an investigation into government health communications – in the context of a current alcohol...

7/29/2019 An investigation into government health communications in the context of a current alcohol campaign

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UNIVERSITY OF WEST LONDON

An investigation into government

health communications in the

context of a current alcohol campaignSubmitted in part requirement for the degree of MSc

Corporate Communications, University of West London

Fiona Cordy

SEPTEMBER 2012


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ACKNOWLEDGEMENTS

To Mike Cordy for his patience and forbearance during what has been an extremely difficult time,

what with job commitments, childrens exams, relocation to a new country (for him) and more. To

Duncan and Rosie Cordy likewise. To Stephen Roberts, my tutor, for his sound advice and for making

himself available at awkward times. To Cecile Lowe, course leader, for her enthusiasm and support,

Gloria Walker for her experience in the field and wise words and all the others on the University of

West London MSC Corporate Communications lecturers panel. Finally, to my fellow students for

their many ideas and shared experiences all the best to you all.

ATTESTATION

I understand the nature of plagiarism and I am aware of the Universitys policy on this.

Signed Date


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ABSTRACT

Governments invest a huge amount of time and money in educating the public around public health

issues. In the context of a current campaign to promote awareness of drinking habits, this study

investigates whether people are over-exposed to such campaigns, whether they are appropriately

targeted, how people view attempts to enforce such campaigns using punitive measures, and

whether Integrated Marketing Communications and other corporate communications techniques

are being usefully employed to get the best out of such campaigns. The study employs a variety of

research methods: an examination of comments about the campaign on the BBC website, a

questionnaire involving 100 people and an analysis of letters to the editor. It finds significant

discrepancies between the views of the people who commented on the website and those who

replied to the questionnaire and recognises the differences between each group of people the

former group, which is self-selected, may be those who feel particularly strongly about the issue and

are therefore motivated to comment, while the latter, which consists of people connected to the

author, may be indifferent.


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CONTENTS

1.INTRODUCTION ................................................................................................................................ 1

2.REVIEW OF LITERATURE ................................................................................................................... 4

What and why do governments need to communicate? ............................................................... 4

Barriers to government communication ........................................................................................ 5

Differences between public and private sector communications .................................................. 7

Similarities in public and private sector communications .............................................................. 8

Two-way communications ............................................................................................................ 10

The Four Ps .................................................................................................................................... 11

Influences and filters ..................................................................................................................... 11

Agenda Setting .............................................................................................................................. 12

3.METHODOLOGY ............................................................................................................................. 14

Website research .......................................................................................................................... 16

Questionnaire ............................................................................................................................... 17

4.ANALYSIS ........................................................................................................................................ 20

Secondary sources ........................................................................................................................ 20

Themes analysis ............................................................................................................................ 21

Research on key words ................................................................................................................. 23

The reaction to minimum pricing ................................................................................................. 26

Minimum pricing - initial analysis by theme ................................................................................. 26

Minimum pricing - key word analysis ........................................................................................... 27

Use of tax as a key word ............................................................................................................ 27

Analysis ofletters to the editor................................................................................................... 27

The authors own questionnaire................................................................................................... 28

Minimum pricing ........................................................................................................................... 31

What aspects of the campaign are people aware of? .................................................................. 34

5.EVALUATION .................................................................................................................................. 39

Corporate Social Responsibility .................................................................................................... 39

Stakeholder theory ....................................................................................................................... 39

Stakeholder perception of campaign ............................................................................................ 40

The use of data and information .................................................................................................. 41

Integrated Marketing and Communication .................................................................................. 42

Two-way communications ............................................................................................................ 43Branding ........................................................................................................................................ 43


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Minimum pricing ........................................................................................................................... 44

6.CONCLUSION .................................................................................................................................. 46

7. BIBLIOGRAPHY ............................................................................................................................ 488

APPENDIX A ..................................................................................................................................... 511

Pilot test questions ......................................................................................................................... 511

APPENDIX B ..................................................................................................................................... 544

Final questionnaire ......................................................................................................................... 544


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TABLE OF FIGURES

Figure 1: analysis of sample by themes ................................................................................................ 21

Figure 2: research on key words by number of occurrences ................................................................ 23

Figure 3: research on key words showing ratios of those in favour of campaign to those against: .... 23

Figure 4: research on "emotive" or "biased" key words....................................................................... 25

Figure 5: Fiona's alcohol survey - numbers who skipped questions ..................................................... 28

Figure 6: Fiona's alcohol survey question one ...................................................................................... 29

Figure 7: Fiona's alcohol survey question six ........................................................................................ 30

Figure 8: Fiona's alcohol survey question nine ..................................................................................... 31

Figure 9: Fiona's alcohol survey question seven ................................................................................. 322

Figure 10: Fiona's alcohol survey question eight ................................................................................ 333

Figure 11: Fiona's alcohol survey question two .................................................................................. 355

Figure 12: Fiona's alcohol survey question three ............................................................................... 366

Figure 13: Fiona's alcohol survey questions four and five .................................................................. 377


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1.INTRODUCTION

The UK has a long history of alcohol usage. Archaeological evidence shows that ancient Britons

were quaffing alcohol back during the Stone Age and when the Romans invaded, they introduced

their habit of drinking wine diluted with water. Later on, beer was drunk as a food as it contained

grain, but it had the added advantage that it as it was boiled, the process killed unhealthy bacteria.

Like many citizens of northern countries, Britons have used and abused alcohol in social situations

where their Mediterranean counterparts might have been content with a stroll round the town

square and making a cup of coffee or a sparkling water last all evening. Drinking with the aim of

inebriation is socially acceptable and getting drunk has been a rite of passage for young people.

Binge drinking is common among teenagers, many use alcohol for stress relief and poor drinking

habits have often continued through till middle age and beyond. Alcohol-related harm is nowestimated to cost society 21 billion annually, and alcohol is one of the three biggest lifestyle risk

factors for disease and death in the UK after smoking and obesity, according to the Home Office

(2012 p.3). In addition to the havoc it can wreak to an individuals health, alcohol is also a known

factor in street violence, domestic violence, costs untold sums in damage to property and uses up

substantial government resources.

While the UK is not alone in its abuse of alcohol - a World Health Organisation report in 2011 calls

for coherent action on alcohol across the European Union - the problem is so severe that the

government launched an alcohol strategy in March 2012. This will attempt to curb the serving of

drinks to people who are already drunk and provide support to hospitals and police dealing with the

problems of drunkenness. One of the key points within this strategy is to introduce a minimum price

for alcohol, probably of 40p a unit, although the Scottish government has already announced plans

to set this at 50p per unit. The thinking behind this is that cheap alcohol is part of the problem and

too many people are drinking at home before they even set foot in a pub. It will also include a

review of drinking guidelines to target, among others, people who drink just a little over the

recommended limits and think they may not be at risk of alcohol-related illness. These moves are

the culmination of a drink campaign launched in February 2012 which focusses on this particular

group of people. The government is using this campaign to prepare stakeholders, using a technique

known as agenda setting.

This recent project is the latest in a long line of alcohol campaigns. The Know your Limits

campaign in 2008, was aimed 18 to 24 year olds, although it also reached out to younger, illegal

drinkers. It used as its key message a shocking depiction of young people in very desperate straits


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at the end of a hard nights drinking. In 2010, the Alcohol Effects programme highlighted the unseen

damage that alcohol can cause, including mouth and breast cancer, high blood pressure and stroke.

Alcohol is not the only subject of public health and information campaigns. The Central Office of

information (COI) was formed in 1946 and spawned numerous memorable and long lasting

campaigns, including the 1970s seat belt campaign Clunk Click, Every Trip, which prepared the

ground for a change in the law; and the Green Cross Code childrens road safety campaign, also from

the 1970s, which led to an 11 per cent fall in casualties but needed constant reinforcement. Even

before the COIs formation, Your Country Needs You and Keep Calm and Carry On were famous

slogans from the two world wars, indicating that the tradition of public information dates back for as

long as half the adult population has had the vote. Although the COI closed in early 2012, this work

will be carried on by individual departments.

The discipline of social marketing refers to the notion of using marketing and communications

techniques to achieve behavioural changes and takes the aims of these campaigns a whole step

further. In fact, in 2010, in Kent, an NHS primary care trust took part in a scheme in which people

were paid to lose weight. Another scheme in Scotland gave pregnant women shopping vouchers for

stopping smoking, while toys have been given to children for eating their fruit and vegetables,

according to Donnelly (2010).

Public health officials might argue that these moves are justified: Sandel (2012) pointed out that

half of UK health spending goes on treating the consequences of unhealthy behaviour, while only

half a per cent of the NHS budget is spent on encouraging healthy behaviour and asked: Is the use

of financial incentives or bribes consistent with true freedom of choice or is it implicitly coercive?

But some people feel that using public health information campaigns is also an intrusive intervention

into peoples lives. As an article in The Economist(2011) pointed out recently: There is a lot of

advice around these days.

Is there in fact too much advice around and is it in fact going further than mere advice?

Commenting on proposals to strip cigarette packets of all branding, Clarke said (2012):

The point at which you so police somebody elses wellbeing that youre prepared to order

them, put penalties on them if they wont stop doing what you think they shouldnt do, is a

step you should take cautiously.

It is this policing of someone elses wellbeing which interests the author. Blacker (2012) says that

until recently, doctors worked with individual patients but now they are pestering us on a daily basis


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with prescriptions on how to live: like secular priests scolding us from the pulpit of science. For

doctors, read also governments who also appear to have taken upon themselves the duty of telling

people how to conduct their lives.

These issues have led the author to question how far people think this work should go. The

government has a corporate reputation to maintain and part of maintaining that reputation is

around fulfilling obligations to ensure the long term health of its population, as well as preventing

the consequences of anti-social behaviour induced through drink. While commercial organisations

measure their reputation in shares and sales, governments measure them in votes.

Furthermore, the government has stakeholders to satisfy and in the context of this study, the

stakeholders would be voters, taxpayers, public services (police, health workers), awareness groups,

as well as balancing these against the rival but lucrative claims of retailers and suppliers. It has a

huge amount of data at its disposal but needs to ensure this is fed through to the public in a way

that they find acceptable.

From a personal point of view, this author has tended to feel successive governments overdo the

paternalistic approach towards its key stakeholders and wanted to establish whether the

government was using sensitive and targeted communications theory in order to achieve the best

possible results in their interests. It was felt that focussing on a current communications campaign

and establishing some answers to the following questions would be a useful step towards achieving

this goal.

a. What is the public's perception of such a campaign (nanny state/necessary intervention?b. How do people view the extension of the campaign using regulation such as minimum

alcohol pricing?

c. What aspects of the government's integrated alcohol campaign are people aware of? (ieresearch, press, TV advert, posters, web content etc?)


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2.REVIEW OF LITERATURE

Public sector communications is big business. Communicators are employed in the health

service, education, foreign office, local authorities and more, as well as the many privatised

industries offering public services such as electricity, water, gas and the railways. This review

sets out to show that good corporate communications is as essential for government as for any

large organisation. It will then discuss the importance of Integrated Marketing Communications

within that context and discuss some of the elements of IMC, as well as behaviour change and

other concepts that can influence public behaviour. Some of the literature referred to describes

the concept of social marketing and while this is often taken to have a much wider definition

than communication/public relations, there are many elements that are common to both.

Indeed, French et al (2009, p.321) say that communications campaigns and social marketing are:

synonymous in many practioners minds.

What and why do governments need to communicate?

Phillis (2004, p.3) argues that: Government needs to be at least as good as any other sector in

communication, and arguably should set new standards. Liu and Horsley describe one of the

attributes of government communications as public good (2007, p.378) and quote Viteritti

(2007, p.379) saying: Meaningful communication between government and the people is a

political, albeit moral, obligation that originates from the basic covenant that exists between the

government and the people. This obligation to communicate is therefore one of the core

functions underpinning a democratic government and should be coordinated by a: management

function that is responsible for overseeing and coordinating the work done by different

practitioners in different specialist disciplines a definition of corporate communications,

according to Cornelissen (2008, p.5). Glenny (2008, p.154) suggests that the management of

strategic relations provides a: constructive framework to examine the role communication plays

in the public sector and quotes Davis (2004) who states: public relations has become a, possibly

the, most important component of modern politics.

While much of this public sector communication serves the purpose of defending the

government as executor of the policies outlined through its political activities, any government

also has an extremely important executive role in running the day to day operations of the

country. Glenny (2008, p.153) describes this as the apolitical or non-partisan activities of a

government and it is this role which concerns this study, in particular by focussing on the current

government campaign to highlight awareness of the impact on health of excess alcohol


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consumption. Neuberger (2011, p.12) says the need for the state to develop and pursue

policies which are of benefit to individuals and the wider public is accepted and it is part of the

role of government to intervene: for example, to tackle obesity and reduce harmful alcohol

consumption on the ground that individual health is a good which the government have a

responsibility to promote.

If the role of Cornelissens management function mentioned above is to support the

corporate objectives and goals of a government, then the promotion of preventative healthcare

must rate high in its priorities, leading as it does, to improved wellbeing and morale in society as

a whole, and also keeping down costs associated with expensive health interventions. Marmot

(2008, p.15) says: Action taken to reduce health inequalities will benefit society in many ways.

It will have economic benefits in reducing losses from illness associated with health inequalities.

These currently account for productivity losses, reduced tax revenue, higher welfare payments

and increased treatment costs. Darzi (2008, p.36) argues that the modernised NHS must be

more proactive, focussing on public health initiatives in alcohol, drugs, sexual health, tackling

obesity and improved mental health. The material and financial cost to the government of, for

example, not solving the binge drinking crisis in the UK was pointed out in The Guardian (2012),

which cited a recent report which predicts that binge drinking will cost the NHS 3.8bn by 2015

and result in 1.5m A&E admissions a year.

Barriers to government communication

Having established the need to communicate health information, the next step is to look at the

barriers to this activity. Government promotional activity can often be distrusted. Liu and

Horsley (2007, p.380) describe a: poor public perception of government communication.

There is: a deep distrust amongst the general public of much of what it is told by government,

according to Phillis (2004, p.29).

This is in part due to the legacy of propaganda use in Soviet Russia and Nazi Germany. There is a

persistent notion that government public relations is not an entirely proper or legitimate

activity, that it constitutes a form of propaganda, says Heise in Glenny (2008, p.154), which has

led to an intense fear of a repetition of those events in the early and middle parts of the

twentieth century . The notion of spin which grew up during the Blair years, has also added to

this suspicion of government communication, particularly in relation to the print and broadcast

media. It is associated with a: partisan form of communications, says Phillis (2004, p.6). Thedoctrine of personal responsibility, beloved of conservative politicians in the UK and abroad,


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which decrees the obligation of the individual to make his or her choices on how to conduct their

lives, also has a role to play in this fear of the nanny state, which has grown as people have

become more educated and have more leisure to make their own choices and to live their lives in

their own way. Thaler and Sunstein (2008, p. 6) say:

Those who reject paternalism often claim that humans do a terrific job of making

choices, and if not terrific, certainly better than anyone else would do (especially if that

someone else works for the government)

Rogers (2012, p.16) describes: a strong libertarian strand in the British psyche that will always

stand up for personal choice. Phelan (2012) quotes Stop Smoking expert Allen Carr as saying

national No Smoking Day is the day on which: any self-respecting smoker will point-blank refuse

to stop, because they dont like being told what to do. Tench and Yeomans (2006, p.581)

suggest that messages can be perceived in different ways by different people and while an

elderly person may ignore certain public messages about special allowances because they

associate governments with taxation, the message may be more effective if its aimed indirectly

through a carer. Murray in French et al (2009, p.1) says some people even believe: big state

interventions breed dependency and sometimes even encourage people to behave in ways that

are not good for them or society as a whole. French et al (p.4) goes on to add that as people

become more empowered, they: trust governments and state organisations less.

Aside from this inbuilt mistrust, the literature also suggests that the public sector has not got the

measure of the population when it comes to implementing its communications. Scriven (2010,

p.153) even suggests: Many health campaigns in the media are driven by the need to do

something and to be seen doing it and French et al (2009, p.12) discuss political pressure to: be

seen to be acting. Tench and Yeomans (2006, p.588) say advertising is used for this reason

because it is highly visible.

Phillis again says (2004, p.6): Interest in government communication is low, unless it concerns a

personal issue such as a local school or hospital or crime in their community and in Tones and

Tilford (2001, p.349), Mendelsohn adds: Among the needs we all have is not to be bombarded

with information we already have or do not have any use for (eg information asserting that

excessive drinking may be bad for us).

Indeed, a GI Insight poll of 1,000 consumers (PR Week 26 June 2008) reported on a:


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Perceived gulf between the relevancy of communications from commercial

organisations, compared with the far less well-targeted messages reaching people from

public sector bodies.

The survey found the public sector scored 18-19 per cent below average and was three per cent

behind banks, and one per cent behind building societies and mobile phone companies.

Supermarkets were 19 per cent above average. Thaler and Sunstein (2008, p.10) suggest some

people will happily accept messages from private institutions but object to government efforts to

influence choice with the goal of improving peoples lives.

Differences between public and private sector communications

Tones and Tilford (2001, p.348) point out that commercial organisations have a huge advantage

over the public sector, however, in that there is a possibility, even a probability that their

product is something consumers actually want or need.

The product which is being promoted by health education is frequently intangible and

offers gratification at some indeterminate time in the (often distant) future. This almost

exactly reverses the pattern of commercial sales techniques which promise immediate

gratification, often on credit.

Moreover, behaviourists understand that most people are driven by the conviction that the

consequences of negative habits simply will not happen to them, particularly when they are

young and these consequences seem so far off. Unrealistic optimism can explain a lot of

individual risk taking, especially in the domain of risks to life and health, say Thaler and Sunstein

(2008, p.32).

In fact, its worse than that, argue Tones and Tilford, because the messages associated with these

products, such as take more exercise or look after yourself (2001, p.349) are inaccessible and

less tangible than commercial goods or services that can be bought on the high street or internet.

In fact, the pains associated with health campaigns, are often worse than the gains. For example:

Like smoking, alcohol consumption provides considerable gratification, both physical and

social. (Tones and Tilford p2001, p.378), who see alcohol as posing a complex health education

message in comparison to, say, smoking. The message:

seeks to promote moderateor sensibledrinking and requires the individual to

calculate relative strengths of different liquor; it requires judgement and decision

making.


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The situation is further complicated by the need for government to mollify big business. Drinks

manufacturers account for a significant contribution to the UK economy. They employ many

people and pay significant taxes. They fund a huge lobbying industry fighting any restriction on:

promotion, pricing or availability, says Rogers (2012, p.17), who adds:

Drinks companies are in a difficult position. Even though many like Diageo have

invested millions in CSR and now purvey responsible drinking messages, the fact is they

can only succeed in the long term by selling more booze.

There is huge irony in that these companies are paying rather tax pounds to the UK economy but

some of it, albeit a fraction of this amount is actually being ploughed back into health education

on the effects of alcohol. McKinley quoted in Tones and Tilford (2001, p.342) says:

How embarrassingly ineffective are our mass media efforts in the health field. When

compared with many of the tax-exempt promotional efforts on behalf of the illness

generating activities or large scale corporations.

The irony is further exacerbated when the huge sums ploughed into advertising by drinks

companies on alcohol advertising are considered. Dawson, P (2012 p.37) says: Health

promotion messages pale in the face of the advertising might of the global drinks industry.

Tones and Tilford (2001, p.378) agree that: expenditure on health education has been

completely insignificant compared with the promotion on alcohol, and point out that direct and

indirect messages in the media about alcohol tend to demonstrate its social acceptability.

A further difference between commercial and social marketing say French et al (2009, p.32) is

that despite the fact that business is increasingly looking to add value to its stakeholder

relationships through corporate social responsibility, this will only ever be a secondary aim in

contrast to public good initiatives, where the primary aim is social good.

Nevertheless, there is a need for the public sector to follow the lead of the private sector which

is: very responsive to peoples needs and wants, say the authors (2009, p.4).

Similarities in public and private sector communications

While there is much that therefore differentiates and adds to the complexity of a government

communications campaign in comparison to the private sector there is also much in common.

For example, the use of integrated marketing communications (IMC) theory can be applied to the

public sector. The campaign to raise awareness of the risks of drinking, launched in early

February 2012, ticks many of the boxes associated with IMC, including branding, pre-campaign


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research, planned messaging, use of a variety of different tools (press and PR, advertising,

leafleting, electronic freebies such as a drinks calculator and social media), in an apparently

coordinated way. French et al (2009, p.12) say media promotions, advertising and other forms

of mass communications should be used as part of a: planned and coordinated strategy, and

not as the default solution.

In a world where people receive an estimated 13,000 messages in a lifetime, integrated

communication strategies are needed to break through the clutter, says Cornelissen (2008,

p.24). Cheng et al (2010 p.10) quote Schultz and Shultz on the philosophy and benefits of an

integrated approach, namely: effective orchestration and delivery of messages into the

marketplace, and applying the strengths of each communication discipline or technique so that

the whole is greater than the sum of the parts and the optimal message impact is achieved.

Cornelissen (2008, p.25) agrees that using messages to complement each other across various

media can lead to greater communication impact than any one single message.

For Schultz (2012, p.14), this is about focussing on customers rather than products and services,

aligning the entire organisation internally and externally to do so and developing a process that

puts a value on customers and invests the right organisational resources in communicating

with those customers over time. For Fill (2009, p.264), the modern interpretation of IMC

includes the notion that it is customer-driven. French et al (2009, p.4) discusses the idea that

services and interventions should be designed to meet customers needs, not the needs of the

bureaucracy.

Hawkins, Bulmer and Eagle (2011, p.229) quote Kliatchko's definition of IMC as: an audience-

driven business process of strategically managing stakeholders, content, channels, and results of

brand communication programs and find that the application of IMC in health promotion

contexts: can result in effective communication that leads to real behaviour change (2011,

p.237).

With the focus on audiences, customers and consumers, the notion of dialogue rises to the fore.

Informational and persuasive communication strategies are weighed in favour of the sender and

do not take into account the needs of the receiver.


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Two-way communications

As mentioned earlier, there is evidence to suggest that many people are distrustful of

government messages and dislike being told what to do by a paternalistic state but a focus on

dialogue rather than monologue, where: the goal is to exchange views and to reach mutual

understanding between both parties, Cornelissen (2008, p.56) would appear to be a more

meaningful way of engaging the doubters. Sweden has a state-controlled service monopoly on

the sale of drinks, known as Systembolaget and this organisations vision excludes dictating

whether it is right or wrong to drink but includes inspiring people: to become interested in what

they drink and to focus on quality, not quantity of what they are drinking Cheng et al (2010,

p.178). It is this invitation to become interested which is key to two-way communications, with

its suggestion that people have a role to play in the evaluation of how they choose and use

alcohol.

Theorists tend to suggest, however, that government communications fail in respect of two-way

symmetrical communication. Garnett in Liu and Horsley (2008, p.380) says: Governments

traditional use of one-way models of communication, rather than two-way models, often limits

dialogue, thereby diminishing the role of public feedback. Glenny (2004, p.155) adds: In many

discussions, government communication is portrayed as a one-way flow of information with a

strong focus on mass media. Dozier et al, quoted in Tench and Yeomans, (2006, p.578) say:

Public communications campaigns fit in with the two-way asymmetric model of communication

to influence a change in knowledge, attitudes and behaviours. Tench and Yeomans suggest

there is evidence that public sector communication is moving towards a: More symmetric style

of communication.

Phillis (2004, p.3) recommends redefining communications to mean:

A continuous dialogue with all interested parties, encompassing a broader range of skills

and techniques than those associated with media relations. The focus of attention should

be the general public.

Phillis adds (2004, p.6): that government communication works most effectively when it engages

members of the public in a two-way conversation and that modern communication is a service

for citizens that involves: listening as much as talking (p.12). French et al (2009, p.4) discuss the

need to engage, listen and help to change people, instead of hectoring them.


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The Four Ps

Within the IMC framework, another commonality between the commercial and the public sector

is the use of the notion of the four Ps product, price, place and promotion as four key tools for

scoping any communications project. Cheng et al (2010, p.2) describe the discipline of social

marketing, which uses marketing techniques including the four Ps to influence behaviour

changes for the benefit of the individual and society. They suggest that in the public arena, the

product might be:

The benefits that the target audience will experience or expect in exchange for

performing the targeted behaviour (eg a healthier life and the reduction in the risk of

becoming obese or overweight).

However, as mentioned earlier the similarity ends here because as Tones and Tilford (2001,

p.347) point out, while commercial campaigns are able to drop a product that doesnt work and

try again with something new, the health promoter must soldier on:

Health education frequently seeks to sell a product which commercial advertisers would

consider no one in their right mind would buy! Potential customers are not uncommonly

urged to stop doing something they find enjoyable and start doing.

Commercial campaigners are also able to offer instant gratification, say the authors, while the

health promoters offering is intangible and realisable a long time off in the distant future.

Other parallels with mainstream marketings Four Ps include price, which would be: The costs

that the target audience will pay for adopting the desired behaviour that leads to the promised

benefits and in the case of health promotion, this could be: time, effort, energy, psychological

costs and/or physical discomfort. Place is where and when the desired behaviour is performed

or how the marketing outputs are delivered Tench and Yeomans (2006, p.585) cite the example

of a campaign to encourage condom use in which condom vending machines were introduced in

public toilets to avoid subjecting people to a potentially embarrassing visit to the local pharmacy.

As with commercial marketing, promotion is about choosing and implementing messages and

delivery channels.

Influences and filters

Sunstein and Thaler (2008) discuss three social influences that have been found to influence

behaviour change information, peer pressure and priming. They cite research that people are

more likely to carry out a particular behaviour if it is made easy for them by the provision of


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information. For example, students who would have known the location of the health centre in

Yale were shown to turn up in larger numbers for tetanus shots when they were given a map

than those who werent. Priming works by providing cues briefcases and boardroom tables

were found to make people more competitive asking people how many times they plan to floss

their teeth apparently results in increased flossing. Finally, theres safety in numbers (2008,

p.64):

Campaigns to inform people that drinking is not the norm have been successful :

Incidents of alcohol abuse are easily recalled and the consequence is to inflate

perceptions. College students are influenced by their beliefs about what other college

students do, and hence alcohol abuse will inevitably increase if students have an

exaggerated sense of how much other students are drinking.

Tench and Yeomans (2006, p.583) describe this as: the group situation and suggest peers are

likely to reinforce the message or discourage acceptance by the individual. The authors say

there are four filters which effect message reception of which this is one the others are

whether the message grabs attention, whether the individual is motivated to do something

about the message and how the message is perceived. Tone and content are important in the

latter Tench and Yeomans say health messages: have to tread a fine line between arousing too

high a level of anxiety among the worried well and encouraging message avoidance among

high-risk groups.

Agenda Setting

Press relations are one of the key elements in IMC and in particular, agenda setting which is

highly used in the public sector in order to highlight an issue and get it talked about. Indeed,

says Weaver in Merilaenen and Voss (2011, p.296) the media agenda is: formed together by

politicians, their advisors and journalists.

The theory, which is attributed to McCombs and Shaw and quoted in Tench and Yeomans (2006)

and Tones and Tilford (2001), suggests that once a concept has been introduced into the public

domain, it is then much easier to get people to think about it and talk about it. Merilaenen and

Voss (2011, p.296) say: what the media report, people at large may seeas more important but

this is qualified by Murrow is quoted in Tones Tilford (2001, p.363): Mass media might not be

at all effective in telling people what to think but were stunningly successful in telling them what

to think about.


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In our example of the alcohol campaign, agenda setting was widely used gaining coverage in

most of the national newspapers, as well as being the subject of a Panorama broadcast by

political spin doctor Alastair Campbell, who highlighted the consequences of professional people

drinking over the recommend amounts on a regular basis. The McCombs and Shaw theory

states that not only does agenda setting get people talking but it also helps people weigh up:

how much importance to attach to an issue from the amount of information in a news story and

its position. (Tones and Tilford 2001, p.363). The alcohol campaign certainly got people talking:

a BBCarticle (2012) on its launch got 687 comments. The authors point out that: while agenda

setting alone is often not seen as enough to achieve the desired results, governments often use it

in order to raise awareness and prepare the ground for legislation. Again in the case of our

alcohol campaign, this looks likely to be the case at the time of writing, the Government is

widely expected to introduce a minimum price for alcohol as part of its alcohol strategy.

Merilaenen and Voss (2011, p.297) suggest that agenda setting is becoming much more public-

led due to the worldwide web and ultimately, this may mean a huge difference to the nature of

the tool, which fits in with the need mentioned earlier for public health communications to

become more customer-driven and two-way. The public sector clearly has more hurdles to cross

in conveying its messages in health campaigns. Social marketeers would argue that the IMC mix

is simply not enough and that further planning and drilling down is needed. Cheng et al (2010,

p.388-9 describe a four-decade campaign in Victoria, Australia to minimise drink driving this

comprised a legislation element, an enforcement element and an advertising element. Tones

and Tilford (2001, p.366) say: The over-riding lesson is that the best results will be attained when

mass media are used to support a wide range of integrated activities, including inter-personal

education. This author will be seeking to ask: What do the general public think of government

attempts to persuade them to adopt behaviour which is less harmful to their long term health?


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3.METHODOLOGY

A review of the literature available, with a focus on the campaign in question, has led the author to

the following research questions:

1. What is the public's perception of such a campaign (nanny state/necessary intervention)?2. How do people view the extension of the campaign using regulation such as minimum

alcohol pricing?

3. What aspects of the government's integrated alcohol campaign are people aware of? (ieresearch, press, TV advert, posters, web content etc?)

Ghauri and Gronhaug quoted in Saunders et al (2007 p.5) suggest the purpose for research may

include: describing, explaining, understanding, criticising and analysing and in fact the author feels

she has run the gamut of this list in undertaking her research as well as trawling, identifying,

sampling, scouring, clarifying, comparing and exhausting the possibilities.

In the course of this work, the author considered a number of different approaches to the collection

of productive data. These included:

1. Interviews with professional communications practitioners2. Focus groups of members of the public3. A survey of public attitudes4. Analysis of comments on social media cites5. Analysis of letters to the editor in national newspapers

On closer examination of these possibilities, it was felt that the first option would have been

interesting as a way of examining whether the current campaign in particular works from a

theoretical point of view. However, the literature review covers much of what professionals could

add to the theory behind the success of public health campaigns in general and in addition, the

author felt the success of this project lay in drilling down to what the public, as key stakeholder, is

experiencing.

Focus groups were considered and discounted as an option due to the practical difficulties of getting

people together and also because the author felt that a questionnaire would enable her to identify

the views of a greater number of people and thus lead to a richer picture of peoples views.

The review of the literature led the author on a seemingly endless trail of avenues to explore in the

quest to understand the problem and in undertaking this task, she stumbled upon what seemed to

be a huge seam of data that because it has been so recently published, was extremely unlikely to


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have been mined before and it was so full of opinions, points of view, debate, meaning and so on,

that it practically begged to be analysed.

This secondary data, which came from comments on a BBC article about the campaign in question,

was useful because it contained a wealth of observations (687 in number) from unnamed people all

over the country. The only processing that had taken place was the elimination of comments by the

website editor on the grounds that they were offensive - so it was virtually raw data. Saunders et al

(2009, p.262) suggests that many secondary data sets are of higher quality: than you could ever

collect yourself. The fact that it comes from the BBC website gives it a certain authority

(Dochartaigh quoted in Saunders 2009, p.265) On the other hand, it should be acknowledged that

there may be a bias due to the demographic of people who read the BBC website and respond to

articles.

The BBCwebsite was chosen over similar pieces in The Guardian and TheDaily Telegraph websites.

This was partly due to the number of comments available but also because, although the BBC can be

seen to identify with a particular group of people: ie the liberal intelligentsia, it tends to be politically

more broadly neutral than either of the other two sources.

An attempt to extend this sample through reviewing Letters to the Editorin newspapers, however,

proved unsatisfactory. An initial search on the term Letters in the Proquestnewspaper database

over three months yielded 26,400 entries. Trying to limit this to newspapers published during ten

days at the beginning of February yielded 29,515. Changing the search term to Letters to the Editor

reduced this to 4,543. Adding the word alcohol to the search reduced the count to 20 items, and for

some unidentified reason, these were dated outside the specified ten days. One of these items, a

letter to the Stoke-on-Trent Sentinel, was a comment on the current health service changes and only

mentioned alcohol in passing. The others came from The Guardian (1), The Daily Telegraph (1) and

The Times (3). All of the others were duplicates of each other, leaving a core of only five different

entries. However, within these five entries, there was often more than one letter.

Having embarked on this course, however, it became clear that this secondary data would not stand

alone in the quest to answer the authors questions but needed supplementing in order to provide a

fuller and reflection of the true picture. It also became clear after an initial perusal that the kind of

people who tend to comment on website articles are those who feel very strongly about the matter

in hand and very often the people who feel so strongly do so because they are against a particular

course or courses of action. In other words, this cohort of responders was largely self-selected.

Luker (2008 p110) says the thing to avoid: at all costs, is choosing the sample to influence the


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outcome. While this was not the authors intention, she chose to also conduct some primary

research of her own in order to provide a fuller picture.

This combination of data collection methods may not conform to what Luker (2008 p40) calls

canonical social science but it is nevertheless backed up by academic thought. Saunders et el

(2009 p.147) say there is no simple answer to the question of which data examination and collection

techniques to use but in the final analysis, the methods used by the author were the ones that

presented themselves as the most obvious when the time arrived. Luker (2008, p.5) says: a good

salsa-dancing social scientist should be open to whatever methods will help you understand that

part of the social world that challenges and intrigues you.

In the case of this study, this has resulted in what is described in Sanders et al (2009, p.146) as

mixed model research a combination of quantitative and qualitative techniques and analysis

procedures at all stages of the research. This can mean, for example, quantifying qualitative data,

which is precisely one of the techniques this author has employed with the BBC website sample.

Website research

It could be argued that the website comments demonstrated that often elusive implementation of

good communications practice: two-way symmetrical communications; albeit through a third party.

Other than this, however, from the point of view of this study, they offered very little insight into the

effectiveness of the campaign from an IMC point of view and could broadly only be used to show

that

People are aware of the issue and To provide insight into the first two research questions the third, involving more technical

input, would have to be posed to people individually.

The comments on the website numbered 687. These included comments on other comments as

well as several people who commented more than once. In fact one responder posted 35 times,

while another posted 32 and yet another 27. A decision was taken to include only comments that

were in response to the original article in the analysis and also to exclude repeat comments. This

was because:

The aim of the research was to analyse individual viewpoints rather than the body of thecontent. If, for example, the word nanny as in nanny state was mentioned in more than

one comment by a single individual, it wouldnt be accurate in quantitative terms.


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The comments on comments could often only be understood in the context of the originalpost and it was felt that this would add to the complexity of the analysis and lead to

possible errors

As far as possible the author wanted to keep to the original research questions - thecomments on other comments often tended to go off at tangents from the original subject

matter. At times they could also get slightly personal

As a result of this piece of work left, the comments were pared down to 370. The disadvantage may

be that the author cannot be sure this did not affect the balance of the research.

The research then proceeded with an overview of these remaining comments to glean an

understanding of the direction of feeling and to identify search terms that could be used in a

Microsoft word search. The author was also aware that her choice of key words could be influenced

by her own views on this matter, so in addition to analysing these, she also conducted a themes

search on a smaller sample. This produced an interesting initial overview of the data. However,

according to Stacks (2002, p.109), such latent content is hard to count; therefore it has reliability

and validity problems.

As a result, the author decided it would be also meaningful to analyse also by looking at key words

and coding them according to whether they were broadly for the campaign or against and in the

case of the second research question, for or against minimum pricing. This would be employing

manifest units of analysis, (Stacks 2002, p.110). According to Colorado State University (2012), this

method makes it: possible to see trends, for example, that are indicative of much larger ideas.

In conducting the word search, if a word came up more than once in a comment, it was only counted

once. The items were searched by semantic root (ie choice/choose was searched on CHO with

entries such as school being discounted. Similarly, price/pricing was searched on PRIC).

In order to come up with answers, throughout this research, a judgement call had to be made on

whether the comments were pro or anti-campaign. As the nature of these comments was

fundamentally discursive almost reflecting a dinner party conversation - it was not always possible

to do this and another category was created to cover all unclear or ambiguous comments.

Questionnaire

As discussed, this process was supplemented by a self-administered questionnaire using Survey

Monkey software. The practicalities of the exercise indicated that a convenience sampling

technique through the authors circle of friends and acquaintances was the most appropriate.


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Stacks (2002, p.157) points out that such nonprobability samples: are often the only way to quickly

and efficiently gather data but adds that there are: restrictions placed on interpretation of data

and an increased amount of error from sampling and measurement.

In designing the questionnaires, the author followed recommendations in Saunders et al (2009,

p.356), who itemise individual question design, questionnaire layout, explanation of the purpose,

pilot testing and careful administration as factors that can result in maximisation of: Response

rates, validity and reliability.

Questionnaires work best with: standardised questions that you can be confident will be

interpreted the same way by all respondents, says Robson in Saunders et al (2009, p.356). As a

rule, the questions used were of a list type, asking the respondent to choose one or more from a

number of items but after a pilot test, it was felt that question one was more suited to a Likert

rating, because it was about the respondents opinion. The other questions were more around

what the respondents felt were questions of fact and the list style is useful when: you need to be

sure that the respondent has considered all possible responses. While the questions were of

closed nature, most included the option to add a comment in order to solicit alternative views.

The limitations of the Survey Monkey approach (ten questions only) meant that no filtering

questions were possible. The author would also have liked to insert demographic questions in order

to analyse by age and background but this was not possible within the limited number of questions.

A pilot test involving five people was conducted before posting the survey (Appendix 1), in order to

determine if there were any areas where questions didnt work or might be phrased in a different

way. The pilot revealed that:

Not everyone was familiar with the alcohol campaign in question A visual identifier would help the person responding to the survey particularly as not

everyone is consciously aware of the campaign. It was decided to use a still taken from the

online advertisement (which was also used in a TV campaign) as a logo for the survey. It was

felt this might serve as a prompt to jog peoples memories.

Some of the questions which were initially designed in a list format, might be moreappropriate designed using the Likert scale. For example, question one initially contained a

list of suggested answers and although responders were able to tick more than one box, it

was pointed out that the answers werent mutually exclusive and would be better framed

using a rating scale for each point.

Finally changes were made to the question order in order to improve the flow.


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As there was not huge scope to tailor a survey, some items, such as an introduction and explanation,

had to be included in the email and Facebook content where people were asked to take part in the

research.

The revised survey was posted on the authors Facebook page, a couple of Facebook group pages

and sent out via email to a number of contacts known to the author and family. Two reminders

were sent out at weekly intervals. Although a convenience sample, this covered age groups from 18

to 60 plus. The disadvantage of this approach is that the demographic served is broadly similar to

that of the authors, ie middle class, educated urban dwellers, mainly based in London.

The on-line survey facility was employed in order to conduct an alternative study into opinions as it

was felt to be a convenient method of getting a reasonably large cross sample of views. A copy of

the survey questionnaire is included in Appendix 2. The disadvantage of Survey Monkey is that the

user is limited to only ten questions unless one is prepared to sign up to a direct debit plan. The

author would have liked to include some more questions, in particular the question: Are you

familiar with the current alcohol campaign and if not, please skip to question xx? A decision was

taken to exclude this and certain other questions. Similarly, the basic plan limits one to a fairly rigid

survey format. Finally, as some people (particularly the elderly) are not familiar with technology,

they are ruled out of taking part in the research.

In reporting the questionnaire data, a descriptive approach was employed, which according to Stacks

(2002 p.209) describes: how the data gathered are distributed within the sample of census

observed.

The data was imported into an Excel spreadsheet and wherever the numbers added up to 100 per

cent, it was shown in a pie chart which provides a clear visual representation of the comparative

items. For example, the website themes content, where it was quantitively described, was output in

pie charts, because it could be categorised into percentages of people who were either

for/against/unclear about a certain question. The key word analysis could have been represented in

individual pie charts but the use of a column chart approach allowed the words to be compared

against each other, as well as coded into for and against in other words, the four parts of the

question could be shown in the same diagram. The rest of the research could not be broken down

into parts of a whole and therefore was represented in column charts.


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4.ANALYSIS

Secondary sources

The total number of comments on the BBC website numbered 687 and amounted to 40,446 words.

Of these comments, seven were removed by the moderator for breaking house rules and six

individuals had all users posts removed. Several of the commentators posted several times and

one posted 35 times. An initial scan of the original comments led the author to drill down to a

smaller more manageable section. The Methodology section provides an account of how this was

carried out. However a number of common themes emerged from this initial scan.

In general, people did not comment on the nature of the campaign itself. Their comments are more

along the lines of whether they welcome government intervention or not, although quite a few

commented on the details of the research which was used as a background to the campaign.

Commentators had to adopt a moniker, and these in themselves were quite illuminating, and

certainly entertaining, including names such as: Son of Maggie and Norman, Leftrightleftright,

Golgotha and Socialreject. For example, Son of Maggie and Normans comments included:

Please please please leave us alone - presumably a plea for the hands-off kind of government the

former prime minister and her right hand man would favour. Leftrightleftright suggests a reaction

against being frogmarched into the kind of behaviour the government would like us to show.

The emerging ideas questioned whether there was anything new in the advice offered in the

campaign, often proved defiant about government intervention in how one led ones life,

questioned the consistency of government statistics, suggested people wouldnt pay any attention,

discussed information overload, suggested politicians themselves could set a better example and

discussed quality versus quantity of life. Some suggested more work is needed into why people

drink so much.

Significantly fewer people made comments about who should fund the healthcare bill for thosepeople who drink excessively, acknowledged the need to do something, said the governments work

didnt go far enough and provided alternative and additional suggestions.

As discussed in the Methodology, the samples were refined in order to provide a fuller analysis of

the material available. This resulted in a larger sample for an analysis on key words and a smaller

sample for a fuller themes analysis.


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Themes analysis

Figure 1: analysis of sample by themes

The themes analysis was based on30 consecutive comments from the middle of the key word

sample on comments numbered 312 to 370. This sample consisted of a total of 1774 words. The

longest comment was 84 words and the shortest ten. The average length of a comment was 59

words

Of these 30, seven could be said to be in favour of government intervention, 19 are against, two do

not appear to take a position and two were felt by the author to be unclear. Of the two that do not

take a position, one laments the lack of moderation in current moeurs, but implies this is an

inherent fault in society rather than something which the government should act against. Chart one

shows 63 per cent of people against intervention.

Of the two which were unclear, one quotes the proverb Give a man or woman enough rope and

nough said. This could be seen as suggesting the government is currently giving too much

rope, but alternatively it could be interpreted as indicating that its up to individuals to take

responsibility for their own lives.

The comments that appear to be against intervention range from the defiant: Am I the only one

tempted to Google how to make bathtub gin? (five similar comments counted) to the angry: Who

in their right mind would listen to government anymore? (this comment also ticked the defiant

box). The term health police was noted and this was used elsewhere in the larger keywordsample. Other comments suggested the government has a hidden agenda, although it could be

23%

63%

7%7%

Analysis of sample by themes

For intervention Against intervention Ambiguous No position


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argued that the use of the agenda setting technique mentioned in the literature review made the

governments intentions more than clear. The government has not tried to hide that it is trying to

gauge reaction to a possible price hike before making a final announcement about how it will be

implemented.

Some commentators suggested the governments figures are questionable. One, for example, felt

that the number of units that could be drunk before causing harm was much higher and others

suggested that the source of the research was vague or that the government had bigged up the

statistics. This latter commentator pointed out that 26,000 people die from medical mistreatment,

suggesting that in the scheme of things, this, rather than drink campaigns, should be prioritised.

Other themes which came up in this sample and have been noted in the larger sample, were the

suggestions that stress is a huge factor in ill health and that because death is inevitable, one should

enjoy life in whatever way one can. The theme of wasting money on campaigns came up twice.

As far as the comments in favour of action were concerned, one suggestion was that those against

might themselves be heavy drinkers who simply dont want to know about the consequences of

their behaviour. Another pointed out that heavy drinking can result in huge costs to the state not

only through illness and large attendances at A&E, but also through accidents and assaults involving

the innocent people who are victims of alcohol-linked behaviour.

Others made suggestions, such as discouraging drinking through retail purchases and trying to

channel it into pubs where it is more controlled. This leads to the concept of minimum pricing.

Another suggested raising the drinking age to 21. Others suggested that pubs should pick up the bill

for social costs due to excess drinking but did not specify how this might work.


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Research on key words

Figure 2: research on key words by number of occurrences

Figure 3: research on key words showing ratios of those in favour of campaign to those against:

Analysis was then carried out using key words which had been identified through the themes

analysis and the initial overview. These included words like life, die. Other words were chosen

0

5

10

15

20

25

30

35

40

45

50

pro-campaign

anti-campaign

unclear

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

anti-campaign

pro-campaign


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because they related to the research questions (price/pricing) and to aspects of IMC (campaign,

advertising, research).

These again were broadly classified as in favour of and against the research and unclear. The

results are shown in chart two. Chart three shows the same key words but splits them up into ratios,

so that the number of comments that are in favour of the campaign can be easily compared against

those against. Chart three shows that with three exceptions, the sample indicates that large

majorities are against the campaign. These exceptions are in the use of the words aware,

information and to a lesser extent, price/pricing.

Of the other words, the terms aware, warning and choice were chosen, because these are the

fundamental reasons public health campaigns are carried out. Awareness is an over-used term in

government and the health industry in particular but the concept implies that by informing the

public, the government has taken steps to help people take responsibility for their own health.

Warning is a step further. The population knows that it should take care but there are

consequences if it fails to do so. Choice suggests that having supplied the information, (or even

raised the price of alcohol), the government can do no more. In a democratic society, outlawing

alcohol would probably be seen as unacceptable and, as prohibition in the USA showed, unworkable

in practice. There are too many corporate interests to appease and the government would have no

interest in duplicating the current debate over other outlawed drugs on a much larger scale. Theterm aware is the one category where there are more pro-campaigners than against but this is a

very small sample of five examples only. Those proponents of awareness", like those who

advocate information, demonstrate the importance of education in order to allow choice.

Choice is a fundamental message and while the antis (9) demand the right to make their own

choice about the consequences of drinking, the pros (4) suggest it is important at least to provide

this information, enabling people to make a choice.

The four remaining words (price will be treated separately), life (38 comments), die (37

comments), smoking (39 comments) and government (59 comments) all appeared frequently.

Usage of the first two of these words was often based around quality of life rather than longevity, as

well as the fact that death is inevitable so people should enjoy life while they are able. The term

smoking was frequently used as example of how government has relentlessly attempted to control

lives by focussing on other potentially harmful activities. A typical comment here was: Doctor,

doctor: if I don't smoke, don't drink and don't go with women will I live to be 100? No; but it'll seem

like it... Of the pro comments, one pointed out that it was only by highlighting the dangers to

others of smoking that perception of it changed from an acceptable activity to an anti-social one.


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Comments containing the term government were probably the most frequent of all and many

were furious, with very few (5 per cent) suggesting the campaign is due to the governments better

instincts. A common theme here was the notion of paternalism. At least three comments referred

to the poor example being set through subsidised bars in the Houses of Parliament.

A separate cohort of words and phrases were identified which were considered by the author as

being particularly emotive and she felt these occurrences showed a particular bias against the

campaign and therefore should be shown in a separate analysis. The research showed that where

these words were used, there was virtually none, or very little existence of positive feelings towards

the campaign. The only exception was where the phrases nanny as in nanny state/nannying

and health police occurred, and this turned up five positive comments.

Figure 4: research on "emotive" or "biased" key words

Like the themes analysis, the keyword analysis contains very little reference to the actual nuts and

bolts of the campaign itselfie the IMC aspects. The word publicity occurs only twice and is used

pejoratively, ie the campaign is seen as a waste of money and those involved as experts seeking

publicity. The three references to advertising saw it as a waste of money and time. The use of

the word campaign echoed the themes of waste and also brought out the suggestion that the

public is sick and tired of being preached at, stigmatise(d), pariahise(d) (sic) and

bombarded. However, the one positive comment in this category was: The myth is that you

0

2

4

6

8

10

12

14

16

18

20

wast (e money) Leave us alone House of Commons nanny/health police

pro-campaign

anti-campaign

unclear


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can't have an alcohol problem unless you drink daily. For such people, and their number is not small,

this would be a sensible campaign.

Interestingly, where the word information is used, the campaign is better received. This is the one

category where the pro-campaigners are equal with the antis. One comment perhaps summed it up

by saying: Give people the information and let them decide. Another said they welcomed the

information but not the initiatives that followed. Overall, there were 32 mentions of these terms

which relate to the technical aspects of the campaign, but these were based around peoples

perceptions of its validity, rather than from an IMC point of view.

The research that lead to the campaign proved material for discussion and a search on the terms:

study research and statistics produced 43 mentions, which again proved overwhelmingly

against the campaign (six comments were felt to be in favour.) Many of the comments were

around how statistics can be misleading, misinterpreted, invalid and contradictory. The phrase:

lies, damned lies and statistics was used. Another commentator suggested: These reports have

one thing in common the words CAN, COULD, MAY, SUGGESTS THAT, ESTIMATED, POSSIBLE, MIGHT

AND MAYBE, never DOES. (sic). However, one argument for the pro-campaigners suggests the

need for continuous reinforcement of such public health messages: Now we have the facts.

Changing a cultural habit is difficult, facts need to [be] stated over and over, not everyone sees the

same study the first time. Others suggested that people need to see the facts so that they canthen make their own choices.

The reaction to minimum pricing

The current campaign, in common with other similar campaigns, is seen as a precursor to follow-up

actions which may be unpopular. While the above analysis suggests peoples perceptions of

government health campaigns and this particular campaign are negative, a further question remains:

what do people feel about the notion of minimum pricing as a way of controlling excess drinking?

Minimum pricing - initial analysis by theme

Of the original thirty comments, seven referred to the subject of raising the cost of alcohol, either

through tax or through minimum pricing. Of these, two were for and five were against. The fors

were divided between one advocating minimum pricing and one advocating tax. Those who

advocated a tax increase suggested it should be fixed so that it only affects supermarkets, not the

pub trade. One of those against suggested that if there was a minimum price for alcohol, why not

one for, say fast food, which is also bad for health. Another pointed out that the campaign was

really just paving the way for alcohol tax hikes. A common theme was the need to maintain and


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boost the role of the pub as a social hub and small business, by raising retail prices only. It was

pointed out that anything that could reduce binge drinking can potentially save the NHS billions of

pounds.

Minimum pricing - key word analysis

In the wider key word analysis, although the majority of people were still against the principle of

minimum pricing, a significant minority, 36 per cent, felt it was a reasonable suggestion. This is

compared to the 15.5 per cent (reducing to 14 per cent if the more emotive words are included) who

are in favour of the campaign in general. Some of these pro comments were quite hard line:

Double the price, A less liberal attitude is required. One commentator suggested that it is

already within the power of local authorities to revoke alcohol licences, so a change in the law is not

required. Others suggested that such a move would make no difference to the middle classes and

only hit the poor, and that it would only hurt responsible and moderate drinkers.

Use of tax as a key word

The use of the word tax was also considered as a key word because an additional tax on alcohol

theoretically has same effect to the end user as minimum pricing. However, many of the comments

containing this word were used in a completely different sense referring to tax in general, rather

than tax as means of increasing the price of alcohol. As a result, this was discounted.

Analysis ofletters to the editor

As stated in Methodology, a sample produced as a result of a database trawl produced very few

letters on the subject. All in all, there were 14 different items, and they came from The Guardian

(1), The Times, (10)and The Daily Telegraph (3) hardly a representative sample. These letters

dealt with the issue of minimum pricing rather than any other aspect of the campaign. Of these, two

were in favour of minimum pricing they included a group of doctors from the British Society of

Gastroenterology, who described the move as a: bold intervention and praised the governments

alcohol strategy but called for alcohol care teams in order to give public health moves time to work.

Of the other writers, three compared British behaviour with that of Germans, Swiss and Spanish and

suggested the UK problem was cultural and that also, the Swiss police, for example, would not

tolerate such behaviour. In another letter, it was suggested the police should be given more

resources to deal with these problems.

Other letters echoed comments from the BBC sample, suggesting that sanctions should be placed

against the offenders and finally, four letters also referred to the subsidised bars in the Houses of


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Parliament also a popular theme in the earlier analysis suggesting a strong feeling of: one rule

for them but an entirely different one for the ordinary citizen.

The authors own questionnaire

This was based on ten questions in different formats, designed specifically with the aim of answering

all three of the research questions. Question one, six and nine were around the principles of public

health campaigns and the current campaign specifically. Questions two, three, four, five and ten

were around the IMC aspects of the campaign and whether the practice meets the theory.

Questions seven and eight were around the principle of minimum pricing. This survey received 100

replies by its closing date going on to reach 101 all in all but the SurveyMonkey providers barred

access beyond the first 100. This was a useful number, because it enabled percentages to be

calculated very easily.

The first observation around these results is that while most people answered the questions about

campaigns in general (a maximum of two people skipped), the numbers who passed increased

significantly when asked about the February 2012 campaign. Over all the questions, an average of

18.4 skipped the questions and the highest numbers of skips were in questions four and five which

were about details of the campaign and numbered 28 and 31 respectively. In emails and also in the

other comments, many people stated that they were not aware of the campaign. So in effect, up

to 31 per cent of this sample were not aware of the campaign.

Figure 5: Fiona's alcohol survey - numbers who skipped questions

0

5

10

15

20

25

30

35

one two three four five six seven eight nine ten


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Figure 6: Fiona's alcohol survey question one

Governments frequently present campaigns to try and improve the nations health. What do you

think of such campaigns?

Question one was designed to investigate peoples perceptions of public health campaigns and used

four different elements to probe into this issue. The questions around government interference in

lifestyles and the consequences of healthier lifestyles for long term government spending resulted in

broadly similar numbers of those who agree and those who disagree. The most marked variations

were in the question about whether it is a government duty to advise people on health issues here

91 per cent felt it was and a high proportion of these felt 23 per cent of the total felt strongly

about this, while only 8 disagreed. Opinion was overwhelmingly in agreement with the suggestion

that if people live healthier lifestyles, the government will save money in the long run, with a total of

81 per cent of people agreeing with this suggestion. In this case, almost half of those in agreement

38 per cent, were strongly in agreement.

In spite of this, however, opinion was not so heavily weighted in favour of spending money to

promote healthier lifestyles. The ratio of those people who agreed with spending money on

preventative campaigns to those who disagreed was 3:2. So while healthier lifestyles are seen as

very important, a smaller proportion of people appear to believe that government campaigning will

bring this about. Finally, there was not a huge disparity in this category between people who favour

0

10

20

30

40

50

60

70

80

People have the right

to decide how they

live their lives and the

government should

keep out of it

These campaigns cost

an awful lot of money

which could be better

spent on other things

It' s the government's

duty to advise its

people on health

issues

If people smoke less,

drink less and eat

more healthily, the

government will save

money in the long

term

Strongly agree

Agree

Disagree

Strongly disagree

Skipped


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government intervention and those who do not (53:46). In both cases, few people had strong

opinions either for or against. Skipping to question six, there was also not a huge disparity between

those who feel campaigns get some or a little attention (35 per cent) and those who believe they get

little or no attention (27 per cent). Of these, only one person in each category felt they got a lot of

attention or no attention at all.

Figure 7: Fiona's alcohol survey question six

How much attention does the public pay to health education campaigns like this one, in your

opinion?

Question nine showed that 41 per cent of people felt that the campaigns were worth it, if they can

do some good, and 28 per cent felt excess drinking was a serious problem that needed to be dealt

with. Only nine per cent felt the current campaign was applicable to them as individuals. Similar

numbers said they did not like being preached to and that there were too many campaigns of this ilk

(12 and 11). Four people commented on this question. One said: It doesnt touch on middle age,

middle class age over drinking, although the author feels that this is one of

an investigation into government health communications – in the context of a current alcohol...

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