Ring-fenced funding, smoking cessation, social marketing and slave labour

Further to this post, a planning document has come to light (h/tip Eddie) entitled The Application of Social Marketing to Behaviour Change in Tayside – A Progress Report. It gives a budget for two items regarding smoking cessation totalling £540,000 and two items on social marketing totalling £162,000.

I am struggling to get hold of what social marketing is really about. Here is a very quick explanation using the smoking example:


Gerard Hastings is an international pioneer on this issue, and loves working with authority at the highest level on interventions supporting the official view of desirable behaviour change. An anonymous commenter on this blog assures me that social marketing is about behaviour change according to people's aspirations, rather than according to the grandiose notions of public health. Perhaps I should have attended this conference?

For the time being, Hastings is the only authority I have consulted, and I've yet to be convinced that there is anything politically radical or right on, or democratic, about 'top down' programmes of behaviour change. Democracy is about being represented – not being managed.*

Social marketing as developed by NHS Tayside is about top-down management. It's about NHS Tayside deciding on a desirable behaviour change, be it handwashing or smoking cessation. I would be the last to claim that the budget here was very high, but still would contend that a handwashing policy in a health service doesn't require a social marketing toolkit. It's basic hygiene.

The smoking cessation programme, with a target of 360,000, has got 800 into its fold of which around half abstain for up to three months. Its target is 1,800 quitters, or 2 per cent, over two years. Nothing startling there in marketing terms, especially if the targets are for a three-month quit. But do we really need to ring-fence that money for a very small number of people to quit smoking? Over half a million pounds?

Reading on we discover that the supermarket vouchers paid out to people passing their carbon monoxide tests probably come from Asda, since Asda is listed among the  'partnerships'.

Asda – now where did that name come up recently? Another initiative to reduce health inequalities? Oh no, it was this:

Unemployed people ‘bullied’ into unpaid work at Tesco, Primark and other multinationals 

Unemployed people are being sent to work without pay in multinational corporations, including Tesco, Asda, Primark and Hilton Hotels, by Jobcentres and companies administering the government's welfare reforms. Some are working for up to six months while receiving unemployment benefit of £67.50 a week or less.

On another page, another company participates in the no-work-no-benefit charade – a registered charity this time:

March 2009 was my first claim. The placement was seven months after. [Before that] I was going to college [to learn English]. I paid £50 for it. Then when I went to the job centre they told me: “Now it's the New Deal. You're going to a placement”. I told them my English was not good but they said: “It doesn’t matter, you have to go. If you're not going, we’ll stop your money.” They told me they would stop my JSA [Job Seekers Allowance] so I stopped my English course.

The first [placement] was with the British Heart Foundation. I worked from 9 or 9.30am to 4.30pm with a half hour break. I did everything. I went for one week and the manager was so rude. One day she ate something and left so much mess in the kitchen. Then she says to me: “Karina, you wash up.” The first time I didn’t say anything. I was scared they would stop my money.

My point isn't to 'get at' Asda or the British Heart Foundation. It's to show how companies that participate in top-down initiatives supposedly to improve our health are capable of profiteering from government initiatives to get people off benefits. Again: 'Instead of being represented, we are now being managed. The governments in all the western countries manage us on behalf of the international system.'*

*with thanks to Tony Benn (reply to second question)

Gerard Hastings: Mandela points out dangers of smoking to prisoners on Robben Island

In this lecture on social marketing (discussed earlier here), Hastings describes how Nelson Mandela made his fellow prisoners aware that getting cigarettes in prison would involve making deals or exchanging favours with prison guards. I think Hastings is pushing the issue by presenting this as a simple attempt by Mandela to stop prisoners from smoking in the interests of their health. He was – I would expect – far more concerned with the vulnerability of prisoners and how this could be exploited by prison guards, than with the issue of smoking as a health concern. The Mandela clip is right at the start of this:



Actually I find his whole message hard to swallow. 'Doing things with, not to, people'? It takes an entire new academic discipline – social marketing – to encourage people towards behaviour change, and simultaneously to encourage them to believe that the changes in behaviour came of their own volition? It may make a kind of sense to some people – but it assumes that a common core of 'health-oriented' goals will motivate everyone, and this is far from being the case. To quote from our banner,

When health is equated with freedom, liberty as a political concept vanishes.

I find it hard to believe that Mandela, as a freedom fighter, would have espoused denormalisation as a strategy, as it is practised against smokers today. One of Mandela's followers, Steve Biko wrote extensively about what he termed 'Black Consciousness' – the necessity for blacks to think 'Black is beautiful', to take pride in black identity, way of life, economy and political cause. Under a pen name Biko wrote through the years after his banning at the age of 26, until his imprisonment and death in incarceration in 1977 aged 30. For example:

What of the white man's religion – Christianity? It seems the people involved in imparting Christianity to the black people steadfastly refuse to get rid of the rotten foundation which many of the missionaries created when they came. To this date black people find no message for them in the Bible simply because our ministers are still too busy with moral trivialities. They blow these up as the most important things that Jesus had to say to people. They constantly urge the people to find fault in themselves and by so doing detract from the struggle in which the people are involved. Deprived of spiritual content, the Black people read the Bible with a gullibility that is shocking. While they sing in a chorus of 'mea culpa' they are joined by white groups who sing a different version – 'tua culpa'. The anachronism of a well-meaning God who allows people to suffer under an obviously immoral system is not lost to young blacks, who continue to drop out of Church by the hundreds. Too many people are involved in religion for the blacks to ignore. Obviously the only path open for us now is to redefine the message in the Bible and to make it relevant to the struggling masses. The Bible must not be seen to preach that all authority is divinely instituted. It must rather preach that it is a sin to allow oneself to be oppressed. ... Black Theology seeks to depict Jesus as a fighting God who saw the exchange of Roman money – the oppressor's coinage – in His father's temple as so sacrilegious that it merited a violent reaction from Him – the Son of Man. (p. 45)

The abuse of power by whites under Apartheid was extreme and decades-old. Denormalisation of smokers and other groups, in its latest manifestation, is a relatively recent phenomenon. It is hard to imagine Biko or Mandela agreeing that health issues, as defined by senior civil servants and professors in social marketing, should define the aspirations of working people or the unemployed. It is particularly hard to imagine them being taken in by the rhetoric of social marketing – manipulating behaviour change of the powerless by the influential. It smacks too much of saying that the powerless want to be just like the influential (70 per cent of them anyway!). Starting with the missionaries long, long ago, says Biko:

Children were taught, under the pretext of hygiene, good manners and other such vague concepts, to despise their mode of upbringing at home and to question the values and customs of their society. The result was the expected one – children and parents saw life differently and the former lost respect for the latter. ...Yet how can one prevent the loss of respect between child and parent when a child is taught by his know-all white tutors to disregard his family's teachings? (p. 110)

 Hastings is correct to credit Nelson Mandela with leadership skills – but not to imagine that Mandela's heart was won over by an anti-smoking campaign that wasn't in progress when Mandela went to prison and was barely perceptible when he came out.

Excerpts from Steve Biko, I Write What I Like, Penguin, 1988 edition.

Plain packaging on the way, Westminster and/or Holyrood

Has Andrew Lansley, who has been weighing up whether to implement the display ban as passed into law, found an even stronger form of deterrence? The BBC announces that the Department of Health will consider requiring plain packaging for tobacco products, and that it will put together a White Paper on the subject (it also says the government 'will ask' shops to cover up displays from next year: the wording is too mild to suggest that any final decision has been made).

Compelling the sale of tobacco in plain packaging cannot fail to make counterfeiting easier and cheaper, but legislation requiring such a move has already been mooted in Australia. The Scottish Government has also expressed interest in this, but does not have the powers to pass legislation on packaging. An SNP spokesman said: “The SNP is favourably disposed to this idea, and if Westminster will not do it then the powers should be transferred to the Scottish Parliament".

It would seem that the SNP might not need the extra powers, if the Westminster government proceeds to bring in legislation. Is this a factor behind the Department of Health's interest in the idea: 'being in the lead in tobacco control'? (or do they wish to prevent the devolution of further powers?)

Within Scotland, the effectiveness of plain packaging as a deterrent to smoking is disputed. Enrico Bonadio of Abertay University predicts a price war, but Crawfood Moodie (of the Institute for Social Marketing – yes, them again!) believes that the deterrent effect will outweigh any price war. The tobacco industry has concerns over its right to a brand image, and warns of legal trouble in the event of any legislation.

Nothing would be less surprising than an aggressive policy of this kind in Scotland, where ASH Scotland rules supreme. The same cannot be said of England however, where even many Tories have felt grounds for hope that the Coalition would adopt a less 'nanny state' line of policy. Dick Puddlecote has been enjoying disabusing them of their hopes of a better future under the Coalition.

LiberalVision also comments: also disillusioned with its leaders over more central control and illiberal governance, in contrast with its promises. More criticism from the Scottish blogosphere would be welcome: surely not everyone in Scotland approves of this policy?

Sheila Duffy, smoking ban on cars and social marketing

This letter appeared almost a week ago. Sheila Duffy remarks that, of all the proposals presented in Beyond Smoke-Free, people were interested only in the proposal of a smoking ban on cars.

But she doesn't want a smoking ban on cars.* She wants a debate and a public consultation on a smoking ban in cars (on a proposal that she claims not to want to be brought into law – doesn't she know we're all tightening our belts now?), and a social marketing campaign on smoking in cars.

Social marketing again. Has she got shares in it?

She might as well advocate a brainwashing campaign, or re-education. What's wrong with a good old-fashioned educational campaign? Not persuasive enough?

* Unlike Dame Helena Shovelton (British Lung Foundation).

Bad science in a good cause is bad science: social marketing under a spotlight

John Davies, a professor with scruples, explains why bad science in a good cause is still bad science.

The object of his attack is social marketing, which is manipulating/influencing people to achieve societal goals, as opposed to marketing in a commercial context, which clearly aims to influence people for commercial gain. Social marketing prides itself on manipulating people for their own benefit. However I don't know a huge amount about this area so have included this link from the Open University, which introduces some of the ideas behind social marketing. It says that social marketing relies on voluntary compliance rather than coercion. My thoughts: velvet glove, iron fist (h/tap Chris Snowdon).

Social marketing appears critical of commercial marketing, however the book Social Marketing carries the subtitle 'Why should the devil have all the best tunes?' Proponents such as Gerard Hastings, the book's author, clearly have much to learn from commercial marketing about the techniques of persuasion, but will they be any more honest than their commercial counterparts? 

The Open University link above explains social marketing as 'marketing to achieve social goals'. But whose social goals? Is there a social consensus about the matters that social marketing is involved with, namely health and the environment? Certainly not, I would suggest, these days.

Social marketing is mentioned frequently in anti-smoking initiatives, indeed John Davies refers to the passive smoking concept as an example in his video. ASH Scotland's recent report Beyond Smoking refers to it in both section 2 (Cessation) and section 3 (reducing exposure to second-hand smoke). In both these sections social marketing is employed to influence people into behavioural changes. The end is clearly felt to justify the means (John Davies tells how it is also employed in education about cocaine use). 

Social marketing also popped its head up at the 2010 UK National Smoking Cessation Conference in Glasgow, in the shape of at least one session featuring the use of social marketing: it featured telling the stories of real life quitters and was presented by Andy Lloyd and Martyn Willmore of Fresh Smoke Free North East (their group is also featured in the recent Forest report, from page 10). Lloyd, interestingly, is Media, Communications and Social Marketing Manager for their organisation, which gives some idea how central social marketing is to the tobacco war. 

We are grateful to John Davies for putting the question: once you start telling lies, or disguising the truth in a good cause, where does it stop? I think he did not quite ask, Who decides what the truth should be? Where's the accountability? All good questions, and ones that the public increasingly begin to ask.

ASH Scotland's vision of a new dawn

For some reason my pc won't cope with pdfs just now, so I went to another place to read the new Beyond Smoke-Free document issued yesterday by ASH Scotland. Surprisingly it doesn't describe a smoke-free Scotland, but one in which tobacco is increasingly regulated. They are less ambitious than I thought, and the name of the document is definitely a misnomer (they are still at the stage of 'Towards Smoke-Free').

The opening image shows a family of four blissfully jogging in the sunshine. I think the implication is meant to be that smokers don't (or perhaps can't) jog.

A brief summary of the doc is as follows.

Part 1: Prevention
Short term
More youth involvement in prevention initiatives
Targets for young people post-2014
Prevention work at local level
Display ban
Tackle illicit tobacco
Tobacco control issues included in Curriculum for Excellence

Medium term
Further reduce visibility: promote law in the UK for standardised, unbranded packaging
Money seized from smuggling to go to youth prevention initiatives
Award scheme for retailers that choose not to sell tobacco

(note: 'TOBACCO IS UNIQUELY DANGEROUS ... it is not a normal product and should not be sold as such': I am not sure if this is thought be a scientific claim.)

Part 2: Cessation
Short term
Already effective and cost effective but more needs to be done: evidenced based, wide variety of solutions should be offered
Service should be more accessible to hard-to-reach groups
Create quality standards and identify gaps in training provision
Engage in evidenced based social marketing to highlight the dangers of  taking up smoking at any age
Encourage government to replace information about tar and nicotine content with general information about the dangers of smoking and where to go for advice on giving up
Tax increases 5% per year

Medium term
All health professionals should be able to discuss smoking with their clients
All health professionals trained in discussion of tobacco and appropriate referral
Support for developments in smoking cessation

Long term
Significant increase in price of hand rolling tobacco and prohibiting tax and duty free tobacco in the UK

Part 3: Second hand smoke exposure
Short term
Extend laws to areas currently covered by exemptions (prisons, mental health facilities)
Social marketing campaigns to increase people's awareness of the dangers of smoking in vehicles
Interventions to prevent smoking in the home, provision of training in implementing such measures
Consultation on legislation to ban smoking in vehicles
Targets for zero exposure at home and in vehicles: awareness raising

Medium term
All health and education institutions to have smoke-free grounds
Effective harm reduction strategies (e.g. NRT to stop people smoking at home)

Long term
Further limitations to exposure

Part 4: Government, society and industry
Short term
Develop a multi-agency national tobacco strategy for each area of Scotland
Transparent reporting on tobacco interests in article with Article 5.3 of the FCTC
Develop reduced ignition propensity cigarettes: four out of 10 home fire deaths result from tobacco smoking – ensuring that tobacco industry has no say in health policy and no increase in customer base

Medium term
Scottish Government will continue to influence UK government on tobacco control
Government will regulate tobacco promotion, marketing, information provision and sale
More tobacco industry accountability on ingredients
Use influence with developing country partners such as Malawi to improve conditions of tobacco growers, with the aim of cultivating other crops instead.

Long term
Tobacco industry to be made more accountable, tobacco proceeds to finance tobacco control.

***

Well there you have it. One or two measures, affecting packaging, product information and the availability of duty-free products, are reserved issues and cannot be taken forward by Scotland alone.

The issue of what information goes on to a pack of tobacco is included in the present consultation on revising the EU tobacco products directive, which is worth looking at: they wish to get a green card from the whole of Europe to maximise government regulation at a Europe-wide level. You can download the consultation here, and anyone can respond.

Please note that the removal of exemptions in the smoking ban legislation is included as a short-term aim. I don't know whether it includes long-stay hospices or care homes, or only the mental health facilities that we already know are under threat.