health reform picToday’s signing of the Affordable Health Care Act for America will, I believe, be one of the most important moments in the history of our nation’s efforts to provide a basic standard of living for its citizens.  It is a massively imperfect piece of legislation, and yet it moves our nation in a positive direction and sets forward many standards for improving the system in countless ways as the reform measures are put in place.  It is already clear that there will be a great deal of “communications” to portray the reform as a great step forward or the dawn of socialism.  But there is a more important aspect of communications related to health reform that I want to highlight, and that is communicating to citizens about what they need to know and do now that their relationship to the healthcare system is changing.

And on this topic, I want to recommend that folks who follow PPC-NYC consider adding to their RSS feeds a blog called On Social Marketing and Social Change. I’ve been reading it for the last several months and learning a lot from it.  They’ve been doing a lot of posts on health issues in particular.  There are three posts in particular I’d like to highlight.

In the first post I’m highlighting, “The Dragons of Behavior Change,” the author lays out some of the key concepts of behavior change related to health and takes on those whose communications have only the modest goal of “awareness.”

Behavior change is the hard part, and why people seem to be so comfortable with ‘just’ building awareness of problems and possible solutions. Advertising and public relations agencies have said for years “Hold us accountable for awareness or brand image, not sales.” Their rationale is that it is the sales people who need to ‘change the behavior’ of the consumer to make the purchase – advertising and promotions can get people into showrooms, stores and other places where you stock the product, in sufficient quantities, at the right place in an appealing way, but that last step… that’s someone else’s responsibility. Unfortunately social marketers don’t get to pass off to others the responsibility for behavior change.

That post provides a strong argument for the need for planning communications around behavior change and not just “awareness.” It also makes the case for being clear about budgeting for communications around behavior change — especially since the forces against good health behaviors often have massive budgets for influencing behavior (advertisers for cigarettes, junk food, etc.)

The second post I’m highlighting is “MINDSPACE for Behavior Change.” This post distills a report that details the specific elements of behavior change that we should all be clear on.

Messenger: We are heavily influenced by who communicates with us.
Incentives: Our responses to incentives are shaped by predictable mental shortcuts, such as strongly avoiding losses.
Norms: We are strongly influenced by what other people do.
Defaults: We tend to ‘go with the flow’ of pre-set options.
Salience: Our attention is drawn to what is novel and seems relevant for us.
Priming: Our actions are often influenced by sub-conscious clues.
Affect: Our emotional associations can powerfully shape our actions.
Commitments: We seek to be consistent with our public promises, and reciprocate acts.
Ego: We act in ways that make us feel better about ourselves.

That post differentiates between “rational” and “cognitive” approaches related to communications and behavior change.  Again, a very strong case is made for focusing resources on getting to the ultimate behavior change rather than necessarily trying to change people’s thinking.  You may think that it is impossible to change behavior without changing people’s thinking, but this post provides a lot of food for thought on that matter.

The third post, “National Objectives for Health Communication and Health Information Technology,” was written BEFORE the final health reform legislation was signed and details some of the actions around health communications that the Department of Health and Human Services was taking to change public behavior independent of the reform legislation. DHS’s newly adopted social marketing objectives are:

Increase social marketing in health promotion and disease prevention.

a: Increase the proportion of state health departments that report using social marketing in health promotion and disease prevention programs.

b: Increase the proportion of Schools of Public Health and accredited MPH programs that offer one or more courses in social marketing.

c: Increase the proportion of Schools of Public Health and accredited MPH programs that offer workforce development activities in social marketing for public health practitioners.

All three of these posts are worth reading in full to get your thinking going about the importance of behavior change in communications around health issues.  I want to make a strong case for the need to do a great deal of communications around what citizens need to know and do about health reform.  Just because the legislation has been passed and it has gotten a lot of press coverage doesn’t mean that people know what they’re supposed to do now.  When a person looses his job, no one tells him all of the benefits that he is eligible for and how to go about getting them. There are already lots of health benefits that families are eligible for that they don’t take advantage of because of the inadequacy of our nation’s outreach to vulnerable populations.  I am afraid that a similar situation will occur with the new benefits and requirements associated with health reform. We need to be investing in telling people what they need to know and do about the new healthcare system.  Yes, the legislation has passed and President Obama has signed it.  But it’s no time to sit back and celebrate.  It’s time to design a system for communicating to the American people — especially the most vulnerable — what they need to know and do to take full advantage of the new reforms.