Social marketing for health promotion in CALD communities

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• Social marketing for health promotion in CALD
  communities
• Is first do no harm more easily said than done?
• Kim Webster,
• Senior Program Adviser

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What is social marketing?

• Social marketing is the systematic application of
  marketing along with other concepts and
  techniques to achieve specific behavioral goals
  for a social good.
• Campaigns and other methods of persuasion
  (community education, advocacy)

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About this presentation

• Draws on practice experience of VicHealth and its
  partners to
• Highlight some of the unintended harms that may
  result from using social marketing approaches to
  promote health in CALD communities
• Discuss some lessons learned
• No neat solutions but some principles

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Applications of social marketing in health
promotion in CALD communities

• Behavior change (ether directly or by seeking to
  strengthen social norms)
• to improve individual self care (eg smoking
  cessation programs)
• to reduce the risk of harm to others in the
  community (eg programs to reduce drink driving)
• to reduce the risk of harm in personal relations
  (eg programs to prevent domestic violence, child
  abuse)
• in the ways people and organizations in the wider
  community treat people from CALD backgrounds
  (anti-racism, cultural awareness, more sensitive
  service provision)
• Messages to CALD communities can be delivered
  through specifically targeted programs or general
  programs designed to reach a diverse audience

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Targets for change

• Typically a social marketing campaign has a
  primary target (the group of people whose
  behaviour the campaign is seeking to change)
• However the messages often reach other
  secondary audiences (either intentionally or
  unintentionally)

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Potential risks

• Social marketing messages can have unintended
  negative impacts on
• The primary target audience
• Groups other than the primary target
• Secondary influences may not always be a bad
  thing and may be a specific goal of the program.
  
• For example anti-smoking campaigns development
  of broader social norms against smoking
  increased commitment to take action on tobacco
  control

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Case study 1 primary prevention of violence
against women

• Primary prevention involves preventing violence
  before it occurs
• Primary target is men (primary perpetrators and
  masculine socialization implicated as a causal
  factor)
• Effective approaches involve addressing gender
  inequalities and gender socialization and
  communicating that violence is unacceptable
  regardless of the circumstances
• Violence is not confined to CALD communities but
  emerging evidence indicates that it may be more
  prevalent (suggesting the need for greater
  resource allocation to these communities to
  address the issue).
• Accordingly, decision makers/service providers
  may be a secondary target.

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Case Study 1 cont

• Risks in high-lighting the issue and/or possible
  higher prevalence in CALD communities
• Secondary audience risks
• Stigmatizing CALD communities and compounding
  marginal status
• Contributing to stereo-types of migrant men as
  patriarchal women as passive victims
• Compromising commitment to settlement of
  particular groups
• In the wider community - undermines understanding
  that the issue cuts across racial and ethnic
  lines (US mainstream campaign example)
• Primary audience risks
• Risks in a zero tolerance/gender equality
  approach
• Disrupting social relations in already fragile
  communities
• May have little resonance with, and may alienate
  those from CALD backgrounds who have been subject
  to collective violence and marginalization prior
  to or following arrival

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Risks in NOT addressing the issue/selectively
retreating from zero tolerance

• Equity? Is CALD womens welfare any less
  important than the welfare of other women?
• CALD women are especially vulnerable face the
  double jeopardy of sexism and racism (domestic
  violence markedly increases the risk of domestic
  homicide)
• Denial of the lived experience of CALD
  women/disempowerment
• Policy/program neglect

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Case study 2 Anti-racism

• Target is the wider community
• Evidence indicates that effective messages are
  those that emphasize commonality with minority
  ethnic groups

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Case study 2 Anti racism

• However this risks unintended harms to the
  secondary ethnic minority group audience as
• Portrayal of minority ethnic groups in ways that
  are acceptable to the wider community may not be
  acceptable to groups themselves (eg emphasis on
  food and dance).
• Results in minority ethnic groups being accepted
  only on the terms of the wider community (thus
  compromising ethnic identity)
• Denial of ethnic identity now regarded as a form
  of racism itself. Has implications for health.

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Case study 3 Infectious disease and refugee
trauma

• Early intervention critical
• Expert consensus that migrants and refugee
  present minimal risk to public health
• Campaign Targets
• new arrivals to encourage early and active help
  seeking
• primary care workers to identify and take a more
  proactive approach with new arrivals

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Case study 3 Infectious disease and refugee
trauma

• Unintended impacts (primary and secondary
  audiences)
• Moral panic and xenophobia
• Stigma
• Stereotyping as weak or vulnerable
• Commitment to settlement of particular groups
  compromised
• Political considerations drive health service
  responses risks over investigation, undermining
  of client autonomy
• Barriers to services

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Case study 3

• Risks in NOT addressing the issue
• Undetected disease can be more complex and costly
  to treat and may be associated with reduced
  quality of life and productivity. May ultimately
  result in loss of life.
• Inadequate resource allocation
• Opportunities to sensitise services foregone

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Some principles to consider

• Consider impacts on other audiences and explore
  this in formative research with a view to
  addressing negative impacts where possible
• Assess risks and benefits (but avoid planning
  to worst case scenario)
• Engagement of affected groups in developing
  messages and imagery

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Human rights or cultural relativism?

• Important in weighing up the potential harms to
  cultural integrity/ethnic identity
• Cultural relativism
• The belief that an individuals beliefs and
  activities can be understood in the context of
  their own culture and that all cultural beliefs
  and practices are equally valid
• A human rights framework
• Culture is important and ought to be respected
  and preserved, but does not transcend basic human
  rights, in particular the right to safety and
  security.
• .

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Human rights or cultural relativism?

• Implications for message framing the violence
  against women example
• In planning - acknowledging mens context but
  not accepting it as an excuse for violence on the
  grounds that womens human rights need to be
  similarly respected
• In message framing use of messages that achieve
  the desired outcome while preserving important
  cultural values (and promoting these to the wider
  community)
• Using cultural reference points (beliefs, key
  opinion leaders) to demonstrate that violence is
  not acceptable
• Examples
• Spectrum Migrant Resource Centre video Family
  men dont do family violence
• Northern Inter-faith Communities poster.

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Some principles to consider

• Plan to contain risk and maximize benefits
• Build political support for the campaign
• Cultivate leaders in both minority ethnic and
  wider communities to respond to problems (but
  also strengthen work!)
• Social marketing (alone) does not a health
  promotion program make!

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More information

• www.vichealth.vic.gov.au