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A Society-Based Development Strategy
Selling the world on iodized salt is not like marketing Coca-Cola. It’s not about boosting market share or getting most people to buy it. It’s about saving the brain of every child -- preserving normal growth by protecting against brain damage.
Nor is universal salt iodization simply a matter of passing laws, telling people to make it and take it. "Just legislate, and save yourself 10 years of hard work," may be the new refrain. Yet when it comes to people who are most urgently at risk and those hardest to reach, whether they be distant farmers or defensive bureaucrats, the truth is: "Just legislate, and waste 10 years of hard work."
Legislation and marketing are essential, but they are not enough
Iodized salt is required by law in most countries, and is priced, packaged and advertised. These measures have saved hundreds of thousands of children from the risk of iodine deficiency disorder (IDD). But over a billion people in more than 100 countries are still vulnerable to mental retardation and physical defects from the lack of iodine in their diets.
Despite well-meaning legislation, practice often lags behind policy. People do not always use the iodized salt even when it’s available or do not use it properly, and health benefits fall short of expectation. Demand for the healthier salt in many countries has not kept up with availability. And without a guaranteed market, salt producers are sometimes reluctant to assume the costs of iodization. Meanwhile, influential agencies and individuals may not know how to create an environment that supports iodized salt consumption, or they may have insufficient incentive to exercise their power to do so.
Marketing is not enough to remedy this situation in regions suffering the most endemic brain damage from IDD. Messages that aim to increase the popularity of iodized salt are often slow to catch on and too weak to make a difference right away. A standard commercial campaign is not likely to reach into remote villages, or even the corners of major cities, fast enough to help the expectant mother carrying a fetus that may be born a cretin, or a young child whose brain is developing now and may be irreversibly damaged. A straight advertising approach may also ignore the communication needs of those in positions of power and authority. Advocacy is an important part of any communication strategy, and it should not be tacked on as an addendum. It should be part of an integrated plan for sustained change.
A broad, systematic, society-based strategy
Surely some program shortfalls may be due to price and availability problems, which need to be constantly monitored and corrected. But following a strictly marketing approach also leaves programs with certain inherent blind spots, where unseen enemies to development may be at work just beyond our notice. The purpose of this communication guide is to place good marketing research and methods within a more comprehensive framework that allows us to examine the unspoken doubts, objections, and the indifference of various groups within society. Presumed to support IDD programs, these groups often undermine program success because they are insufficiently involved or "mobilized."
This framework of activities is called social mobilization, a strategy intended to ensure that progress toward ending IDD will last and that those most in need will benefit. As more and more countries approach universal salt iodization, the problems of sustaining political will, motivating industry, and creating demand for good quality iodized salt among the entire population become more apparent. The social mobilization strategy can help because it is based on building partnerships, creating a dialogue, and working together with all segments of society. The whole point of approaching IDD with this orientation is to improve the efficiency and effectiveness of programs so they eventually will stand alone, without international support, continuing to protect future generations.
Though this strategy is flexible and still evolving, and unexplored possibilities emerge each time a new situation arises, social mobilization remains the most comprehensive development approach. It stresses the importance of sustained change through societal and environmental factors and recognizes the importance of involving target audience/partners in planning, developing solutions, implementing, monitoring and evaluation. If carried out properly, social mobilization is very likely to bring about sustainable development.
The communication process
Communication researchers have suggested many theories to explain how people come to accept new ideas and adopt new behaviors. Early research concentrated on the diffusion of agricultural innovations out to fairly passive recipients. The last people to accept new farming methods and technologies were referred to as "laggards."
Aware that they were "blaming the victim," researchers shifted to communication models that put greater emphasis on the influence of the social, economic, cultural and political environment, including existing beliefs and previous learning. We have come to understand communication as a process of exchanging ideas, information, and feelings. Instead of target audiences, we now think more in terms of partners -- participating individuals and groups in an interactive process.
Health educators have removed all trace of blame from their concept of communication by describing the interaction between health worker and client as "mutual discovery." And researchers have adapted anthropological techniques to develop health messages with the help of target audiences, providing some measure of exchange in the communication process, even in the context of large-scale national communication campaigns.
Partnerships are profitable
We also have come to understand that people learn, practice and adopt new behaviors indirectly through their interaction in groups as much and perhaps even more than they do as individuals directly exposed to messages. This is one reason program planners are increasingly concerned with creating close ties, or partnerships, with societal groups that influence the people they want to reach.
Another reason for working with partners is the success of the business communication process of turning potential competitors into partners through negotiation. By finding areas of common interest, collaboration, and profitability, a number of companies can work together to grow and thrive.In a world where government and industry are mutually dependent, creating "win-win" situations has become an effective development strategy as well as an enlightened business practice.
Social mobilization by any other name ...
In the early 1980’s, UNICEF first used the term "social mobilization" to describe a development approach based on building partnerships and dialogue. About the same time, WHO used the term "health promotion" for its expanded concept of health education that included advocacy and social support on the community and policy levels.
Private advertising firms, which had used "social marketing" as a product-oriented and media-driven approach to development, broadened their definition to focus on consumers and to include advocacy and the building of partnerships. Today, the best social marketing work takes a broad, systematic approach to promoting a health "product" by putting more emphasis on social and political support and on training and motivating the people who can make the program work. By any name, building broad social and political support is part of good program management.
Of course, many agencies still prefer to use their well-established terms -- health education, health communication, health promotion, IEC, social marketing. And new terms are always arising, such as "strategic mobilization" and "communication for behavior change" which are terms used to indicate a combination of mobilization and marketing approaches. But no matter what label is attached to a development strategy, the critical element in the communication process itself is dialogue with people.
The idea is not to tell people what to do, but to work together in a partnership, a partnership of equals, listening to what interests they have, encouraging them see for themselves the value of a new idea or practice and letting the program be influenced by their perception. By acknowledging and allowing for the agenda of each partner, groups and individuals come to recognize what stake they hold in the program and will lend support in their own way and out of their own self-interest. The listening, the dialogue, the partnership relationship -- these are what underlie the mobilization process. By any name, the strategy is the same: to involve everyone concerned, gather strength through concerted action, and let each stakeholder do what he or she does best.
Social mobilization sustains social change
Strength and consistency are crucial because putting an end to IDD is a bigger job than it seems. Getting everyone to consume iodized salt means creating a new habit, a new standard for generations to come, a standard that requires not just a large market share, but almost 100% compliance. We are fostering a new norm to be followed by all people for all time. And to end mental retardation due to lack of iodine, once and for all, we need changes in attitudes, changes in behaviors, changes in our way of doing business.
The social mobilization framework, as it has evolved, helps to maximize the impact of communication efforts to create and sustain exactly these kinds of changes in thinking, acting, and interacting. This broad, societal approach promotes political commitment, community participation, and decentralized action, and encompasses the important elements of marketing such as audience segmentation and message design. But it is much more than the sum of its activities.
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Box 1 - The Strengths of Social Mobilization
- Raises policy commitment;
- Coordinates human and financial resources;
-Unites government sectors for a common purpose;
-Brings together bureaucrats and professionals;
- Strengthens commitment in regions, districts and communities; and
- Empowers consumers with the information they need to demand healthier salt.
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Even today, few national plans include strategic planning for communication. Many influential leaders in health and science still see communication as mere publicity, an event or two, a few announcements or, even worse, patronizing explanations of what may prove to be unfeasible health measures.
Sustained mobilization for development counts on awakening interest and stimulating discussion and action through the cumulative effect of efforts at many levels. It relies on positive reinforcement for change -- whether in individual attitudes and behaviors, or in bureaucratic and organizational ways of thinking and working. It is a broad-scale effort involving a range of players working in complementary ways toward common development goals. It is an integrated approach that reaches across societies and involves people at all levels. The purpose, each step of the way, is to build partnerships and encourage dialogue.
National scale
Social mobilization is usually national in scope, or is intended to expand rapidly from one phase or geographical area to national coverage. Therefore, only a major objective is likely to motivate the masses, their political leadership, and the bureaucratic and other organized forces in society. Although popular support for IDD work is often passive, inarticulate and uninformed, it is certainly there. Nobody wants a child’s intellectual and physical growth to be retarded, and no government official wants to see this retardation continue unchecked across widespread geographical areas.
Moving to national scale is not only possible, it is often necessary. IDD is a national effort because everybodyhas to use iodized salt to make sure protection against IDD is lasting. And while there is usually agreement in principle to take national action, program planners themselves often hesitate to commit to this scale of action, aware of the resources required to reach the community level. Some may fear that the social mobilization approach to ending IDD is too costly and difficult to carry out. After all, budgets are tight, and programs are under pressure to show fast, noticeable results.
And yet, social mobilization, if systematically carried out, actually can help lower the cost of programs by involving a wide range of government and private institutions which know how to communicate with their own clients and customers through media already in place. Popular institutions can make change more acceptable, and trusted peers can prepare people for what they will see and hear through the mass media. So social mobilization embraces many elements of marketing and smoothes the way for individual behavior change.
Reaching and involving the consumer is a major thrust of our work, but we need to assure simultaneously that the policy positions required to help the consumer are strongly advocated and publicly known. For instance, we may need to stress "all salt." Universal, after all, means "all." Ideally, at least all alimentary salt, should be iodized. It follows that in most countries iodizing salt has to be a nationwide effort, not a special measure for special, targeted people. Some suggest that we could ask industrial users of salt, like glass and steel producers, to file for exemption permission to buy non-iodized salt. We could ask industry to take on the burden of exemption, instead of putting the health and nutrition people in the position of pleading for the production and marketing of iodized salt that benefits the whole population. Children and the common good should come first.
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Box 2 - Early Lessons: Work with Industry and Sustain the Effort (Ecuador)
One of the earliest social marketing efforts to promote iodized salt was a 1974-76 study in Ecuador that used radio messages combined with structural support by ECUSAL, a subsidiary of Morton Salt. This collaboration led to a remarkable increase in reported use of iodized salt from 5%-98% in two provinces. But researchers discovered that Mestizos benefited more than Indian populations, and when the researchers’ contract was up, continued success was uncertain.
Pioneering social marketing experiences such as this one demonstrated the powerful impact of mass media campaigns and highlighted the importance of salt industry support. Studies also have shown the limitations of media campaigns: they may not reach everyone at risk, and behavior change may not be lasting.
Episodic efforts tend to fizzle out -- whether they are radio advertising for iodized salt, door-to-door visits to promote the use and proper storage of the salt, a national IDD Day to increase general awareness, or a publication for leaders advocating IDD legislation. What’s needed is a strong, sustained educational movement, not disjointed campaigns or flurries of interest.
Manoff, Richard K. 1976b. Mass Media Nutrition Education: Ecuador
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Partners from the Five Segments of Society
Social Mobilization Continuum
An Illustration of Social Groups in Partnership
An Illustration of Social Groups in Partnership
Figure 1
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Communication Channels:
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Interpersonal
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Media
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Traditional
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Special Events
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Ling/Apted, 1991
Though circumstances differ from country to country, and often from one part of a country to another, programs generally look for partners, or stakeholders, in the five segments of society illustrated in Figure 1:
I. Political -- Policy Makers
The extreme left column in Fig. 1 names some types of policy makers. Advocacy with and among leaders in this group helps foster the commitment that will clear the way for action. The goal here is to build consensus, to create a knowledgeable and supportive environment for decision-making, including the allocation of adequate resources.
II. Bureaucratic/Technocratic -- Government workers and technical experts
Policy makers depend on the technocrats, bureaucrats, and service professionals (shown in the second column in Fig. 1) to provide the rationale for decisions as well as to plan and implement programs. This sector includes a multitude of groups, each with its own agenda, interests, and concerns.
III. Professional, Civil and Social -- National non-governmental groups, including religious, commercial, industrial, professional, and civic groups, NGOs and special interest groups
The center column in Fig. 1 covers various social institutions and associations that represent organized support, a critical ingredient for common action. Like the administrators and technicians in the bureaucratic column, NGO staff mediate the interaction between government services and communities. The communication goal for these mediating, or in-between, levels of society is to keep the mechanisms of collaboration working smoothly, to improve efficiency and effectiveness.
Like government bureaucracies, the non-governmental organizations are a very complex segment of society, especially in democratic countries, and may have many branches or sub-groups. This is why Fig. 1 can only suggest examples of the kind of groups to be found in this arena. The names and numbers of NGOs in each country vary widely.
IV. Community-based organizations -- Local groups, including schools, churches, and other grassroots initiatives
National or regional organizations in the center column of Fig. 1 should be distinguished from community-level groups in the next column to the right. Just as bureaucrats seldom exactly follow the directives of government decision-makers, local organizations usually enjoy considerable independence from the national bodies affiliated with them. Local schools, day care centers, churches, grassroots organizations, and ad hoc issue groups are extremely important in transforming development goals into societal action because it is at this level that program action and popular participation take place.
V. Family and Individuals-- Household members, including mothers, fathers, and grandparents, who may make decisions on the purchase and use of salt
When communities are involved, resources are available and necessary skills are acquired, people (represented in the far right column in Fig. 1) are motivated to make informed choices. The Social Mobilization approach, with its emphasis on the influence of groups on individual behavior, has been instrumental in calling attention to other decision-makers within the household besides the mother or cook.
Channels
To reach and involve each of the target audiences or partners, planners generally consider a range of communication channels. The choice of channels begins with an assessment of the needs of the segmented audience and the available resources. Face-to-face interactions, mass media, special events, and traditional methods of communication, or a mix of media, can be effective depending on the characteristics of the target audience, the ideas to be communicated, and the setting where the communication takes place.
