How should we talk about health in advertising?

What is the most successful way for campaigners, charities and the government to talk to the public about health?

Controversial posters for Harrison’s Fund, a charity that funds research into the rare and little known condition, Duchenne Muscular Dystrophy

Health is a sensitive subject, and as such requires careful handling in its advertising and messaging. It is a sector that comes with unique challenges: messages have to be clear and easy to understand, and we also need straightforward instructions about what we need to do in response to them. To achieve this in a striking and interesting way is tough, especially when we – and the media – are very quick to criticise any messages that might be perceived as patronising.

“It’s the balance between giving people advice and not coming across like the nanny state,” says Emma de la Fosse, chief creative officer at OgilvyOne EAME, who has previously worked with health clients including Public Health England, Cancer Research UK and Drink Aware. “The sad truth is that most of the ill-health in our nation – not all, but a lot of it – is brought on by our own behaviours. We either smoke or drink too much, or we eat too much … but actually it’s quite tricky telling people that those are behaviours they need to change, without people taking umbrage.”

Another common complaint about health messaging is that it is confusing, and open to change – as consumers it can feel hard to keep up with what is good for us when the scientific evidence shifts over time. It can at times feel easier to ignore the advice altogether, a disastrous response.

Yet for those delivering the messages, the science can present a different problem: health campaigns require strict approval and are often complicated, making it difficult to articulate healthy lifestyle advice in a way that is easy to understand or act upon.

“A good example of this is the five-a-day initiative,” continues de la Fosse. “Scientists would probably tell you it’s not five-a-day, it’s nine-a-day or something ridiculous. And actually they’ve all got to be different coloured fruit and vegetables. But as marketers, we know that if you go out and say [that] to the public, people are just going to shut the message out and not do anything. So it’s finding a way through between what the scientists are saying people should do, and what you know people will do. Trying to find that middle ground.

“Then the real challenge is after you’ve delivered a message,” she continues, “providing them with the right tools or support services that allow them to act. Advertising stops at that point.”

Despite – or perhaps because of – these numerous restrictions and challenges, the health sector produces some of the most powerful advertising in the world. It comes in many different forms though there are broad recurring themes. Probably one of the most familiar is the shock ad. Remember that anti-smoking ad with the cigarettes oozing fat? Of course you do, it was disgusting, yet impossible to ignore.

Many drink ads – particularly drink-driving work – has been similarly devastating, with the potential consequences of alcoholism or even just a night of over-indulgence spelt out in unequivocal terms. Shock tactics can be useful for waking up people to the realities of their habits – we all know that smoking is bad for our health now, so it takes something significant, and possibly gruesome, to really ram that message home.

Controversy can also be useful for gaining attention for less well-known health conditions too. One of the most striking – and contentious – recent ad campaigns has been for Harrison’s Fund, a charity that is committed to raising money to aid research into Duchenne Muscular Dystrophy, a devastating condition that kills most sufferers in their late teens or early twenties.

Harrison’s Fund was set up by Alex and Donna Smith whose eldest son – the Harrison of the charity’s moniker – has Duchenne. The charity has released two print ads so far. The first, released in 2013, focused on the lack of knowledge in the public realm about Duchenne as well as its bleak prognosis. It features a simple, black-and-white photograph of Alex holding Harrison combined with the headline ‘I wish my son had cancer’.

The second ad is more subtle – presented in a similar style to the first, it shows a dog looking plaintively out at the viewer. The text refers entirely to Harrison though, and plays on the fact that we in the UK are more likely to donate to animal charities than children’s health charities. Combined, the two ads are immensely challenging.

The messages came directly from the Smith family’s personal experience. “I wanted to start a conversation about options, about choices,” says Alex Smith. “I was trying to say that if he had a cancer diagnosis there would be a chance, however small it is, that there would be an option. Whereas where we stood, and where we still stand today, we have no choices and no options…. We’re trying to give people a poke and say ‘have you thought about your choices, have you thought about why you’re giving where you’re giving?’.”

The ads have had negative reactions – “I’ve been told I don’t deserve children, that I should have my children taken away from me,” says Smith, “it’s perversely ironic” – but from other families with Duchenne, the reaction has been “overwhelmingly positive”.

The thing about shock tactics is they tend to work on the law of diminishing returns

“The common theme was ‘thank you very much for saying out loud what we were afraid to say’,” he continues. “I think if you say something shocking but it’s based on honesty and truth, and you’re happy to say it out loud, then say it out loud and stick it in the Evening Standard, stick it on a billboard, because it has integrity in that respect.”

Shock for shock’s sake can have its downsides. “The thing about shock tactics is they tend to work on the law of diminishing returns, so the more you show people shocking stuff, the less shocking it actually seems,” says Emma de la Fosse. Though when used tactically as part of a wider campaign it can prove very useful at grabbing attention.

“We’re not a shock charity at our core,” stresses Smith. “We’re generally a very positive, upbeat, hopeful organisation. We will do this probably every couple of years … whether it will be another shocking ad, or just another poke at something. I think it’s necessary, I think you need to shake things up occasionally, I just think it’s important.”

Let’s work together

While a shock campaign might work well to shine attention on an unfamiliar condition, many health charities require a more nuanced approach. Instead of focusing on the debilitating, frightening aspects of an illness, it can therefore be more fruitful to deal in positives, and bring people together as a consequence.

For a campaign from the Scottish Government to encourage older people to take a home bowel cancer screening test, The Leith Agency in Scotland decided to target multiple generations, creating a more straightforward, sober ad for the core audience, and a tongue-in-cheek film, featuring a singing toilet, for a younger audience. “We thought a two-strand approach would be really interesting,” says Claire Wood, associate planner at Leith, “[and] we also wanted to get younger people involved, to nudge their older relatives into doing the test.”

The poo song risked being misunderstood by an older audience, who may have been offended by its flippancy, but was perfect for the younger group. “It was a really effective way of giving them some content that they would share because it was funny, but also had a really serious point,” says Wood.

While health is rarely amusing in itself, humour can be a very useful way of discussing it, even when the subject is deathly – no pun intended – serious. One of the most successful health campaigns of recent years was the 2011 British Heart Foundation film starring Vinnie Jones, which demonstrated how to do hands-only CPR. The film was out-and-out funny – so very shareable – yet as well as delivering laughs managed to clearly demonstrate the techniques required to save lives.

Social media can be a useful tool for spreading messages of support and encouragement too, with charities increasingly using channels such as Facebook and Twitter to talk to supporters. Campaigns such as Dry January, where people stop drinking for January, or Stoptober, where they don’t smoke in October, have grown in popularity since the advent of social media, where people can share their stories and successes. It is also increasingly important for more traditional charities too.

The power of social media

“Social media is incredibly important for us in many ways,” says Anthony Newman, brand, product marketing and communications director at Cancer Research UK. “It allows us to connect and interact with our supporters, volunteers, fundraisers and other healthcare professionals, and gives us a space to publicise our latest news. It’s instant and has had a huge impact on the way we operate.”

There have been a number of hugely successful fundraising campaigns on social media of late, one of which – the #nomakeupselfie campaign, where people shared make-up free images of themselves online – benefitted CRUK. It wasn’t started by the charity, though with some quick thinking, it managed to turn it into an enormously successful fundraising exercise.

We couldn’t believe how successful it was, and were truly taken aback by the generosity of the public

“We noticed people started asking how sharing a selfie could help cure cancer and so we took it as an opportunity to provide a text-to-donate code,” continues Newman.

“We really didn’t know how long it would run for, we just kept listening to the audience and responding to that. When we got the first total through, we decided not to keep pushing the text-to-donate code but to thank everyone and this actually helped maintain momentum. We couldn’t believe how successful it was, and were truly taken aback by the generosity of the public.”

A delicate touch

Because they hadn’t created it, CRUK couldn’t have ownership of the #nomakeupselfie message, but with careful handling – including monitoring the social media channels constantly – the charity was able to successfully navigate a campaign that went viral. But while social media can be kind, it can also be cruel, and requires delicate handling, particularly if the subject matter is a sensitive one.

In November last year, the Samaritans launched an app on Twitter which aimed to alert people if their followers were struggling, by spotting key phrases such as “hate myself” and then contacting them with advice and help. Well-intentioned, the app was criticised for invasion of privacy and poor design, and received a severe backlash online before being pulled

Perhaps with this in mind, when The Leith Agency launched a social media campaign with the charity Young Minds earlier this year, which encouraged friends to watch out for each other, it put the emphasis on friendship rather than health, creating a campaign around the hashtag #matesmatter.

Broad-brush advertising isn’t very helpful

“We were very keen to steer clear of anything explicitly [to do with] mental health,” says Claire Wood. “Young people weren’t remotely keen on the idea of having a hashtag that said ‘I think you’ve got problems’, but they were really happy with the idea of celebrating friendships.”

While there is a need for caution, Emma de la Fosse envisions a time when there will be more targeted messaging using social media, however. “I do think it’s underused,” she says, “or if it’s being used, it’s probably not being used to its full potential. A lot of the messaging we need to get to people will actually be most effective if we can get it to them at the right moment in time.

“I think broad-brush advertising isn’t very helpful whereas if we can target people at moments that matter and when we know they are doing those behaviours – because they’re talking about them on social media – then it gives us a really powerful, laser-like tool to be able to go in at the right time, with the right message.”

Alongside the brave new world of social media, there is a still a place – a significant role in fact – for simple, emotional filmmaking in articulating health messages, and not all of these need to shy away from harsh realities. A beautiful recent example of this is an animation created by ad agency Real Science Communications for drug company Takeda to use at a medical conference.

Titled The Boy I Used To Know, it is set to a voiceover by the father of Steve, a schizophrenia sufferer, and tells the story of how his son’s condition has impacted on the family and how different medications helped.

The tale is brought to life by simple but elegant animation by animator Ben Simpkin of Finger Industries and uses soaring music to express its emotion and sadness. “I think you can really convey that with just this gentle, slow flow of animation,” says Marcus Kenyon, MD of Finger Industries and editor on the project. “It’s very simple, it’s moody and dramatic and dark, without being too fussy.”

It’s got to communicate well to a very large number of people, very simply

There are a multitude of ways that health messages can be articulated, both to clinicians and the public. In the case of the latter, they can be shocking, intended to jerk you out of your comfort zone and make you pay attention. They can be funny, deflating the seriousness of the message and making work more shareable. Or they can be emotional, tackling the pain and upset that lie at the heart of many conditions.

Whatever the style, what unites all the public health messages featured here is clarity: to be successful, a health message or ad must be simple, it must be engaging, and it must be aimed squarely at the widest audience possible. “The tone of voice that works well for health messaging, in my experience, is populist,” says Emma de la Fosse.

“It’s got to communicate well to a very large number of people, very simply. You’ve got to think about real people doing real things. People love joining together to do things, getting into a team to do things, memorable phrases … all that stuff works really well for health messaging, which may come as a bit of a surprise to people because they maybe think it needs to be rather medical and official. You need to be able to convey the important facts, but in a populist way.”

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Fushi Wellbeing

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Monddi Design Agency