Social marketing for public health.

Marketing techniques and tools, imported from the private sector, are increasingly being advocated for their potential value in crafting and disseminating effective social change strategies. This paper describes the field of social marketing as it is used to improve the health of the public. A disciplined process of strategic planning can yield promising new insights into consumer behavior and product design. But the "technology" cannot simply be transferred without some translation to reconcile differences between commercial marketing and public health.

PIP: While the administration of US President Bill Clinton is trying to reform the US health care system, less attention is being given to changing behavior. The problems caused by excessive alcohol drinking, poor diets, and the use of tobacco products and other harmful substances often tend to be more related to a country's health status than are acute, short-lived illnesses. Private sector-derived marketing techniques and tools are increasingly being used to create and disseminate effective social change strategies. The authors describe how social marketing can be used to improve public health. They draw from information obtained from major textbooks, conference proceedings, telephone interviews with more than 30 practitioners and scholars in the field, and data on the application of social marketing in maternal and child health and nutrition in developing countries, family planning in developing countries, the anti-smoking campaign in the US, cardiovascular disease risk reduction, and substance abuse prevention among adolescents. Sections consider the historical convergence of marketing and health promotion; the essential elements of a social marketing approach to health; lessons learned from applications of social marketing to health; and limitations, caveats, and issues for the future.

Who needs Medicaid?

Faced by a worsening economy and a powerful public mandate to decrease taxes and non-defense government expenditures, many are calling for additional cuts in spending for Medicaid-a large, not very popular program that pays for the medical care of many of the nation's poor. Available evidence suggests that Medicaid has been far more valuable than is commonly realized: It serves a broad cross-section of the American people, its adoption coincides with major improvements in the health of Americans, and its costs per recipient are about the same as the costs of care per person for all Americans of similar age. Not widely recognized is the program's importance to the financial well-being (if not the very survival) of any major teaching hospitals and the majority of nursing homes in this country. Public and professional awareness of the accomplishments of this program may be a crucial factor in determining whether the cuts will spare many of the gains in access to medical care that have been made during the past two decades. If we do not wish to reduce needed medical services to the poor, health-care institutions and health professionals will have to cooperate with each other and with the government in developing less costly ways of delivering high-quality care.

An era of stress for health institutions. The 1980s.

The United States enters the 1980s beset with serious economic problems. The picture currently projected from long-term economic forecasts supplemented by national opinion polls for the early to mid-1980s suggests a downturn in our nation's economy and a sharp decrease in monies available for further growth or improvements in America's medical care system. These prospects have serious implications for many of America's most important health care institutions, their health professionals, and how plan for the future.

Medical technology -- a different view of the contentious debate over costs.

There is a growing conviction that medical technologies are major contributors to escalating costs, and regulating them is generally viewed as the least contentious way to control expenses in the 1980's. Five forms of technology control are being discussed or developed. All aim to reduce costs by controlling big, expensive technologies in the class of computed tomographic (CT) scanning. We present evidence that technologies such as the CT scanner account for far less of the growth in medical expenditures than do the collective expenses of thousands of small tests and procedures. Furthermore, we suggest that each strategy for controlling large technology involves substantial practical and conceptual problems that would severely limit its effectiveness. We thus suggest a shift away from attempts to harness the big technologies, and toward incentives to encourage the more discerning use of all technologies. To this end, we propose changes in physician reimbursement and education and expanded insurance incentives to encourage physicians and hospitals to be more selective in the use of technology.