

A review of the literature on the effectiveness of social marketing by the UK Department of Health and the National Consumer Council and the National Health Service (NCC, 2006) concluded that:

a. When the core concepts and principles of social marketing are applied systematically they can significantly improve the impact and effectiveness of work, whether at local, national or international level.

a. Social marketing has potential to support achievement of specific behavioral goals across a diverse range of issues and topics. While social marketing has a developing history in the health sector, it is also increasingly being used in other areas such as sustainability and community safety.

b. Social marketing can help to achieve behavioral goals and directly support service development and redesign by ensuring that they respond to, and meet the needs of, their intended audiences or consumers.


Potential Data Source
We propose that the Centers for Disease Control and Prevention support the development of a data source (or sources) that will provide a national sample of programs that use evidence-based social marketing for health promotion and disease prevention that can be evaluated for their use of best practices. A similar mechanism, such as through existing Cooperative Agreements or Prevention Research Centers, should be established to measure progress on the training and education components. These resources will support national organizations such as the Association of State and Territorial Health Officers (ASTHO), Association of Schools of Public Health (ASPH), Society for Public Health Education (SOPHE), National Public Health Information Coalition (NPHIC) and others who propose a program establishing a sampling frame for a systematic selection of programs to be evaluated. We propose a baseline survey(s) to be completed by the end of FY2011 with three additional biennial surveys for monitoring and feedback to stakeholders throughout the decade.

Anticipated Number of Data Points During the Decade
A total of four data points are proposed for each objective.

Proposed Target
A 50% increase above baseline level for the primary objective and each subobjective.

Health Determinant Identification
Indicate the relevant health determinant(s) for which the proposed objective applies:
___ Physical Environment _x__ Social Environment _x__ Individual Behavior
___ Biology and Genetics _X__Health Services

Proposed 2020 Topic Area Identification
See listings below to indicate the relevant cross-cutting focus area(s), and/or sub area, for which the proposed objective applies (not attached here).

Organizational Support
The decisions above are supported by a large group of social marketing practitioners in public health represented by a workgroup designated by participants at the 2009 National Conference on Social Marketing in Public Health. This group also received support from the agencies listed below. Please feel free to contact us with any questions.

Association of State and Territorial Health Officers (ASTHO)
Society for Public Health Education (SOPHE)
National Public Health Information Coalition (NPHIC)
Centers for Disease Control and Prevention

ACTION:
1. Go the Public Comment website (see above), log in and make your comment supporting its inclusion - and why if you like - in Healthy People 2020.
2. Have your organization, health agency or firm Log In and comment for organizational support as well, perhaps adding ways in which social marketing has been or is being used to improve public health in your area.
3. Note on this page - after this entry under "what we have done" - what you have accomplished. You will need to scroll back to the top of the page, click 'Easy Edit' and then scroll back here to make your entry. Click 'Save' when done and 'Save' again when the smaller 'Edit Note' box appears.

And thanks for your help.

What We have Done - our thanks to those who have helped and those yet to.

Letter of support from the Association of State and Territorial Health Officials.
Letter of support from the National Public Health Information Coalition.
Letter of support from the National Association of Chronic Disease Directors.
Letter of support from the Brown University Public Health Program.