New Zealand’s Covid-19 Response – Implications for Social Marketing

New Zealand’s Covid-19 Response – Implications for Social Marketing

Social marketing – the use of commercial marketing and communication techniques for social purposes – is a powerful tool for positively and voluntarily changing the behaviours of individuals and populations.

Social marketing is more than the use of just social media, or advertising, or any other single tool; it is the strategic choice and use of a combination of techniques, products and technologies to achieve voluntary behaviour change for social good.

Social marketing in New Zealand has a varied recent history. It has come in and out of fashion with different administrations, and the public sector’s institutional understanding of the evidence base and key tenets of good practice has waxed and waned. Achieving social behaviour change is complex and there are many traps for inexperienced or careless players: underinvestment, over-communication, and short-termism to name just a few.

But through this history New Zealand is blessed with a number of experts – within the public sector and in its partners in the private, academic and non-government sectors – with practical experience and theoretical insights to contribute.

The pandemic and the long term social-impacts it will create provide fresh challenges for social marketing and behaviour change practitioners in the public sector. Many of the social problems that social marketing sets out to address will be more difficult to solve; more complex and more entrenched. But these challenging times also bring an opportunity to reflect on lessons of the past and change how we work; to modernise our practice and make it more progressive.

Three enduring features of good practice

The success of the Government’s COVID-19 communication and marketing programme, causing nearly the entire population to change working, social and recreational habits almost over night, is evidence of just how powerful this tool can be, and how capable the public sector is of wielding it effectively, alongside strong policy and regulatory initiatives.

The actions of the New Zealand Government in March set out almost a case book for how to approach behaviour change. That’s not to say they’ve got everything right – and time will no doubt be the critic’s friend, as hindsight reveals flaws like no other kind of vision ever can. But the scale of public behaviour change relating to COVID-19, and the rapidity of it, is unlike anything we’ve seen before.

In part, we can attribute this to the clear and obvious need to act, that was playing out on the global stage. But in mid-March the Government was walking a tightrope: if it had moved too soon, it would have moved ahead of public willingness to respond and comply. If it had moved too slowly it would have risked panic, confusion and losing the trust that was so crucial in bringing people along. So the COVID-19 programme is a great case study for the enduring features of behaviour change best practice.

First, it took a multi-layered and integrated approach to communications, ensuring they were unmissable for the target audience (in this case – and perhaps for the only time in history justifiably – all New Zealanders). Rather than relying on one mechanism (for example, television advertising), the campaign is visible through news media, social media, advertising on a very wide range of channels; through partnerships and use of collateral; through word of mouth and aligned spokespeople from every agency of Government (and beyond). And it was repetitive and enduring — with briefings to media and the public happening daily and all other forms of marketing and commentary sustained throughout the lockdown phase and beyond.

The second key tenet of best practice, where the COVID-19 campaign is so strong, is its clear focus on behaviour (and a single, “non-divisible” behaviour [1] at that). The Government didn’t ask people to “be virus-wise” or promote a bundle of behaviours (eg “protect our community”). Instead, the simple catch cry that headlined every communication from the start of the COVID-19 response was “stay home”. Although there was debate about what we might be allowed to do if we didn’t stay home (can I surf? Can I go mountain-biking?) these were marginal to what was a very swift response at a mass level, that was enabled by the absolute clarity of the message.

The third tenet of best practice (and perhaps the most important) is a focus on the audience, or citizens. The UK’s National Social Marketing Centre’s Benchmark Criteria make this clear, placing Customer Orientation as their first criterion. Successful behaviour change programmes understand and respond to what will motivate people; and what will stop them from behaving the way you need them to. We have seen with the COVID-19 communications a powerful balance held between the policy changes required by the science and economics of the pandemic; and the emotional and practical needs of the citizens who would be asked to implement those changes.

Not every programme over the years has had the success of the COVID-19 communications, in part because not all programmes have been designed in a way that is consistent with good practice; but other difficulties have also been in play. Less perceived urgency, less investment, less combined expertise in the creation of the programme and less strength in leadership have all been a feature of our practice’s history – and will likely be so in the future, for we are all human, and human behaviour change is particularly complex and difficult.

And if it was complex in the past, in the immediate, post-COVID future we will have new challenges, as communities are harder pressed than ever before. Even at its evidence-based best, old social marketing practice might not be enough to see us through. This is a moment to test the State’s involvement in social marketing, and to find new ways to operate to meet these challenges.

An invitation to change

As we imagine the post-COVID-19 future, some features stand out more than others as potentially challenging for public sector behaviour change practice; and open the door to some interesting new ways to work.

These features were not absent in the past, but our practice has generally been slow to respond to them. My hope is that now it will be clear we must tackle them; and that now we will be able to find previously unreachable ways to do so.

First we have an opportunity to really examine how social marketing practice contributes to or reduces inequalities. Despite generally setting out to reduce inequality, in some cases social marketing practice has had the opposite impact; either by increasing inequality; or increasing the stigma that is associated with inequality. To a degree, it is in the very nature of social marketing, which targets communities perceived as being most in need of change; but this is exacerbated in the way many programmes are initiated, conceived and conducted; by reinforcing dependency and deficits, and taking an expert-led, rather than community-led approach.

With the very real risk of deepening health, social and economic inequality as a result of COVID-19, we have the opportunity and the obligation to ask ourselves, how can our practice contribute to reducing inequality? What can we do differently to shift the balance of power? How can we shift our practice from paternalism to partnership?

Community-based practice and true co-design are not new concepts, and they are in place in some programmes and some areas. But these days they are the domain of the brave and the patient; they are like the slow food of policy and behaviour change practice; they demand a degree of flexibility and openness that isn’t always easy to achieve. But what an opportunity we have now to find the time and the space to deeply and genuinely engage with communities, and to ensure our approaches are designed in ways that enable those communities to participate in engagement.

A second area for reflection for behaviour change practice lies in our response to the deepening complexity of social problems. The problems themselves do not arise from a single source; so the solutions should not arise from a single source either. And so another opportunity we can seize now is to act on what UK think tank Demos has called the public sector’s “moral obligation” to collaborate.

Collaboration has been an unresolved question for social marketing and behaviour change practice for many years. It’s an area where intention and action have been slow to connect, as the time needed to collaborate generally works against the sometimes urgent (and perhaps artificial) deadlines for many behaviour change programmes. COVID-19 has shown us that collaboration can happen, even in genuinely urgent circumstances, and that determined leadership can make it happen. The benefits of that collaboration are obvious, and enduring.

The third challenge and opportunity that the pandemic and its aftermath invite us to consider is an external one. Like the others it is not new; and like the others, the current environment makes it more urgent to confront than ever – and more possible.

How does the rapidly changing media environment change our ways of reaching people with our behaviour change programmes? What does the loss of orthodoxy mean for our ability to communicate with many people, from a single source? What opportunities and risks arise from the voice that social media has conferred on people previously invisible in a heavily mainstreamed media and entertainment context?

If good communications is “simple clear messages, repeated often, by a variety of trusted sources [2]”, how can we take advantage of the new environment to identify, empower and motivate a greater variety of trusted sources? And let us be careful not to transfer our old over-reliance on “above the line” communications (advertising) into the new paradigm, but find ways to elevate real and diverse community voices through a rich portfolio of channels.

The benefits of these approaches will be manifold: In a future of greater collaboration we may see fewer social marketing programmes initiating from Government, and at the same time, more that address root causes of harm. In a future of greater citizen-centricity, we may see greater shared ownership of problems and solutions; in a future of more diverse communication channels we may see a wider range of voices sharing social good messaging in more intimate and trusted ways.

Marketing and communication are powerful tools government can use to generate real and positive change for New Zealand citizens. Right now – when so much has changed; and we are rethinking what our future might look like – we have the opportunity to embed good behaviour change practice more consistently, and create new approaches that put communities and citizens at the centre. It’s a bright future, if we are patient and brave.

[1] Doug McKenzie-Mohr, Community Based Social Marketing www.cbsm.com

This article was first published under the title “The State and Social Marketing: Can We Embrace Change” by the New Zealand Public Service Association as part of its Progressive Thinking series. You can read other articles in the series here.

[2] Dr Edward Maibach, in conversation.

Featured Image Credit: “Covid-19 handmade facemask” by Flickr User Olgierd

10 Action Areas to Encourage COVID-19 Vaccination Uptake

10 Action Areas to Encourage COVID-19 Vaccination Uptake

Since the beginning of the COVID-19 pandemic there has been a tsunami of misinformation and conspiracy theories that have the potential to reduce the uptake of any of the 20 + candidate vaccines that are in the pipe-line.

With the imminent availability of one or more vaccines it will not be long before governments and public health agencies are in the game of persuading the mass of the population to take advantage of the vaccine availability. However, as we know only too well, significant sections of populations in most countries display low trust in governments and in vaccine safety.

To address this issue myself and colleagues Sameer Deshpande (Griffith University), Doug Evans (George Washington University), Rafael Obregon (UNICEF) have just published a paper that sets out what we know about the factors that need to be addressed and what actions need to be put in place to ensure the maximum positive uptake of COVID19 vaccines as they come on stream.

Research shows that general vaccine hesitancy (i.e. ‘the delay in acceptance or refusal of vaccines despite the availability of vaccination services’) is rising for several diseases, resulting in serious disease outbreaks. For example, 11 European countries experienced more than 1000 cases of measles in 2008. Vaccine hesitancy has also steadily increased in more than 90% of countries since 2014.

Given this situation’s potential to undermine vaccination coverage, all states must take steps to understand the extent and nature of hesitancy and to start promoting COVID-19 vaccine uptake now in advance of its availability.

As the WHO recommends, ‘each country should develop a strategy to increase acceptance and demand for vaccination’. To do this each country must consider the appropriate time to start promoting the uptake of COVID-19 vaccines based on the specific trajectory of COVID-19 infection and its ability to provide access to vaccination. As COVID-19 vaccination uptake develops, governments will also of course need to continue to promote other protective behaviours such as handwashing and physical distancing.

In the paper we set out ten action areas based on what we know works that governments and public health bodies across the world should take to enhance the impact of their pro-vaccination strategy. We base our summary on recommended best practice with the aim of assisting professionals to digest the mass of guidance that already.

Our key message is that it is imperative that planning for a COVID-19 vaccination uptake promotion begins in advance of vaccine availability for two reasons. First, countries will need to build consensus about the order in which population sub groups will get access to the vaccine. Second is the need to proactively reduce fear and concern and create demand for vaccines among all the subgroups that exist in each country.

A key part of this strategy is also to counter the anti-vaccination movement that is already promoting hesitancy and resistance. To counter the anti-vaccination movement effectively it will be necessary to build a positive narrative about the personal, community and global benefits associated with vaccination.

Key guidelines for developing a proactive COVID-19 Pro-Vaccination Strategy

  1. Systematic behaviour change planning
  2. Audience targeting and segmentation
  3. Competition and barrier analysis and action
  4. Mobilization of all assets, partners and stakeholders
  5. Vaccine demand building
  6. Community engagement
  7. Ease of vaccine access
  8. Marketing promotions strategy
  9. News and media relations and outreach
  10. Digital media strategy

Finally, we argue that key to the success of promoting vaccine uptake will be a significant and sustained strategic program, including strengthening of local capacities, to build and maintain a dialogue, confidence and trust. A crucial factor in the delivery of such a two-way communication approach, trust and demand building approach is the need for investment in communication, behavioral influence, and community engagement capital and capability.

Communication and behavioral influence are often underfunded and under-resourced in public health organizations and within government ministries. Building communication and behavioral influence capacity and expertise should now be a top priority.

It is now often said that everything will be different in the post COVID world. Hopefully one difference will be a commitment to investment in developing and delivering on these 10 key action elements.

This investment will need to be sustained over time in line with best practice requirements regarding risk communication, health promotion and community engagement so that we are better prepared for inevitable future events.

Read the full paper.

Professor Jeff French is a global thought-leader in the fields of behavioural influence, social marketing, and social communication. He is the Chief Executive Officer of Strategic Social Marketing, a visiting professor at the University of Brighton and a Fellow at Kings College University in London.

The Yellow Brick Road To Recovery

The Yellow Brick Road To Recovery

What do the Wizard of Oz, a lion, a scarecrow and a tin man have to do with the road to recovery from COVID19?

At the end of June, our Founder Luke van der Beeke joined Victoria’s Chief Health Officer, Professor Brett Sutton and health economist, Professor Jonathan Karnon to answer the question: Will the road to recovery be paved with casualties?

An abridged transcript of Luke’s presentation is provided below. The webinar was hosted by The Health Issues Centre of Victoria.

The road thus far

Each country’s experience of COVID has been different. This is in part due to the relative effectiveness of government responses, but it is also a function of other contributing variables which impact the virus’ ability to spread. People’s behaviours (do they self-isolate, do they test when symptoms arise, do they comply with social distancing rules) are perhaps the most significant of those variables.

In relative terms Australia has fared well. The response from federal and state governments has been generally been very good. For some, their government’s response has served to rebuild trust. That said, it’s also fair to say that Australia has once again earned a reputation as the lucky country.

COVID presents government and civil society with unprecedented health, social and economic challenges. At the heart of these challenges are human beings, and we are fickle creatures. Our attitudes shift and change quickly over time, and as a general rule of thumb, our behaviour is predictably irrational. (For more on that read Dan Ariely’s excellent book Predictably Irrational)

Commercial marketers have leveraged people’s predictable irrationality for years to influence consumer behaviour. Regrettably, this knowledge has historically been used to leverage behavioural biases which result in people consuming products that are bad for them or the planet.

For example, commercial marketers know one reason we’re prepared to consume products that do us harm is that we tend to discount the future costs of doing so. The immediate sense of gratification felt by eating a Mars bar or drinking alcohol with friends more than offsets the potential future cost to our health. Behavioural economists call this phenomenon hyperbolic discounting.

Thankfully, social marketers, and more recently behavioural economists, use this same knowledge to influence behaviours for good – both downstream, where efforts are made to influence individual choices; and upstream, where strategic social marketing and behavioural insights are used to inform government policy and communications.

The Wizard of AUS

I do find it hard to resist a good metaphor. Some might say that the PM (and in fairness, state Premiers) have performed acts of wizardry keeping the majority of Australians safe over the past few months. So, my road to recovery is comprised of yellow brick. In order to navigate it safely, and to minimise casualties, government will need to show courage, be smart, and have a heart.

A few assumptions

  1. Human behaviour and our government’s ability to manage it effectively will be a key determinant of how successful we are at navigating the road to a post-COVID world.
Pets don’t spread the virus!

2. There is also an assumption that we’re now actually on a road to recovery. I’m not so sure. Global cases continue to rise exponentially and a vaccine may be months or years away. Furthermore, political and economic pressures may lead to the opening of borders and easing of restrictions well before it is completely safe to do so.

Notably, Australian commentators often caution the public about the risk of a second wave. This of course assumes there was a first wave. Here in Australia, that first wave was more akin to a ripple. Should a second wave come, I fear that without due consideration of the likely less compliant behavioural response from large portions of the public, it could quickly turn into a tsunami.

3. Another assumption is that adaptation as opposed to elimination remains the preferred choice as the pandemic continues to evolve. This is important for many reasons, not least of which being COVID will remain a background threat to people’s health for months if not years to come. This will impact behavioural and attitudinal responses to government efforts to reduce the impact of COVID as we make our way forward.

And of course, casualties have not, and would not, be limited to COVID related cases and deaths. Our response needs to account for the myriad other adverse impacts COVID creates and amplifies, including mental health, economic hardship, health inequalities and domestic violence to name just a few.

4. My final assumption – pets don’t spread the virus…

The response to date

Susan Michie’s Behaviour Change Wheel (below) is useful because it highlights sources of behaviour (based on the COM-B model), as well as intervention functions and policy categories.

Interventions to date (in red) have predominantly relied on restrictions (border and business closures, social distancing), education, and persuasion. Each of these interventions have been successful in large part because most Australians have had the motivation (initially fear, then concern for others, a sense of social responsibility/civic duty), capability and opportunity (green circle) to comply.

Behaviour Change Wheel - Susan Michie

It must be said that over time the amount of conflicting and confusing messaging has increased. Complex and at times counter-intuitive policy settings on a range of issues have also started to chip-away at public confidence.

Fear

Fear can be a powerful motivator. And inhibitor.

As far as motivators go, fear can be very effective. Fear appeals have been used for decades to influence people’s choices – think graphic anti-smoking ads or road safety commercials.

But not every fear appeal is successful. Just because a person is scared of something doesn’t mean they’ll behave in a way that reduces the perceived threat.

Two conditions that studies consistently link to behavioural intention are perceived threat and perceived efficacy.

In the case of COVID, the perceived threat was initially extremely high in terms of the likelihood of exposure and impact. This was helped along by cases of alarmist journalism which served to build a sense of panic.

Initially, most Australians felt they had the ability to practice social distancing and abide by restrictions to movement. But that only lasted a short while. Within weeks other concerns took hold, not least of which being the economic impact of restrictions. Covid remained cause for concern, but the loss of jobs and other impacts at home became a more prevalent attitudinal driver. As a result, people’s perceived efficacy (i.e. their ability to abide by restrictions) began to decline.

Looking forward, when the efficacy element does not overpower the source of fear (COVID), individuals may choose not to adopt a suggested response, either because they feel incapable of completing the protective action or because the suggested action will not be effective. Rather than concerning themselves with eliminating the threat, individuals may look to control their fear by avoiding thoughts about the threat or minimizing the issue.

Should a second wave arise this is something government needs to be very mindful of.

Presenting facts isn’t enough

We are moving from a system based around vertical axis of trust, where we trust people who seem to have more authority than we do, to one predicated on horizontal axes of trust: we take advice from our peer group.

Gillian Tett, Financial Times, July 01, 2016.

Whether we’re hit by a second wave or not, the optimal road to recovery will require an understanding of what drives human behaviour. Sadly, as recently observed by a colleague of mine, Professor Jeff French… “we remain far more adept at counting the sick and the dead and reporting facts than we are at understanding what truly moves and motivates the people we purport to serve.”

The truth of this statement is evidenced in many ways, including how we engage (or fail to engage) with communities and the persistent top-down approach to health communications. As the road to recovery winds on, presenting facts and expecting people to change their behaviour because an expert say it’s in their best interests simply won’t suffice.

For the past few decades democracies have been moving away from vertical axes of trust. Citizens tend to pick and choose what information they believe based on their own pre-existing views. It’s called confirmation bias and the impact it’s had on our political and social fabric can’t be overstated.

This brings me to the three central characters in my metaphor – the lion, the scarecrow and the tin man. I think they have the attributes needed to ensure a successful road to recovery.

The lion – COURAGE

Governments must be courageous, and that means being open and transparent with the public. During a pandemic like COVID, which threatens so many lives, there is an ethical obligation on government to provide all relevant facts so that people can make truly informed choices. Thankfully, this openness and transparency is already evident in most jurisdictions, but it must be remembered that “shared responsibility” is a two-way street.

During the first few months of the pandemic some messages were framed in ways that were misleading. For example, misleading information was provided about the level of protection afforded by face masks. Statements about the safety of children attending schools were also not entirely evidence-based.

Finally, debate and responses to questions from the press (and others) tend to be characterised by repeated assertion of talking points to which factual rebuttals are often ignored. Governments need to be courageous enough to listen and respond to questions openly. The press could help by adopting a more measured, balanced approach to questions so as not to force politicians onto the defensive.

In many respects, despite all the negatives, COVID provides government with a unique opportunity to rebuild lost trust, and reframe its relationship with the public. Early signs are some jurisdictions are doing it better than others.

The scarecrow – BRAIN

The collection and use of reliable data in terms of contact tracing, community spread, and behavioural intent will remain critical as Australia’s COVID journey unfolds.

For example, the WA Government’s DETECT Snapshot program, which ended last week, failed to find a single case of coronavirus from more than 16,000 targeted tests of frontline workers. This has boosted local confidence that there are no hidden pockets of COVID infection in the community and will be used to inform policy adjustments, particularly around social gatherings.

Notably, the COVID safe app has been plagued by technical challenges, and as perceived risk has fallen the number of people downloading the app has done so too. We’re still about 1.5m below the 40% download target, and Australians are more supportive of using telecommunication company metadata (79%) to track close contacts than they are using the app (70%).

Reshaping environments to make it easier for people to practice physical distancing will remain useful. Even simple behavioural prompts can be very effective.

The public is more intelligent than some like to think. It’s also worth considering that many people don’t solely rely on government messaging to inform their behavioural choices with regard to COVID. So, messages need to be consistent across all Australian jurisdictions. Our response should also account for the impact that information originating from other sources (credible or otherwise) has on shaping people’s attitudes and beliefs.

The tin man – HEART

Our final character is the tin man.

There is a great deal to be gained through effective and appropriate application of behavioural insights, behavioural design, and data-informed interventions. That said, I also believe that to affect sustainable change, governments need to act with heart.

Will the road to recovery be paved with casualties? It’s hard to tell. What is certain is the socio-economically disadvantaged will be at greater risk from the direct and indirect impacts of COVID. A recent UK study found that the mortality rate of deaths involving COVID in the most deprived areas is 2.3x that of the least deprived.

While politics and health will always be intertwined, it will be important to ensure that the politics of health doesn’t lead to unnecessary casualties as we navigate our way through the new normal.

Health literacy is also a challenge for many Australian health consumers. It’s in this context that governments (State and Federal) need to convey essential health information to the public.

Many in Culturally and Linguistically Diverse (CaLD) communities, including a large number of older Australians, source their information from other community members and service organisations. Social distancing and organisational closures results in large numbers of people without access to their trusted information sources. We must ensure measures are in place to account for this.

If we want people to change their behaviours we need to ensure they understand what we’re asking them to do. We also need to help people do it. When asked how government should encourage adoption of new behaviours, 68% of respondents to a University of Washington survey said they wanted to be helped to do it (see figure below).

Source: Evans School of Public Policy and Governance at University of Washington

We also need to confer agency to the public and provide opportunities for people to actively contribute toward fighting the virus. This has the added benefit of helping to combat any sense of hopelessness which were seen in some areas during the lockdown. This will be particularly important should a second wave eventuate.

Final thoughts

The road ahead is uncertain and will be unique for each Australian. Government has the unenviable task of laying each (yellow) brick with the ultimate aim of leading the country to a full recovery.

As the journey unfolds, attitudes and behaviours toward COVID will change. While many are now applauding the success of preventative health measures there are others who believe we overreacted, due in large part to the very success we’ve had.

The relative success of Australia’s response has already led to complacency, If a second wave hits (and it almost certainly will) there’s a real danger people will be less willing to comply with physical distancing and self-isolation measures.

Government needs to consider this now, and future behaviour change strategies may need to be a little different to what we’ve seen thus far. For example, more controls may be necessary as voluntary compliance wains.

My final observation is that when many Australians were at their most vulnerable we were afforded a glimpse of just how good the new normal could be.

Whether our collective experiences to date are enough of a disruptor to completely break old habits remains to be seen. But has there been a shift in values? I’m not sure.

What I do know is that no matter what challenges we face on the yellow brick road to recovery, if we approach each one of them ethically and draw on evidence and lived experience to formulate our approach we will minimise the number of casualties along the way.

I want to end with a fantastic ad out of New Zealand that seeks to build social solidarity. It’s something we’ll need here in Australia too as our journey along the road to recovery continues.

If you’d like a copy of the slideset feel free to get in touch with me via email.

Director Zia Mandviwalla
Agency: Clemenger BBDO Production Company: FINCH

Watch the webinar…