Marketing and advertising are powerful tools to influence behavior. A good ad can have profound effects on our decisions – making us crave the latest gadget, causing us to switch away from a brand our family has trusted for generations, or to vote for a candidate we know little about. When it comes to health, marketing and advertising have traditionally been monopolized by industries promoting unhealthy habits and behaviors. Big tobacco’s advertising strategies are legendary. Their tactics have been dramatized in movies such as Thank You for Smoking, and documented by plaintiffs’ attorneys and judges.
In her judgment and opinion in the US government’s landmark lawsuit against the tobacco industry, Judge Gladys Kessler found that major US tobacco companies have misled and defrauded the American public about the health risks of smoking and about their marketing strategies targeting youth. In order to help prevent the tobacco industry continuing to deceive the public, Judge Kessler ordered tobacco companies to make corrective statements in advertisements on television, in newspapers, on their websites, and on cigarette packets. Judge Kessler’s findings recognize the powerful harmful effects of tobacco industry advertising. Her orders for corrective statements aim to correct the harms by harnessing the power of advertising against the industry that has used it so effectively in the past. Although tobacco advertising is now more strictly regulated, the alcohol, fast food, and sugary drink industries are following in big tobacco’s footsteps. In 2012, the fast food industry spent a whopping $4.6 billion on advertising in the United States.
Government agencies and health promotion organizations are also recognizing and embracing the power of advertising to discourage harmful behaviors such as smoking, and to improve health outcomes more generally. Effective ads now appear in print, on television and radio, and more recently on social media. They invoke different emotional reactions and responses, from embarrassment, shame, fear, and guilt, to inspiration, empowerment, and pride. They aim to discourage harmful activities such as smoking, dangerous driving, and violence against women, and encourage healthful activities like breastfeeding infants, engaging in physical activity, and getting tested and treated for sexually transmitted infections. More and more, we see messages tailored to achieving health outcomes in different target groups that have been shown to respond to different messages.
But are public health advertisements effective, and how do we evaluate the health and behavioral outcomes of such campaigns? Anecdotal evidence and common sense suggest that if advertising can be used effectively to encourage harmful and unhealthy behaviors such as smoking and fast food consumption, it can also be used to discourage such behaviors. There is an emerging body of evidence confirming the potential of health promotion advertising. A study by Boles et al. found that mass media campaigns addressing sugary drinks may raise awareness of health risks associated with excessive sugar consumption, and prompt intentions towards reducing consumption. Terry-McElrath et al. found that anti-tobacco advertising was significantly associated with quitting, but found no relationship between anti-smoking advertisements and smoking uptake.
All this suggests that health promotion advertising should be seen by public health policy makers and attorneys as a potentially effective means of raising awareness of and promoting compliance with health and safety laws, and educating the public and encouraging uptake of healthful behaviors. There is room for more rigorous evaluation of what sort of advertising and messaging works, and to further hone our messages to achieve the greatest impact in terms of direct public health messaging, and messaging to support and integrate with broader health campaigns, laws, and policies.
In the meantime, here are 6 of the best public health ad campaigns from around the globe… New South Wales Roads and Traffic Authority’s anti-speeding “Speeding: No One Thinks Big of You” campaign (Australia)
The “Speeding: No One Thinks Big of You” campaign targets young male drivers, suggesting that they are speeding to compensate for the size of their “manhood.” The 44-second television ad, which does not involve speaking parts, shows young women, older women, and even other young men, waving their “pinkie” fingers when young drivers show-off their masculinity by speeding. The 2007-2009 television, radio, print, and billboard campaign made an impact, with around 75 per cent of young Australian drivers reporting that the ads had encouraged them to comply with speed limits. “The Real Bears” (United States) This online video, a collaboration between the Center for Science in the Public Interest and Grammy Award-winning artist Jason Mraz, uses cartoon polar bears and a catchy tune to address the health effects of soda consumption. The family of soda-loving polar bears experience obesity, type 2 diabetes (and complications such as erectile dysfunction and amputations), and tooth decay. The cartoon’s message is backed up by statistics and information from The Lancet, the Surgeon General’s Report on Oral Health, and the CDC. “Bell Bajao – Ring the Bell” campaign against domestic violence (India) “Bell Bajao – Ring the Bell” is a broad public education campaign designed to promote awareness of and compliance with India’s Protection of Women Against Domestic Violence Act (2005). The ad component of Bell Bajao aims to encourage men and boys to stop domestic violence by the simple act of ringing the doorbell. The ad intersperses shots of a man interrupting an assault in a nearby home by ringing the doorbell, with messages about the destructive impacts of domestic violence on women, families, and communities.
Bell Bajao, an initiative of Breakthrough, a human rights organization, has received support from the United Nations Secretary-General Ban Ki-moon, who joined Bell Bajao as its first global champion. Building on success in India, television advertisements have been adapted for use in Canada, Pakistan, China, and Vietnam. Quit Victoria’s anti-smoking “Last Dance” ad (Australia) Quit Victoria’s “Last Dance” ad is a highly emotive depiction of a couple dancing in their living room, while their young son looks on. The father, wearing a breathing tube, and obviously very unwell, struggles from bed to join his wife dancing to an acoustic version of Que Sera, Sera. The ad is a chilling plea to smokers to quit – ending with the tagline: “What will be, doesn’t have to be.” Talking babies for breastfeeding (Vietnam) In addition to discouraging unhealthy and dangerous behaviors, creative advertisements can also be used to encourage positive behaviors – such as exclusive breastfeeding for the first six months of life. Alive & Thrive, a 6-year initiative with initial funding from the Gates Foundation, aims to improve infant nutrition in Bangladesh, Ethiopia, and Vietnam. One method of reaching this goal is through its “Talking babies for breastfeeding” campaign in Vietnam, which includes ads depicting babies talking to each other and their mothers about the benefits of exclusive breastfeeding. The ad also addresses the problem of parents giving infants water in addition to breastmilk – with the talking babies explaining that infants do not require water to wash-out their mouths or quench their thirst. “GYT: Get Yourself Tested” (United States) “GYT: Get Yourself Tested” also promotes healthful behavior – it encourages young people to get tested (and if required, treated) for STIs and HIV. The campaign is a partnership of leading health organizations – the Kaiser Family Foundation, the American College Health Association, the Planned Parenthood Federation of America, and the National Coalition of STD Directors – and MTV. GYT is a cross-platform campaign including PSAs, special programming on MTV, and an online and mobile presence.
GYT’s messages have evolved from year to year, with taglines like “get yourself talking, get yourself tested” and “know yourself, know your status.” The campaign moves away from traditional stigmatization associated with an HIV positive status, by using the term “positive” to highlight ways to avoid contracting STIs, using phrases like “I’m positive that we talked about it before our first time” and “I’m positive I always have one (just in case).”
The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.