Delivered to the 2009 National DrinkWise Forum Solutions for a Safer Drinking Future
Australia has had a problem with alcohol since January 26 1788.
…and long before Europeans invaded Australia – about 12,000 plus years ago – proto-Neolithic humans were producing alcohol.
This history implies, to me at least, that changing alcohol consumption patterns is unlikely to be an overnight job, and that long-term generational change is the most productive way to go if you want to change consumption patterns.
In talking today about that long-term generational change I am wearing two hats. First, as a DrinkWise director, and with this hat on I want to give you some insights into how the DrinkWise social marketing campaign has been developed and where it is going. Second, as someone who has worked on social marketing campaigns over many years with VicHealth, Australian and State Governments and a number of agencies and organisations some insights into what works and what doesn’t.
POPULATION CONTROL MODEL
Now I should say that I am only talking today about social marketing and recognise there are policy perspectives advanced by others – particularly in the anti-alcohol part of the health lobby – which are relevant.
Essentially this lobby would argue that the most effective way to control alcohol problems is heavy taxation, restrictions on availability and bans on advertising and sponsorship.
There is strong evidence that these measures can influence alcohol consumption and reduce alcohol related harm although whether the measures would be successful in the face of community, electoral and taxpayer opposition is another issue.
Saunders and de Burgh’s work in Drinking Patterns and their Consequences canvass these issues in more detail than I can today.
But perhaps it is sufficient to say that approaches which generate widespread community hostility and seek to control the bulk of moderate consumers of alcohol as if they were people with significant alcohol problems may lead to the proverbial unintended consequences.
The reaction of many people to the exposure draft of the NH&MRC alcohol consumption guidelines are an example of both unintended consequences and the reality of the old saying that you should be careful what you wish for.
Particularly when there are alternatives available which treat people as citzens capable of changing behaviours without draconian regulation and punitive taxation.
WHAT DRINKWISE DID
But I want to talk about what DrinkWise did and why.
After we were set up we decided that in a field as crowded as this we needed to identify a niche in which we could make a difference.
We didn’t have the resources to be a major policy player or a major research centre although we have funded a wide range of research and demonstration projects which we hope will have some impact on the formulation of policy and practice.
The niche was social marketing – an inevitable choice when you consider the mix of private sector skills and community input which we have as a result of our structure.
Social marketing is not new. They have been around for centuries.
Berridge ascribes the modern emphasis on social marketing to changes in attitudes to public health in the years after World War II
She cites a 1950s radio interview with Dr Jerry Morris of the British Social Medicine Unit: “We are dealing with a different social situation. The 19th century epidemics, bred in poverty and malnutrition, arose from the failures of the social system … It is (now) becoming clear that in the modification of personal behaviour, of diet, smoking, physical exercise and the rest…the responsibility of the individual for his (sic) own health will be far greater than formerly. It will not be possible to impose from without (as drains were built) the new norms of behaviour better serving the needs of middle and old age. They will come about in a new kind of partnership between community and individual.” (History Today August 2007 19-21)
There is a particular philosophical viewpoint implicit in this approach – the concept of partnership between the community and the individual – that DrinkWise tends to support.
That viewpoint was summarised in The Economist (April 8 2006) when it wrote : “By helping people to make forward-looking decisions for themselves that they cannot easily renege on later, they enlarge their freedom – giving Ulysses the rope with which to lash himself to the mast adds to his choices.” In contrast it argued do we want to regard “reasoning, judgement, discrimination and self-control …..as burdens the state can and should lighten.”
A former colleague of mine, Dr Ed Maibach, now at George Washington University defines social marketing as the application of marketing principles, the marketing process and all marketing tools (not just advertising) to further a social goal.
He also stresses that we need to avoid the education fallacy – the mistaken belief that knowledge shapes attitudes and then brings about behavioural change in some sort of automatic process.
At DrinkWise we examined a wide range of social marketing models and we don’t use any one exclusively. For convenience sake, however, we often use Andreason’s SEE, THINK, ACT, REINFORCE categorisation as a useful rule of thumb for strategic thinking.
We also analysed a range of best practice campaigns to identify early what works and what doesn’t.
One thing which has surprised some commentators who obviously haven’t read the literature is that we rejected fear campaigns.
The most famous social marketing campaigns are fear campaigns, for example the TAC road accident campaign and the Grim Reaper campaign.
Having been involved in a paid review of the TAC campaign I am a bit restricted in what I can say but I can say that when we cross-correlate the campaign with other factors there is some doubt about its impact on the road tolls compared with other factors such as the state of the economy and the distances travelled as a result; prevalence of booze buses and other factors.
A more interesting case is the Grim Reaper campaign which – in conjunction with the Glenn Close film Fatal Attraction – probably frightened the life out of many middle aged middle class heterosexual men. But the impact on AIDS was limited, particularly when compared with campaigns, devised in conjunction with the gay community and other high-risk groups, targeting specific practices and risks.
In contrast The Canadian Let’s Talk campaign, which focussed on rationality and discussion, was much more effective.
There is also some evidence that subversive, humorous campaigns devised by young people themselves have some success. While there is no time to discuss it here it is well worth looking at the excellent Florida anti-smoking campaign, Truth, which achieved astonishing results.
The Australian Snake Condom campaign with young indigenous Australians is another brilliant example of this approach.
Nevertheless Governments, industry, the health lobby and the media love fear campaigns.
The Government can appear tough and decisive because they have screened tough and confronting advertising.
The media is pre-disposed to believe in the efficacy of the campaigns because they mirror the characteristics of much of the media – sensationalism, short-termism and moral panics.
For the health lobby they add to the concern that drives research funding and puts a variety of otherwise unpalatable policy prescriptions in play.
The smarter sections of industry love them because they can sleep easy having been thrashed with a feather duster and knowing the campaigns have probably increased demand for their products.
The doubts about fear campaigns are particularly pronounced when we consider alcohol-related social marketing campaigns.
The best practice review we undertook supported a 2000 finding by Shanahan and Elliott that public information campaigns addressing youth-risk taking sometimes work as a double-edged sword by initially raising awareness and then curiosity, eventually culminating in increased experimentation with the behaviour they set out to prevent.
Young males, in particular, tend to be risk-takers – reminding them of risks therefore, can encourage more than it discourages.
This was confirmed by research into a Howard Government campaign on a youth drinking featuring youths vomiting and falling about. A significant response was – that’s like the sort of like party, like I’d like to go to.
Paul Dillon has made another substantive criticism about the recent Rudd Government youth drinking campaign by saying that it is “too late” to target that target group and that the process has to start earlier.
Interestingly Paul Dillon was the only person I could find who criticised the campaign although many social marketing professionals and academics I have spoken to had real doubts about the campaign’s likely effectiveness. Given the vehemently sarcastic response by one Sydney journalist to the DrinkWise campaign I can understand the caution. Questioning the conventional wisdom on this subject is regarded as tantamount to questioning Anzac Day, motherhood and safe sex and supporting terrorism.
But if we want any final proof of whether these fear campaigns are successful I just want you to pause for a moment, think of all the alcohol fear campaigns which have been run by Governments since the 1980s and then compare them with this.
These are Face book images put up by young people themselves. They chose to display these images of themselves and their friends. If this is their choice it is difficult to imagine that they are going to be shocked or discouraged by the scenes in the Government ads.
Within this context DrinkWise undertook extensive research – mining existing data and literature, commissioning benchmark quantitative research, undertaking ethnographic research and looking closely at consumption patterns.
We then puzzled over the data and developed some insights.
First, and this obviously wasn’t a new insight, the problems with alcohol are the patterns of consumption and less alcohol consumption as such.
So where should we start??
We thought a good starting place was with those who had most influence on children and our mining of the Quantum Australia Scan data base indicated the following:
We then commissioned more research which segmented various audiences and looked at their attitudes to alcohol, to risk and their needs and concerns.
From there we developed a campaign brief. I’ll talk briefly about the summary here although I will skip over the more detailed brief elements which are in the presentation copy available and will be in the DrinkWise website.
The result of all this was The Kids Absorb Your Drinking campaign based on:
- Starting early and focussing on people with real influence modelling behaviours which could result in life-long changes.
- Empowering parents to help them do what they want to do.
Of course the campaign involved much more than advertising and encompassed partnerships (more of which are being developed); websites; spokespeople; expert advice; publications and so on.
It is very early days yet. We are really in the SEE and THINK stages of the Andreason model but the findings are very encouraging:
- 28% of the parents surveyed said they have reduced the amount of alcohol they drink in front of their children.
- 41% say they are more self-conscious about how they drink in front of children.
- 36% indicate that they have discussed with their partner how they drink in front of children.
- 29% indicate they have discussed drinking in the presence of children with friends or colleagues.
- 83% agree that the campaign made them think about how children form their attitudes to alcohol.
- 48% of parents surveyed agreed that parents are children’s role models and that children are influenced at a young age by their actions.
These changes which indicate both attitudinal and behavioural change are an important platform for future campaigns.
SO WHAT NEXT?
So what is the next step in the DrinkWise campaign?
First, we intend to continue the Kids Absorb your Drinking campaign. It still has plenty of life and we have to recognise that every few years there is a new generation of parents of young children facing the same problems as the one we targeted with this campaign.
Second, consistent with a long-term approach, we intend to move up the age range a bit to target parents of pre-teen children.
This is also research-driven.
Roche et al found that the age of initiation of alcohol over the past 50 years has decreased from approximately 19 to 15.5 years.
The Australian Secondary School Survey found that risky drinking for short-term harm among 12 to 15 year olds who drank in the previous week had increased significantly from 16% in 1999 to 21% in 2005.
Dr Aaron White will be speaking to you shortly about what this involves and the risks.
In our preliminary thinking on the next stage of the campaign we believe this risk of adolescent brain damage, and the consequent developmental implications, may be a very important lever and trigger to help parents to work with their children to delay the onset of the first drink.
Parents and their pre-teen children are at an important stage of life. The transition from primary to secondary school is an important trigger event where it is possible to encourage, according to social marketing theory and practice, significant behavioural changes.
We will also, given the audiences involved, move much more heavily in the future into social media for our own communication and to facilitate communication between parents.
Gradually, logically and deliberately we will address each generation of Australians and the harmful patterns of their alcohol consumption. At each stage we will seek to re-inforce previous stages and work with new generations coming through the cycle. We will not just use advertising in the next stages although advertising will continue to be used to raise awareness and get people thinking about issues.
Concurrent with this long-term social marketing approach we will continue to work on policies, demonstration programs and research which help bring about safer drinking cultures. This research and the demonstration projects will cross-fertilise the social marketing campaigns.
Looking at the literature it appears that no-one anywhere has adopted a long-term social marketing approach such as this.
Governments should be able to, but this is probably not the only issue where some Governments are concerned more with the next electoral cycle than the shape of Australia in 30 years time.
Ironically, at the risk of being accused of being an industry apologist, I think industry should be in a good position to take such a long-term approach because they have a vested commercial interest in doing so. If they want to stay in business they need the consent of the many stakeholders who make up the environment in which they operate. To do that they need to genuinely help eliminate the problems associated with alcohol.
It is a great pity that some people in the health lobby believe, seemingly with religious fervour, that they should have no contact with the alcohol industry and that any such contact contaminates them.
Perhaps if governments and health and industry lobbyists put aside their ideological positions they might find that productive partnerships could do more to solve alcohol problems than pursuing their own narrow agendas.
And heaven forbid – given the huge numbers of people with an interest in a fight to the death between industry and opponents – we might be able to free up some resources, some goodwill and some creativity to make a difference.