This article suggests that a new "media blitz - plus the powers of the federal government, business and advocates" might well be effective in motivating Americans to take even small steps to improve their diet and increase exercise - toward better health.
This burgeoning social marketing effort draws on both the accomplishments and shortcomings of previous health campaigns in that country, which have sought to sell healthy behaviour, such as quitting smoking (3 decades of efforts have reduced the proportion of Americans who smoke by 47%, but 22.5% of Americans still smoke), wearing safety belts while driving (18% still never wear seat belts), and refraining from drinking alcohol and driving (17,000 are killed each year by drunk drivers).

Author Melissa Healy begins by suggesting that partnership, even amongst organisations competing for market share, could be a key strategy in approaching health communication campaigning. She claims, for example, that in the last 18 months, the federal government, health advocates and private companies have joined forces to prevent HIV/AIDS and cancer and to address health problems such as obesity and inactivity, and health advocacy organisations are forming partnerships with companies seeking to spread the health message broadly. That said, "Very few behaviors change because someone saw an ad. You need social norms in place, environmental supports, the products, the placement, all the things that make the right decisions easy," in the words of Carol Schechter, director of health communications for the Academy for Educational Development.

As Healy reports, these collaborative campaigns frequently draw on market research to craft strategies that are tailored to the sensibilities and media consumption habits of particular groups, often using humour or sexual imagery and piggybacking on entertaining ways of learning more about an issue ("These new campaigns offer encouragement by instant message, downloadable cellphone games with disease-prevention ideas, reality shows, websites with attitude and information, and potty humor for kids.") The strategy involves creating pro-health messages that emphasise social acceptance and status - not scare tactics or lectures. In the words of Peggy Conlon, president and chief executive of the U.S. Ad Council, "The key to advertising is...to coax out the positive behaviors" by appealing to a deeply felt need such as an obligation to children or a desire to be "sexy, admired or envied."

The article cites one particular example of this strategy - the Truth anti-smoking campaign - which "is currently one of the edgiest public health efforts on the American landscape." This youth-oriented, multi-media initiative of the American Legacy Foundation, which is funded by money collected from the tobacco industry in a settlement of a lawsuit brought by 46 states, "rarely mentions the long-term health effects of smoking in its ads, and you have to hunt for that data on its website. Such an appeal would be ineffective for the campaign's intended audience of teens and young adults, whose sense of immortality is virtually impenetrable, say the campaign's architects. Instead, Truth...portrays the tobacco industry as a corrupt, hypocritical institution that could be a worthy stand-in for the entire, loathsome world of adults. In short...Truth positions the decision not to smoke as an act of defiance." Healy quotes Cheryl Healton, president of the American Legacy Foundation and a key architect of the campaign: "We're selling rebellion...Just think how hard it is to get a health message across to someone who's 14 and thinks they're going to live forever."

While "selling rebellion", as in Truth, can be an effective strategy for one group (e.g., American teenagers), Healy urges that, in addressing other audiences in an effort to address behaviours such as overeating and inactivity, parental support and modeling can be key: "parents...must also get on board and lead by example...Some of those parents will be nudged to action by the lure of losing double chins, or love handles or spare tires - all unwanted body parts portrayed as lost in the government's new campaign. Other parents may be prodded into action by their kids, now also being targeted with get active campaigns." To cite an example of the latter, in mid-2005, the Ad Council and McCann-Erickson rolled out a new set of healthy-eating messages aimed at young kids that are part of a campaign known as "Fun With Food". More than a dozen advertisements for television, radio, print media, billboards and buses have been produced; an estimated 105 million Americans have seen the ads, and 1.2 million people have logged on to the Small Steps website...

Gleaning key lessons learned from the above analysis, Healy suggests the following behaviour change strategies:

• Keep it light, keep it positive - effective advertising campaigns don't "scare the life out of people," but empower audiences to act in their best interest...
• Sell the sizzle - "sex sells, and so do social benefits such as status, attractiveness and self-confidence. So sell those - not the prospect of a longer life."
• Offer peer acceptance to young audiences - no motivator is more powerful than the acceptance or admiration of peers who are the same age or a bit older.
• Make it immediate - young kids live in the moment, and that's when they need to believe their reward will come if they do what the advertisement says.
• Speak the audience's language - "many of the anti-smoking advertisements that appear on MTV would be unintelligible to an adult who has no teenager living at home (and some who do). But if the message is to be authentic and believable," it must be communicated with the tone, phrasing, and verbiage familiar to that particular audience.
• La familia importa - with Latino audiences, family relations are paramount, and appeals to this audience should reflect that priority.
• Let the Web do the work - for all audiences, but for teens in particular, the internet is the place to learn and connect to an issue; many campaign websites extend and convey messages with computer games and even opportunities to chat and instant message with other kids.

Click here to access a related peer-reviewed summary on the Health e Communication website, and to participate in peer review.