1. Focus on public health campaigns for older people
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Introduction
The increase in life expectancy is a positive step forward for medicine and
public health. One reason for increasing longevity is the capacity for medicine to
cure infectious diseases. As a result, there has been a shift in focus to chronic
conditions such as arthritis, hypertension, heart disease, cancer and dementia.
Many of conditions of later life can be prevented, delayed, or controlled through
health promotion and the risks associated with the conditions can be reduced
through changing behaviours.
A public health campaign is an effort to persuade a defined public to engage in
behaviours that will improve health or refrain from behaviours that are unhealthy
(Springston, 2005). Public health campaigns can contribute by raising
awareness of conditions and their risk factors and educating people as to how
lifestyle changes can prevent or delay the onset of chronic conditions.
This edition of the CARDI “Focus on” series examines public health campaigns
as they relate to older people in both the Republic of Ireland (ROI) and Northern
Ireland (NI). It examines what the role of government is and the key elements
that make public health campaigns work.
March 2013

2. 2 March 2013
Key findings
 Public health campaigns seek to promote public
health through education and raising awareness
as well as promoting better health through
changing behaviours (Health Development
Agency, 2004).
 A US literature review of ten years of health
communications found that if well-executed,
health campaigns can have small-to-moderate
effects on health knowledge, beliefs, and
attitudes, and can also be effective in changing
behaviours (Noar, 2006).
 Elements of successful public health campaigns
include targeting to the specific audience,
providing accurate information through clear,
unambiguous messages and providing additional
services in support of the campaign (Health
Development Agency, 2004).
 Healthy ageing and maintaining independence in
old age require a life-course approach.
Governments can serve as a driving force to
galvanise key stakeholders as well as older
people themselves in bringing about a
fundamental change on public health issues.
Public health campaigns
Public health refers to all organized measures (whether public or private) to
prevent disease, promote health, and prolong life among the population as a
whole (World Health Organization, 2013). Public health campaigns seek to
promote public health in two main ways. The first is through health education
and raising awareness about particular conditions and their impact. The second
is through a campaign designed to change behaviours, such as promoting
physical activity as a means to improve health and wellbeing. A literature review
conducted in 2006 on public health campaigns in mass media found that
targeted, well-executed health campaigns can have small-to-moderate effects
on health knowledge, beliefs, and attitudes, and can also be effective in
changing behaviours (Noar, 2006).
Public health campaigns to change health-related behaviour may range from a
simple, face-to-face consultation between a doctor and patient to a complex
programme, often involving the use of mass media such as television or radio
advertising (Health Development Agency, 2004). Such campaigns can also be
used to build a better understanding of conditions like dementia which have a
stigma attached to them due to misconceptions. The NI Life and Times Survey
in 2010 included a module of questions exploring attitudes and knowledge of
dementia. The results, presented in Figure 1, showed a good understanding of
dementia in NI, but also indicated that misconceptions remain.

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Figure 1 Perception and understanding of dementia in NI
Source: (McManus & Devlin, 2011)
Issues are selected for public health campaigns as a result of public health
planning. In public health, planning can be initiated and led by a variety of public
health agencies or by other health-interested organisations. In theory, public
health planning and decisions on what should be selected for a public health
campaign are based on several factors:
1. Data analysis concerning the burden of disease
2. Distribution of available resources
3. Resource utilisation and health outcomes (GALE Cengage Learning,
2003).
Figure 2 overleaf shows the development of “Open your eyes”, the Health
Service Executive campaign on the issue of elder abuse in ROI. The genesis of
the campaign was a submission to the Minister for Health and Children on the
issue by the National Council for the Elderly. This developed into an exploratory
study published in 1998 and the establishment of a working group on the issue
in 1999. The exploratory study cited a “growing body of literature and research”
highlighting the extent of the problem of elder abuse (O'Loughlin & Duggan,
1998). When the working group reported in 2002, one of the recommendations
was the establishment of a national implementation group. In 2007, the National
Elder Abuse Steering Committee was established, tasked among other things
with the development of a public health campaign.

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Figure 2: Development of elder abuse public health campaign in ROI
Source: Health Service Executive (2011)
Campaigns for older people
The table overleaf presents some examples of public health campaigns related
to older people in ROI and NI. Public health campaigns are usually launched
and supported by governments as they can provide the necessary resources
and support.
Governments can also fund voluntary or community sector organisations to
operate public health campaigns. It is also possible that campaigns can be run
privately by NGOs.
While government campaigns tend to be supported by public services, private
campaigns tend to be lobbying for services to be put in place, e.g. the “Can’t
heat or eat” campaign in NI.e social support accelerates and improves patient
recovery from conditions such as cancer, cerebrovascular disease and
cardiovascular disease (Seeman, 2000).
A positive social environment can also be as helpful to a patient diagnosed with
a chronic disease as information or instrumental support (Arora et al., 2007).

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Table 1 Sample public health campaigns for older people on the island of
Ireland
Issue Details
Elder abuse
in NI
What: Comic Relief funded a campaign, “Uniting against elder
abuse”. The aim was to provide independent advocacy for frail
older people and people with dementia and raise awareness of
the problem of elder abuse.
When: The campaign ran from 2009 to 2011.
Who: Operated by Age NI and the Alzheimer’s Society in NI.
Impact: The review of the campaign published in 2011
suggested that more could be done to raise awareness of the
issue among the general public, especially as there had been
high-profile media coverage of elder abuse in NI (Age NI /
Alzheimers Society, 2011).
Fuel poverty
in ROI
What: “Keeping well and warm” is a public health campaign
developed by an inter-departmental / agency working group on
energy affordability in 2008, aimed at reducing deaths and
illnesses related to fuel poverty in ROI each winter.
When: Launched in 2008 and is currently ongoing.
Who: www.wellandwarm.ie is a website hosted by the
Sustainable Energy Authority of Ireland in conjunction with
several partners including Age Action. The website gives
information on keeping warm, energy efficiency and financial
and support services.
Impact: 19.4% of all households in ROI were fuel poor in 2008.
There has been an overall decrease in mortality due to fuel
poverty for all ages and, in particular, older age groups (The
Irish Examiner, 2012).
Physical
activity in NI
What: “Get a life, get active” is a dedicated campaign for
promoting physical activity, “Get a life, get active”, including a
website, radio and television advertising. For older adults, the
campaign suggests activities such as walking, cycling, dancing
and swimming for increased mobility and muscle strength,
managing weight and building balance.
When: Campaign first launched in June 1999 and is ongoing.
Who: The Public Health Agency in NI.
Impact: Following Phase 2 of the campaign, 63% of people
surveyed reported having seen elements of the campaign, with
the television element being the most frequently recalled. 23%
of respondents reported being more active during the
campaign period.

6. 6 March 2013
What makes public health campaigns work?
An NHS Health Development Agency health briefing on the effectiveness of
public health campaigns presents evidence on the key elements for success of
campaigns in changing health behaviour. The characteristics include:
 Targeted and tailored campaigns in terms of age and gender.
 Providing basic, accurate information through clear, unambiguous
messages.
 Joining up services with other community provisions (e.g. providing
transport links from community centres to clinics).
 Working with community members as advocates of appropriate services.
 Addressing peer norms and social pressure (Health Development
Agency, 2004).
It is important that public health campaigns are designed with their target
audience in mind, and that they utilise the most effective means of
communication for that target audience. Older people have consistently cited
word of mouth sources such as GPs or family and friends as the preferred
mode of information provision. It has also been noted that informal sources of
information are particularly important for the older population (McDaid, 2012).
The success of public health campaigns is dependent on many factors. In the
area of health, high levels of public spending and improved services can lead to
better outcomes, but success also requires better engagement and participation
from people themselves (Halpern & Bates, 2004).
Non-governmental organisations such as charities have an important role to
play in raising awareness of public health issues or challenging stereotypes
when it comes to conditions such as dementia. Any public health campaign
should ensure that key stakeholders are involved in shaping the message and
providing support services. (Alzheimer's Disease International / World Health
Organization, 2012).
Monitoring and evaluation being built into a campaign can also increase the
chances of success. This can lead to evolution of the messages or means of
communication in response to the reaction of the target audience so the
campaign is always relevant and using the right way of getting its message
across (Alzheimer's Disease International / World Health Organization, 2012).
It can be difficult to assess the actual impact that a public health campaign may
have on the area of health it is designed to address. An assessment of the
ACTIVE for LIFE campaign in England found mixed results on the impact of the
advertising. In a nationally representative sample of 3,189 adults aged 16-74
years, 38% were aware of the main advertising images when asked 6-8 months
after the main television advertisement.
The proportion of participants knowledgeable about moderate physical activity
recommendations increased significantly following the campaign, but there was
no evidence that the ACTIVE for LIFE campaign actually improved the levels of
physical activity among the sample (Hillsdon et al., 2001).
A successful campaign will likely be as a result of many different factors working
together – a media campaign, provision of support services, involvement of key
stakeholder groups or changes in behaviour of healthcare professionals.
Smoking rates have decreased significantly in the past decade in both ROI and

7. 7 March 2013
NI, but in addition to media campaigns, there have also been the ban on
smoking in public places, tax increases, new quit smoking therapies and other
measures. Thus it can be difficult to evaluate what the successful decrease in
smoking rates results from. As a result, it is important that monitoring and
evaluation of campaigns are built into the objectives, to ensure that success can
be measured and lessons can be learned for other campaigns in the future.
An examination of the proportion of the decline in coronary heart disease
deaths in ROI attributable to (a) medical and surgical treatments, and (b)
changes in major cardiovascular risk factors was conducted in 2006. The
changes in risk factors such as smoking, cholesterol and blood pressure were
the result of public health initiatives.
Between 1985 and 2000, coronary heart disease mortality rates in ROI fell by
47% in the 25-84 age group. According to the research, 43.6% of the observed
decrease in mortality was attributed to treatment effects and 48.1% to
favourable population risk factor trends, i.e. the elements that public health
campaigns can influence (Bennett, et al., 2006).
In ROI, the overall prevalence of smoking in June 2003 was 28.3%. This
reduced to 21.9% by June 2012 as a result of the ban on smoking in public
places and extensive public health campaigning (Office of Tobacco Control,
2012).
Road deaths have been the subject of extensive public health campaigns in
both NI and ROI, involving mass media advertising, changes to drink driving
and speeding laws, the introduction of penalty points and targeted police
campaigns. This has led to significant success in reducing road fatalities. There
were 365 road deaths in ROI in 2006, but this had reduced to 162 in 2012 (An
Garda Síochána, 2012).
Road traffic fatalities on NI roads have seen a huge decrease as a result of
extensive public health campaigning. In 1972, there were 372 fatalities. There
were 171 fatalities in the year 2000 and this had reduced to 59 by 2011 (Police
Service of Northern Ireland, 2012).
The approach used in success public health campaigns for heart disease and
road traffic deaths could be applied to further campaigns for older people across
the island of Ireland, in areas such as falls. In order to achieve that success,
public health interventions should be comprehensive, address the multiple
factors that influence the particular health problem and strike a balance
between efforts directed at the individual and the social-environmental context
in which people live (Eriksen, 2005).

8. 8 March 2013
The role of government
The role of government in the area of public health is a contentious issue. One
view is that bans on smoking public places or junk food advertising is an
unnecessary government intrusion into the personal lives as citizens. On the
other hand, the argument is that only the state can alter the environment that
shapes people’s decisions and behaviour (Jochelson, 2006).
In addition to supporting public health campaigns through funding of charities
and other stakeholders, governments in NI and ROI can work to change how
ageing is viewed in a public health sense. It has been noted that there is a view
of ageing which focuses health concerns on clinical medical care, whereas a
focus on social, economic, political and environmental factors could contribute
to more healthy ageing (Popejoy, 2012). In devising public health campaigns for
older people, policymakers in Ireland, North and South should ensure that as
well as emphasising health diets, exercise and other behavioural changes,
campaigns are accompanied by a drive to bring more opportunities for social
interaction, increased access to support programmes and access to quality
healthcare for older people.
Adshead & Thorpe (2007) argue that unless people themselves are engaged in
public health, supporting a cultural shift towards a health promoting society, it is
unlikely that the necessary sustainable impact on challenges such as obesity,
diabetes and other chronic diseases will be achieved (Adshead & Thorpe,
2007). Thus the role of government in public health campaigns may be as a
driving force to galvanise key stakeholders, the voluntary and community
sector, and older people themselves in bringing about a fundamental change on
public health issues.
Case study: Mind your mind, Australia
Alzheimer’s Australia launched “Mind your mind” in 2005 with
government funding. The aim was to educate people in Australia
about what they can do reduce their risk of dementia. The campaign
was based around seven “signposts” to dementia risk reduction,
addressing physical, mental and social activity, cardiovascular risk
factors, diet, smoking and alcohol, and prevention of head injuries.
“Mind your mind” utilised several different means to get the message
across, including community education sessions, training for staff to
deliver the sessions, a range of printed resources, promotion in the
media, a mobile app and a dedicated website. Evaluation of the
campaign indicated a high level of satisfaction with their interaction
with “Mind your Mind”, increased knowledge about dementia risk
factors, and increased intention to modify their behaviour to address
risk factors (Alzheimer's Disease International / World Health
Organization, 2012).
“Mind your mind” was replaced in 2012 by a new campaign, “Your
brain matters”, which focuses on the brain, body and heart in
reducing dementia risk. The three strands are keeping the brain
active, being fit and healthy and looking after the heart (Alzheimer’s
Australia, 2012).

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Conclusion
The fact that people are living longer is a major social and medical advance, but
it brings public health challenges in terms of increasing incidence of chronic
conditions. An older population means increased incidence of conditions such
as dementia. Public health campaigns can help to influence behaviour in a way
that improves the chances of living longer, healthier lives and not just adding
extra years to life which may be spent in poor health. Lessons can be learned
from successful public health campaigns in areas such as road deaths or
reduced coronary heart disease mortality, and applied to health issues affecting
older people such as falls.
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