Social Marketing´s Products: Ideas and Practices

Social marketing is distinguished by its emphasis on so-called non-tangible products-ideas and practices-as opposed to the tangible products and services that are the focus of commercial marketing.

An integral part of ideas are beliefs regarding certain issues and the way they should be dealt with. These beliefs range from general world views (of religions, for example) to culture-specific notions (such as a "dowry system") or identification with a group ("we as employees of the Novartis Foundation"), to a person's self-image ("I as a committed environmentalist"). Ideas also include attitudes toward people, things, concepts, or events. Our approval or disapproval of them depends largely on our individual value premises.

Individual and societal behavior, exemplified by actions (as well as failures to act), is largely conditioned by whether we are pragmatic or act on the basis of values, tradition, or emotions. Pragmatic behavior considers the purpose, means, and consequences of a course of action or nonaction, whereas value-oriented behavior rests on ethical, aesthetic, religious, or other considerations regarding the intrinsic value of a certain mode of conduct without regard to the consequences.

The traditionalist acts in accordance with institutionalized norms and practices, while emotional behavior is shaped largely by moods. Therefore social change can best be effected by bringing about new ideas and beliefs and there- by behavior.

To cite just one example of this process in more detail, social and psychological factors play a greater role in connection with leprosy than with almost any other disease. A social study that we carried out in Sri Lanka in 1989 revealed that traditional beliefs about leprosy lead to feelings of guilt and shame in patients, to apathy and resignation, and even to aggressiveness toward society. Leprosy is often seen as an act of God, as punishment for sins committed in an earlier life, so that nothing can or should be done against it: it is fate.

The afflicted seldom enjoy tolerance or support from the community; on the contrary, they are threatened with banishment from family and neighborhood as social outcasts. Healthy members of the family are also looked on as "tainted," leading to social problems. Patients try to elude social rejection by concealing themselves and their illness. This enables the disease to progress to the point of irreversible and visible physical deformities, and also increases the likelihood of it being transmitted to others.

Since 1982, multiple drug therapy (MDT), recommended by the World Health Organization, has been the standard treatment for all registered leprosy patients in Sri Lanka. In 1989, however, an estimated 12,000-15,000 leprosy sufferers remained untreated, many of them highly infectious. Efforts to find these hidden cases relied mainly on actively searching for them in house-to-house surveys. Only a few hundred cases were thus detected, and about a third of them refused to accept the diagnosis as they associated leprosy with deformities and not with the relatively harmless looking early signs on their bodies. Moreover, with the personnel constraints in the anti-leprosy unit of the Ministry of Health (three medical doctors and fifteen leprosy workers), and with few medical or paramedical workers willing to join the program because of the poor perception of the disease, a dramatically different approach was required to find the hidden cases.

The new approach was social marketing, and this was carried out in close collaboration by the Sri Lankan Ministry of Health, Leprosy Relief Emmaus Switzerland, and the then Ciba-Geigy Leprosy Fund. The campaign "markets" two social "products": an attitude-"do not fear leprosy"-and a behavior-"seek and comply with treatment." The campaign hinges on MDT as its "tangible" product basis, without which the two social products would be void.