Curbing the 'epidemic'_A study into the promotion of childhood health

1 Curbing the ‘epidemic” A study into the promotion of childhood health | Tess Michalski


Contents:

Executive Summary...............................................................................................................................….........4
Purpose and Ambitions……………………………………………………………..…………………...……...5
Points to Note Before Reading……………………………………………………………..……………………5
Victorian Context………………………………………………………………………………………………...6
Chapter 1: Social Marketing……………………………………………………………………….…………….8
- Definitions (section 1.1)...................................................................................................................9
- History and Development (section 1.2)…………………………………………………………...13
- Social Marketing as Distinct from Other Change Strategies (section 1.3)………………………..14
- Social Marketing in the Corporate Environment (section 1.4)……………………………………16
- Social Marketing in the Non-Profit Environment (section 1.5)…………………………………..18
- Elements of Social Marketing (section 1.6)……………………………………………………….19
- Social Marketing in Practice (section 1.7)………………………………………………………...22
- Issues with Social Marketing (section 1.8)………………………………………….……….……24
Chapter 2: Childhood Nutritional and Physical Health…………………………………….………………….25
- Problems Associated with Poor Childhood Health and Nutrition (section 2.1)…….……………26
- Definition of Overweight and Obesity in Children (section 2.2)………………………………....27
- The Notion of an Epidemic (section 2.3)………………………………………………………….29
- Causes of Poor Health in Children (section 2.4)………………………………………………….30
Chapter 3: The Kids – ‘Go for your life’ Program……………………………………………………………..40
- Social Marketing as a Framework for Analysis (section 3.1)…………………………………….41
- Analysis of Kids – ‘Go for your life’ (section 3.2)………………………………………..……...42


Chapter 4: Government Intervention..................................................................................................................65
- Liberal Democracy – Definitions and Conflicts (section 4.1)…………………………….............66
- Government Intervention in a Liberal Democratic Society – Focus on Minors (section 4.2)……67
- Impacts of Lobbying in a Liberal Democratic Society (section 4.3)……………………………...70
- Social Marketing Contrasted with Government Intervention (section 4.4)……………………….72
Conclusion…………………………………………………………….…………………………………..........77
Reference List…………………………………………………………………………………………………...80
Bibliography…………………………………………………………………………………………................84
Appendices.........................................................................................................................................................91
- Glossary and Referenced Organisations (appendix 1)....................................................................91
- Timeline of Social Marketing Academia (appendix 2)...................................................................92
- Kids – ‘Go for your life’ Social marketing Plan Summary (appendix 3)........................................93
- ‘Tap into water every day – and limit sweet drinks’ Social Marketing Plan (appendix 4)…….….93


Executive Summary:
This report serves to analyse the effectiveness of social marketing as an appropriate strategy to engender
behaviour change in a liberal democratic society. Specifically, it looks at improving eating habits and
increasing physical activity in Victorian children. Methods of mandatory legislation will be considered as an
alternative to social marketing. The Victorian State Government funded Kids – ‘Go for your life’ program will
be profiled and critiqued as a social marketing campaign.
Conclusions and recommendations will be made based on research outcomes including:
• Relevant literature around social marketing, the Australian obesity ‘epidemic’, liberal democracy, and
rational for government intervention
• Available social marketing plans
• Critical analysis
• An interview with Kids – ‘Go for your life’
This report concludes that while social marketing is a successful method for inducing behaviour change it is not
the most appropriate strategy for combating the obesity ‘epidemic’. Government intervention in the form of
legislation is more effective due to the broad nature (and target adopter base) of the problem and the relatively
slow pace of social marketing in inducing behavioural change.


Purpose and Ambitions:
The purpose of this report is to position social marketing as an appropriate planning process for analysing
Victorian childhood health campaigns. This report strives to achieve the following:
A) Make a localised case for social marketing as an effective tool in combating the childhood obesity
‘epidemic’.
B) Examine the practise of social marketing in contrast and in cohesion with forced intervention as a
strategy for change.
C) Profile the Victorian State Governments childhood health program, Kids – ‘Go for your life’.
D) Use a social marketing framework to analyse and critique the Kids – ‘Go for your life’ program.
E) Suggest reforms that could be adopted in current or future childhood health campaigns to increase
effectiveness.
Points to Note Before Reading:
• This report is an independent study by the researcher and has no affiliation with the Victorian State
Government or the Kids – ‘Go for your life’ program.
• The Kids – ‘Go for your life’ program was profiled because it is the biggest childhood health
campaign currently underway in Victoria. It also has roots in the chosen theoretical framework.
• The Kids – ‘Go for your life’ program will be assessed on its individual merit as a standalone
program (separate from the wider ‘Go for your life’ program). The assessment is largely based on
publically available website documents and interviews with people involved in the campaign.
• The Kids – ‘Go for your life’ program is closely related to the wider ‘Go for your life’ program.
The ‘Go for your life’ program will be referenced in this report but not profiled.


Victorian Context:
The health of Australian children is declining. A recent front page article in The Age Newspaper (20 June 2008)
labelled Australia as a ticking ‘fat bomb’ suggesting that the obesity ‘epidemic’ could cause 123,000 premature
deaths in the next two decades (Stark 2008b, p. 1). This equates to health costs in excess of $6 billion and an
extra 700,000 people being admitted to hospital for weight-related health conditions (Stark 2008b, p. 1).
In 2006 the population of Victoria was 4,932,422 (ABS 2007A). 19.3 per cent of Victorians (in 2006) were
under 14 years of age and 23.8 per cent are born overseas. This equates to 950,393 and 1,173,201 people
respectively (ABS 2007A). The 2004 Victorian Population Health Survey found that almost half of all
Victorians failed to meet the national guideline minimum daily exercise requirement (‘Go for your life’
Strategic Plan 2006-2010, p. 6).
In Victoria, obesity is the second most common cause of premature death and disability. It contributes 8 per
cent to the overall burden of disease (‘Go for your life’ strategic plan 2006-2010, p. 6). The most recent
national Australian Bureau of Statistics (ABS) figures (2006A) show that 62 per cent (up from 52 per cent in
1995) of men and 45 per cent (up from 37 per cent in 1995) of women are classified as overweight or obese
according to the BMI (section 3.2). However, when the population was surveyed only 32 per cent of men and
37 per cent of women self-assessed themselves as being overweight (ABS 2006A). According to 2004–05 data
56.4 per cent of the entire Australian population rated themselves as being in ‘excellent or very good’ health
and a further 27. 8 per cent classed themselves as being in ‘good’ health (ABS 2006B). These figures highlight
Australia’s degenerative, and somewhat unrecognised, weight management problem.
Of the 1,294,387 Victorian families (in 2006), 805,520 or 62.3 per cent have children (ABS 2007A). Sweet
(2007, p. 107) notes that the instance of overweight or obesity for parents with overweight children is likely to
be significantly higher than that of the general population. As the primary caregiver, parents have enormous
influence over the health of their children (section 2.4.5). The attitudes of one or both parents are often adopted
by their offspring (Curry 2000, p. 72). With more than half the Australian adult population classed as
overweight or obese this becomes a serious problem (ABS 2006). Parents who engage in extreme dieting
practices are often imitated by their children. As a result, their children are more likely to develop unhealthy
attitudes and habits around eating (Curry 2000, p. 80). When children mimic their parents harmful eating habits
a sick cycle eventuates. Many of the precursors to serious health conditions such as heart disease begin in


childhood. According to the Bogalusa Heart Study, between 53 per cent and 90 per cent of overweight children
become overweight adults (depending on what age they became overweight) (cited in Sweet 2007, p. 86).
A second important point illustrated by the aforementioned statistics is a lack of ability to recognise the issue.
Based on the ABS statistics, Australian adults tended to rate themselves as more healthy and less fat than they
actually were. When people self assess their eating habits, independent verifications show they generally
underestimate the amount of food they consume (Sweet 2007, p. 69). Studies have shown that in addition to not
recognising the extent of their own weight problems, Australian adults are also failing to recognise weight
problems in their children. “They prefer to use words like ‘heavy’ or ‘solid’, and do not see excess weight as a
health issue” (Sweet 2007, p. 106). It is seen as a matter of appearance rather than a potentially serious health
problem (Sweet 2007, p. 82). In fact, some parents equate chubbiness in children with good health, or they see
it as puppy fat that their children will grow out of in later years. For most children this is not the case, “the
concept of harmless puppy fat can lead to complacency and down playing of the incidence of childhood
overweight and obesity” (Curry 2000, p. 71).
A further factor pertaining specifically to Victoria’s obesity ‘epidemic’ is its diverse and highly multicultural
community. 23.8 per cent of Victorians were born overseas while 25.6 per cent speak a language other than
English at home (ABS 2007A). As noted in section 2.4.6, children of particular ethnicities, specifically Pacific
Islander, Aboriginal, and Middle Eastern are most at risk of becoming overweight (Editorial 2008, p. 9). This is
most probably due to a move away from traditional cultural diets in favour of less healthy fast-food options
(Jennings & O’Dea 2008, p. 8).


Chapter 1: Social Marketing


1.1 Definitions:
In the book Social Marketing: Influencing behaviours for good, Kotler & Lee (2008, p. 7) provide a list of
useful definitions from social marketing academics:
“Social marketing is a process for creating, communicating and delivering benefits that a target
audience(s) wants in exchange for audience behaviour that benefits society without financial profit to
the marketer” (Bill Smith 2006 cited in Kotler & Lee 2008, p. 7)
“Social marketing is the application of commercial marketing technologies to the analysis, planning,
execution, and evaluation of programs designed to influence the voluntary behaviour of target audience
in order to improve their personal welfare and that of their society” (Alan Andreasen 1995 cited in
Kotler & Lee 2008, p. 7)
“Social marketing is the systematic application of marketing concepts and techniques to achieve specific
behavioural goals relevant to a social good” (Jeff French & Clive Blair-Stevens 2005 cited in Kotler &
Lee 2008, p. 7)
The current definition upheld by the Social Marketing Institute is:
“The planning and implementation of programs designed to bring about social change using concepts from
commercial marketing” (O’Reilly & Madill 2007, p. 6)
Each of these definitions has commonalities. These include:
1. A systematic planning process based in the application of traditional marketing principles
2. The influencing of behaviour
3. Intent to deliver a positive benefit for society


A systematic Planning Process Based in the Application of Traditional Marketing Principles:
Traditional marketing forms its basis in the ‘4Ps’, product, place, price, and promotion. These ‘4Ps’ are
independent variables which are strategically altered to achieve a desired reaction from a target public. This
strategic alteration of the ‘4Ps’ is commonly referred to as the marketing mix (Kotler & Lee 2007, p. 12).
A product is “anything that can be offered to a market to satisfy a want or need” (Aswathappa 2006, p. 289).
Traditional marketing theory suggests that when developing a product it should be examined on three levels:
core product, actual product and augmented product (Kotler & Lee 2008, p. 206). Core product refers to the
benefit that the target public expects to gain (Kotler & Lee 2008, p. 206). Actual product is the specific
behaviour the marketer wants to influence (Kotler & Lee 208, p. 209). The final product of any social
marketing plan is never physical. An augmented product is a tangible good that assists in reducing barriers to
the uptake of the desired behaviour (Kotler & Lee 2008, p. 210). The following table (Kotler & Lee 2008, p.
207) provides examples of these product levels:
Core Product Actual Product Augmented Product
Price is the amount a consumer is expected to pay to obtain the product. Both low and high pricing can be
points of differentiation (Hooley, Saunders & Piercy 1998, p. 382). In addition to monetary costs it is important
to consider non-monetary costs such as the time and effort required to perform a desired behaviour as well the
psychological risks involved (Kotler & Lee 2008, p. 228).
Place refers to where the product is obtained or where the target public puts their motivation into action (Kotler
& Zaltman 1971 cited in Neiger & Thackeray 2003). The wider process involves identifying how to reach the
target adopter and how to make the product (or behaviour) available to them (Wilson & Olds 1991 cited in
Neiger & Thackeray 2003).
Prevention of alcohol
poisoning
Drink less than five drinks at
one sitting
Breathalysers in bars
Early detection and treatment
of breast cancers
Conduct a monthly breast
self-exam
Laminated instruction card
for placement on shower
nozzle


The final element of the mix is promotion. This involves the different types of communications employed to
inspire a target adopters into action (Kotler & Lee 2008, p. 268). Promotion should highlight the beliefs and
features of a product as well as providing information about access (Kotler & Lee 2008, p. 268). Television
advertising, print media and the Internet are all forms of promotion (Hooley, Saunders & Piercy 1998, p. 383).
The elements of the marketing mix are co-dependent and should not be considered in isolation. For example, a
high end positioned product which differentiates from its competition due to its superior product quality may be
unsuccessful if it retails for too low a price. The target public may perceive low price to mean low quality.
The Influencing of Behaviour:
The primary aim of social marketing is behaviour change. This is the key differentiating factor between social
marketing and other corporate social initiatives such as corporate philanthropy and volunteering. These other
social initiatives exist to spark awareness (of a cause or brand), generate goodwill amongst stakeholders, or
raise money. They generally do not aim to change behaviour (Kotler & Lee 2004). In addition to motivating
behavioural changes within a target public, social marketing can also bring about changes to secondary target
adopters whose cooperative actions can contribute to the success of a campaign. These publics can include, but
are not limited to, the media, family members, and policymakers (Andreasen 2002, p. 8).
Social marketing results in changed behavioural patterns (Kotler & Lee 2004). Kotler and Lee state that
although increasing knowledge, and altering existing beliefs and attitudes may be encouraging proxies, the
ultimate bottom line for a social marketing campaign is: did the target adopter ‘buy’ the desired behaviour?
(Kotler & Lee 2008, p. 8).
When people change the way they act, and then personally (either directly or indirectly as a member of society)
benefit from this change, they are likely to have a strong positive association with the company that motivated
the change (Kotler & Lee 2004).
For example, a bicycle company may become involved in an initiative to encourage children to ride to school A
parent may observe the promotional campaign around the initiative and encourage their child to ride to school.
They may also notice that after a month of riding to school, their child has more energy, is more social, and has


lost weight. Therefore, they are likely to develop a positive image of the particular brand of bicycle. They now
associate it with a more energetic, social, and healthy child.
Intent to Deliver a Positive Benefit for Society:
Social marketing is most commonly utilised for the sake of improving health, public safety, community
involvement, or for environmental causes (Kotler & Lee 2004). The standing of these social issues is improved
through an increased adoption of desired related behaviours (Kotler & Lee 2008, p. 16).
Kotler (2005, p. 146) saw social marketing as an alternative to coercion, illegal actions and education. The
former two options were inherently unethical. The latter he believed was too slow in appropriating desirable
change. Social marketing generally achieves its behavioural change goals through the use of incentives,
facilitation and promotion (Kotler 2005, p. 145). Incentives are important not only for motivating individual
target adopters but also the support networks that facilitate change (Walsh et al 1993, p. 112) Social marketing
relies heavily on “rewarding good behaviours”, as opposed to “punishing bad ones” which is commonly the
purpose of involuntary legal recourse (Kotler & Lee 2008, p. 8).
One of the most distinguishing features of social marketing is its ethical focus, “Social marketers must regard
themselves as being ethically responsible for all aspects of social marketing efforts” (Kotler & Roberto 1989, p.
363). Murphy and Bloom (1990, p. 69) note that marketing is essentially an exchange. The central concept of
any exchange relies on the ethical element of fairness. Social marketers should be viewed as responsible,
disciplined, and accountable (Kotler & Roberto 1989, p. 342). A second reason for the focus on ethics is that
social marketing campaigns have the ability to impact a public’s long-term well being and satisfaction (Kotler
& Roberto 1989, p. 342).
Corporate social marketing is effective when used in partnership with government and the non-profit sector
(Kotler 2004). The greatest benefit of social marketing is that (over time) it is the surest way to have a
measurable impact on a social issue because it increases the number of people who are willing to act in a way
that benefits society (Kotler & Lee 2004). Persistence and a long time frame are critical elements of social
marketing, Walsh et al (1993, p. 111) reference numerous studies into cardiovascular risk reduction programs
that take up to 10 years for “effective diffusion of new ideas and practices to produce measurable and
consequential social change” (Walsh et al 1993, p. 111).


1.2 History and Development:
The wider concept of marketing emerged after the industrial revolution when mass production caused the
supply of goods to exceed customer demand (Fine 1990, p. 2). Before this time, products were made to order.
Social marketing was first examined as an academic concept in the 1951 article by G.D Weibe (Andreasen
2002, p. 3). It wasn’t recognised as a distinct marketing discipline until the 1970’s when Philip Kotler defined
and named the term (Kotler & Lee 2004).Kotler is the recognised authority on social marketing. His book
Social Marketing: Strategies for Changing Public Behaviour, which he wrote in partnership with Eduardo L.
Roberto, was the first text book devoted to the role of marketing in social campaigns (Bates 1991, p. 108).
During its introductory period (the 1970’s and 1980’s), social marketing struggled to establish a separate
identity from generic marketing practice (Andreasen 2002, p. 3). Early academic works distinguishing social
marketing as a divergent marketing practice include Kotler and Levy’s ‘Broadening the concept of marketing’
(1969), and Kotler and Zaltman’s ‘Social Marketing: An approach to planned social change’ (1971). However,
It wasn’t until the 1990’s that a wide and general acceptance of the concept was realised. This acceptance
became apparent through: the publication of books devoted entirely to social marketing, the inclusion of social
marketing chapters in marketing text books, a journal on social marketing (Social Marketing Quarterly,
founded in 1994), executives within communications firms with ‘social marketing’ in their titles, the
establishment of social marketing centers (Scotland, Canada, and Poland), and finally the establishment Social
Marketing Institute in 1999 (Andreasen 2002, p. 3).
Social marketing aimed to provide a more proactive toolkit for social action, creating voluntary and ethical
behavioural change within society (Kotler 2005, p. 146). According to Andreasen (2002, p. 4) the development
of social marketing fits consistently with the general pattern of inter-sector transfer of marketing concepts
where the concept takes on a broader application. It has moved from being viewed purely as an agent for
marketing products of social change (for example contraceptives) into a multiple sector encompassing
behavioural change model.
A timeline of significant academic works and publications around social marketing can be found in appendix 2.


1.3 Social Marketing as Distinct from Other Change Strategies:
In addition to social marketing, a number of other concepts have been utilised by organisations to induce
voluntary change. Similarities can be drawn between social marketing and elements of these alternate concepts
(Andreasen 2002, p. 6). Change agents generally seek to influence their target public to do one of four things:
1) Accept a new behaviour (encourage child to walk to school once a week)
2) Reject an undesirable behaviour (do not offer afterschool snacks high in sugar)
3) Modify a current behaviour (encourage child to order fruit instead of chips with a meal)
4) Abandon an undesirable behaviour (use fat-free cooking methods like baking or steaming)
(Kotler & Lee 2008, p. 8).
Some alternative concepts include:
1. Social learning theory which emphasises building on the target adopter’s belief that they can
make behaviour happen (Bandura 1997).
2. Behavioural reinforcement theory which is based on a model of reward and punishment for
certain behaviours (Rothschild 1999).
3. Enter-educate programs which combine educational messages with entertainment to bring about
behavioural change (Piotrow and Coleman 1992).
More generally, Rothschild’s (1999) theoretical framework is inclusive of social marketing as well as the law
and education, as strategic apparatus for influencing behaviour. Each of these approaches to change are
considered based on whether or not members of a target market have the motivation, opportunity, and ability to
potentially change their behaviour (Rothschild 1999 cited in O’Reilly & Madill 2006, p. 20). O’Reilly and
Madill (2006, p. 21) further clarify this statement by adopting Rothschild’s (1999) definition of each key
proponent of behavioural change. ‘Motivation’ is the goal-directed arousal of the target public, ‘opportunity’ is
dependent on environmental factors being receptive to change, and ‘ability’ is the degree to which the
individual is empowered to solve problems (Rothschild 1999 cited in O’Reilly & Madill 2006, p. 21).


Social marketing, education, and the law are each useful for instigating some forms of change. However, none
are universally applicable (Dann & Dann 2008, p. 3).
Education can be used to communicate a message or build a particular skill set, however Kotler and Lee (2008,
p. 22) state that it does not pay enough attention to creating and maintaining behaviour change. It is more
concerned with informational transfer and awareness campaigns. Education programs are most valuable when
there is a gap in the target adopter’s knowledge about an issue (Dann & Dann 2008, p. 11).
In circumstances where voluntary change strategies are not adopted legal intervention is sometimes required. If
a presented message runs against the individual values of the target adopter it is unlikely that the social
marketer will be able to institute behavioural change. In such a circumstance, social change agents may be
required to use legal sanctions to enforce a new behaviour. Legislation is a highly effective way of ensuring
swift behaviour (Dann & Dann 2008, p. 11). This is not social marketing because ultimately the decision to
change behaviour is not voluntary (Dann & Dann 2008, p. 11). Legal intervention is especially effective when a
large majority have adopted high consensus behaviour and only a small minority resist (Kotler & Lee 2008, p.
17). Mill notes that state intervention should be a measure of last resort. This is because policy makers rely on
generalisations when making law. Unlike social marketing, which targets specific populations, governments
generally do not tailor laws for a specific individual. They create a blanket policy for the approximation of the
individual (Mill 1863, p. 150).
In addition to the aforementioned education and legal models of change Kotler and Lee (2008, p. 17) highlight
the media, as an alternate form of inducing change. Individual behaviours are in part a result of personal values
which are often gleaned from current events, trends and social norms depicted through the media (Kotler & Lee
2008, p. 22). The media shapes and reflects public opinion. This means the support of the media is essential to
the success of a social marketing campaign (Dann & Dann 2008, p. 24).
Kotler and Lee (2008, p. 22) believe that each of these mechanisms can work in cooperation with social
marketing. For instance, the success of a social marketing campaign may lie in whether or not the target adopter
has been educated or equipped with the learned skills to interpret the message and correctly implement the
initiative (Walsh et al 1993, p. 113).


1.4 Social Marketing in the Corporate Environment:
While this report is focused on social marketing in a non-corporate environment, it is important to understand
the concept in a wider context. Increasingly non-profit organisations are calling for more professional, business
like behaviour from managers (Bates 1991, p. 109). Due to a rapidly shifting economic climate it is becoming
harder for non-profits to operate “outside the “rules and regulations” of for-profit enterprise” (Bates 1991, p.
109).
It has only been in the last 15 years that social marketing has been prevalent in the corporate arena. Perhaps, in
part due to its relevant infancy corporate social marketing (CSM) is often misunderstood (Kotler & Lee 2004).
CSM is a “strategy that uses marketing principles and techniques to foster behaviour change in a target
population, improving society while at the same time building markets for products or services” (Kotler & Lee
2004). As with other forms of social marketing, behaviour change is the major aim of CSM (Kotler & Lee
2004).
Another reason for the late development of CSM is a basic misunderstanding around its goals and challenges.
Often corporations who undertake corporate social marketing label their initiative as something else: ‘cause
marketing’ or ‘corporate social responsibility’. This is a result of companies failing to distinguish between
raising awareness and changing behaviour (Kotler & Lee 2004). The distinction between commercial marketing
and CSM is often blurred, such as in the case with condom manufacturers who provide information on AIDS
while making a profit from a tangible product output (Lefebvre & Flora 1988, p. 300). To identify a CSM
campaign it is necessary to examine the objectives of the marketer to identify an interest in motivating
beneficial behaviour (Lefebvre & Flora 1988, p. 300).
There are a number of differences between CSM and commercial marketing. Kotler and Lee (2008, p. 13) point
to the type of product sold as the largest distinguishing factor between the two. They note that in the
commercial sector the marketing process revolves around financial gain from the selling of a good or service.
Conversely, social marketing aims to sell a desired behaviour for the benefit of society (Kotler & Lee 2008, p.
13). Where in commercial marketing the marketer (or the company they represent) is often a profiteer, a CSM
campaign serves primarily to benefit the target adopter and society as a collective (O’Reilly & Madill 2007,
p.6). A further distinction is the selection of target audience, “commercial marketers often favour choosing
primary target market segments that will provide the greatest volume of profitable sales. In social marketing


segments are selected based on a different set of criteria including prevalence of the social problem, ability to
reach the audience, readiness for change” (Kotler & Lee 2008, p. 13).
While there are differences between social marketing and commercial marketing there are also many
similarities. In both cases the marketer seeks to gain the greatest output for their input of resources. The
principals and techniques that influence each strain of marketing are the same. They include a customer
orientation, a basis in exchange theory (target adopter must perceive benefits that equal or exceed perceived
cost associated with performing behaviour), market research is utilised heavily, audience require segmentation,
each of the ‘4Ps’ are considered, and finally results are measured and used for future improvement (Kotler and
Lee 2008, p. 14).


1.5 Social Marketing in the Non-Profit Environment:
According to Kotler and Lee, “When a public-sector agency considers the wants, needs, problems, and
preferences of citizens in developing and delivering programs and services, its needs are served and its
performance improves” (Kotler & Lee 2007, p. 12). The utilisation of social marketing by non profits is
increasingly frequent. Government agencies, charities and other organisations classed as non-profit are under
increasingly intense public scrutiny. They need to be accountable and prove that they produce tangible
outcomes that benefit a wide section of society (Bates 1999, p. 109). This is especially important for
organisations that are taxpayer funded. Taxpayers want to know that their money is going towards causes and
initiatives that are making a marked difference in the community (Bates 1999, p. 109).
Fine (1990 separates the non-profit sector into two distinct categories.
1. Government agencies funded by taxes
2. Private organisations (such as charities) funded by government grants and personal contributions


1.6 Elements of Social Marketing:
Kotler and Roberto (1989) provide a list of the central elements of a social marketing campaign. These are
cause, change agent, target adopters, channels, and change strategy.
Cause:
A social objective aimed at providing a desirable answer to a social problem (Kotler & Roberto 1989, p. 17-19).
There are three types of causes:
• Those that aim to present new information and raise awareness of a cause and affect a cognitive
change in the target adopter.
• Those that seek to to “persuade a maximum number of individuals to perform a specific act...”
(Kotler & Roberto 1989, p. 19). A social marketer must go beyond cognitive attitude change. The
target adopter must perform a discrete act.
• Those that require a social marketer to convince target adopters to positively change their behaviour
and maintain the new behaviour.
Change Agent:
A change agent is an individual, organisation or alliance that seeks to bring about social change (Kotler &
Roberto 1989, p. 18).
Target Adopters:
In this report, target adopters are the people whose behaviour a campaign aims to change. To induce change
among a target adopter group, Fine (1990, p. 293) suggest that they must possess the following:
• The knowledge and ability to make the desired change
• The desire to upset old habits in order to take up the promoted behaviour
• Permission to make the change
Efforts should go beyond simply influencing the behaviourally problematic individual to influencing those who
can facilitate a change in their behaviour (Kotler and Lee 2008, p. 11). An effective social marketing effort


requires leadership and support, “A visible imprimatur for national and local decisions workers, political
figures, and opinion leaders can be crucial to a social marketing programs success” (Walsh 1993, p. 113).
Kotler and Roberto (1989, p. 27) suggest a number of influence groups that need to be appropriately consulted
to aid in the successful execution of a social marketing campaign. These groups include permission granting
groups, support groups, opposition groups and evaluation groups.
Professionals (for example, doctors or lawyers) also play an important role in persuading target publics to
embrace the cause of a social marketer (Kotler & Roberto 1989, p. 177).
Because social marketing is entrenched in behavioural change it is important to collect enough data to predict
how consumers will react to particular stimuli. Kotler and Roberto (1989, p. 27) suggest that target adopters be
separated according to their sociodemograpic characteristics (class, education, age), psychological profile
(values, motivation and personality), and behavioural characteristics (buying habits and decision making skills).
According to Lilley the entire concept of social marketing supersedes normal methods of communication, “data
is key...social marketing is nothing if it is not backed up with accurate data” (Lilley 2007, p. 22). After publics
are segmented qualitative and quantitative data collection techniques are implemented to create a profile of the
target public (Walsh et al 1993, p. 109). This allows for accurate behavioural predictions to be made. O’Reilly
and Madill support this view by quoting Rothschild (2001), “Prior levels of motivation, opportunity, and ability
in the target will determine behaviour...” (Rothschild 2001 cited in O’Reilly & Madill 2006, p. 21).
When undertaking any social marketing campaign target adopters must be communicated to in a personal
manner though every stage of the promotion and adaptation of the social product (Bates 1991, p. 109). Kotler
and Roberto (1989, p. 19) note that mass communication messages on their own are often insufficient for
appropriating long-term behavioural change. Such communication needs to be complimented by personal
communication (Kotler & Roberto 1989, p. 19). Kotler and Lee (2008, p. 53) suggest that a “simple, clear,
action orientated message is most likely to support your target market to adopt, reject, modify or abandon a
specific behaviour” (Kotler & Lee 2008, p. 53). The message should be presented in such a way that target
adopters know exactly what they need to do and whether or not they have done it. This is best achieved when
simple, doable behaviours are promoted one at a time (Kotler & Lee 2008, p. 53).


Channels:
This refers to both communication and distribution channels. Channels are pathways though which messages
are exchanged and influence imparted between change agents and target adopters (Kotler & Roberto 1989, p.
18). The media is regarded as the prime channel for marketing and distributing intangible social products
(Kotler & Roberto 1989, p. 167). Access via channels should be made as effortless as possible. This may be in
the form of a ‘convenient location’ or an ‘easy way to sign up’ to attain tangible products and receive services
(Kotler & Lee 2008, p. 59). According to Lefebvre & Flora (1988, p. 305), public health programs require an
assortment of channels through which to promote messages, products, and services. The range of channels is
broad. Any person or organisation having access to a target public is a potential channel (Lefebvre & Flora
1988, p. 305). Rogers (1983 cited Lefebvre and Flora 1988, p. 305) suggest that while informational appeals
can be effectively and thoroughly transmitted through media channels, behavioural change adaptations
generally require the utilisation of interpersonal networks to be influential.
Change Strategy:
A change strategy is a deliberate program implemented by the change agent to cause a change in the attitudes
and behaviours of target adopters (Kotler & Roberto 1989, p. 18).


1.7 Social Marketing in Practice:
While social marketing uses design elements of traditional marketing, often a marketing plan is neglected.
Kotler and Lee (2008, p. 27) suggest the following reasons for this:
• Lack of time
• Lack of funding
• Belief that staff know what they are doing and preparing a plan would be a waste of resources
Kotler and Lee (2008, p. 31) provide a neat template for developing a social marketing plan. They suggest that
the first step in planning any social marketing campaign should be a clarified purpose and focus for the effort.
This is followed by an analysis of the current situation and environment. Next target adopters are identified then
marketing objectives and goals set. This is followed by a position statement (achieved through manipulation of
the ‘4Ps’). The final stage of the planning process involves incorporating data driven evaluation plans into the
model (Kotler & Lee 2008, p. 31).
The background focus and purpose are a series of well researched, concise statements. Once these statements
are set out the social marketer should engage in a situation analysis. This should be relevant to the pre-stated
purpose and focus of the plan (Kotler & Lee 2008, p. 35).
The third step is the selection of target adopters. Kotler and Lee (2008, p. 34) state that it is important that target
adopters are selected before establishing objectives. This is because marketing objectives should influence the
behaviours of target adopters. This means it is important to have a profile of current behavioural patterns before
appropriate objectives can be set (Kotler & Lee 2008, p. 3). Behavioural objectives are always included in
social marketing plans (Kotler & Lee 2008, p. 38). Sometimes however, behavioural objectives can’t be met
without first achieving knowledge objectives (information the target public needs to be aware of) and belief
objectives (feelings and attitudes) (Kotler and Lee 2008, p. 38). When setting objectives, it is important to
ensure that they are specific, measurable, and attainable (Kotler & Roberto 1989, p. 42). It is not enough to use
phrases such as ‘improve productivity’ or ‘raise quality of life’ because these statements are not specific and
therefore not measurable (Kotler & Roberto, p. 42). Attainability relates to the target adopters ability to achieve
and maintain the promoted desirable behaviour, “Objectives should not be set so high that they cannot be
obtained with the available resources or so low as to be unchallenging” (Kotler & Roberto 1989, p. 42).


Objectives should also be ranked in order of importance, it is naive for an organisation to attempt to achieve all
their campaign objectives at once therefore they must concentrate on those that are of the highest priority (Fine
1990, p. 5). According to Kotler and Lee (2008, p. 38), this is the ideal point in the plan to introduce goals.
Goals should be related to knowledge, belief, and behavioural objectives. It is important to clearly distinguish
between goals and objectives. Brady (1984, p. 45) states that goals are “long term outcomes, usually two years
or longer; somewhat generally stated” while objectives are “short term, one year performance tasks; stated in
more specific terms...” (Brady 1984, p. 45).
The design phase of a social product should be built upon the needs and motivators of target adopters (Kotler &
Roberto 1989, p. 139). According to Kotler and Roberto (1989, p. 139) this is a duel element task. The first
element is the identification of distinct needs that a specific social offering can satisfy. The second is to
determine how to most effectively present the social product.
When positioning a product using the ‘4Ps’ it is important not to consider individual elements of the marketing
mix in isolation (section 1.1), putting together disparate elements will not necessarily result in an optimal plan
for a social change campaign (Kotler & Roberto 1989, p. 275).
The final phase of managing a social marketing plan is data-driven evaluation (Kotler & Roberto 1989, p. 342).
Evaluation is a measurement and final report on what happened (Kotler & Lee 2008, p. 327). The first step in
an evaluation plan should be to define what will be measured (Fine 1990, p. 174). It is important to distinguish
this from monitoring which refers to “the measures that are conducted sometime after you launch your social
marketing effort but before it is completed” (Kotler & Lee 2008, p. 327). Monitoring is an important part of any
social marketing effort as it allows the marketer to track results and make adjustments if necessary (Kotler &
Lee 2008, p. 65).
A social marketing evaluation should fall into one of three categories: outputs, outcomes and impacts. Outputs
focus on quantifying marketing activities (Kotler & Lee 2008, p. 329). An example of output is the number of
flyers distributed. Outcomes measure the customer response to outputs and should be related to specific and
measurable goal and objectives (Kotler & Lee 2008, p. 30). An example of an outcome may be the number of
primary schools that stop selling sugary drinks in their canteen. Impacts measure the effect that the change in
behaviour (primary schools no longer selling sugary drinks in the canteen) have had on the wider social issue
(health of primary school students) (Kotler & Lee 2008, p. 332).


1.8 Issues with Social Marketing:
Like traditional marketing, one of the most fundamental principles underlying social marketing is identifying
barriers preventing uptake of desired behaviours. However, unlike many traditional marketing efforts social
marketing upholds an ethical imperative (Kotler & Lee 2008, p. 10). There are scholars (Bartels 1976, Luck
1969) who question the long term affects of applying marketing principals in a broadened context (O’Reilly &
Madill 2007, p. 5). Such theorists believe the definition of marketing should not extend past buy-and-sell
transactions (O’Reilly & Madill 2007, p. 5).
In 1999 the Social Marketing Institute was established. One of the first undertakings of the Institute was the
identification of major problem areas that threaten to curdle the growth of social marketing (Andreasen 2002, p.
4). These areas include:
• Lack of appreciation of social marketing at top management levels. This can lead to promising
campaigns not receiving the funding or resources to adequately implement a social marketing campaign
(Andreasen 2002, p. 4).
• Lack of clarity around the concept leading to poor branding. “Social marketing as an approach to social
change lacks clarity and is perceived by key influential people as having several undesirable
traits”(Andreasen 2002, p. 4). Andreasen (2002, p. 4) notes social marketing lacks differentiation from
other marketing concepts, has too many definitions, and an image of being manipulative.
• Lack of evidence and publicity surrounding the successes of the practice.
• Lack of academic legitimacy. As a standalone discipline it is rarely included in academic curriculum.
Another issue lies in the socially beneficial nature of social marketing. Kotler and Lee (2008, p. 11) state that it
is not always easy to define weather the outcomes of a social marketing effort are beneficial. While social
marketing generally supports high consensus notions there are circumstances where parties may have strongly
supported opposing views on whether an initiative contributes to the good of society (for example, abortion).


Chapter 2: Childhood Nutrition and Physical Health
This chapter provides a context and background for the report. The impacts, academically suggested causes,
and possible solutions for the obesity ‘epidemic’ will be examined.


2.1 Problems Associated With Poor Childhood Health and Nutrition:
The most prevalent issues affecting Australian children are: obesity, dental disease, emotional and behavioural
problems, and learning delays. Each of these can be intrinsically linked to poor nutrition and lack of exercise
(Alexander 2008).
Obesity is a precursor to heart disease, respiratory problems, diabetes and a range of other chronic illnesses
(Stephanie Alexander 2008). Every day around 80 Australians die from heart disease making it the nation’s
number one killer of adults (Curry 2000, p. 7). Clogging of the arteries, as a result of high cholesterol intake, is
one of the key causes of heart disease. It has been evidenced in children as young as 12. Previously these risk
factors were only apparent in middle aged Australians (Curry 2000, p. 138). Children may develop fatty streaks
in their aortas at four years and in the coronary vessels before 10 years (Curry 2000, p. 71). This decline in
health is directly related to unhealthy diets and lack of physical activity. Children who participate in high
intensity sport at least three times per week are at lower risk of developing heart disease and other lifestyle
associated diseases (Curry 2000, p. 138).
Research has conclusively proven the link between childhood obesity and preventable conditions such as type 2
diabetes, stroke, and high blood pressure. Type 2 diabetes is normally found in adults, however, it is becoming
increasingly prevalent in children (1Seven 2008). The National Health and Medical Research Council suggest
that in Australia, 66 per cent of type 2 diabetes is a result of obesity (Sweet 2007, p. 97). Obese Australians are
twice as likely to have high blood pressure as people who fall within the healthy weight range (‘Go for your
life’ Strategic Plan 2006-2010, p. 6). Other side effects of children being overweight include: mental health
issues, problems with the hips and joints, and problems breathing. Breathing problems are especially prevalent
at night which can lead to disrupted sleep patterns, and a lack of energy and mental alertness during the day
(Curry 2000, p. 71).


2.2 Definition of Overweight and Obesity in Children:
It is difficult to define healthy and unhealthy weight ranges in children because all children grow at different
rates. A healthy child should gain weight in proportion to their height and age. However, factors such as
genetics and environment may influence the rate of growth and the final size of a child (Curry 2000, p. 69).
The Body Mass Index (BMI) is a commonly used technique for measuring overweight and obesity levels in
adults. The BMI system is used by the Victorian State Government funded state wide health initiative, ‘Go for
your life’ (Strategic Plan 2006 – 2010). The formula used to calculate BMI is weight (in kilograms) by height
(in meters) squared. In adults a BMI higher than 24.9 is considered overweight and a BMI above 29.9 is
considered obese (Sark 2008, p. 1). However, the BMI does not distinguish between muscle and fat, and is
therefore not always an accurate measure of a person’s weight. For example, many athletes are considered
overweight or obese on the BMI due to large amounts of muscle mass (Stark 2008a, p. 1). Standard BMI
calculations are unsuitable for children. This is due to the rapid rate of childhood development. BMI (as
measured by the standard formula for adults) in childhood changes markedly with age. It falls during the pre-
school years where children become leaner then rises in the early primary school years (Curry 2000, p. 71).
This makes it difficult to use the generalised system to a high degree of accuracy. For this reason, BMI up until
the age of 18 is best calculated using an age reference chart. As of 2002, the Australian standard definition for
measuring childhood obesity was the government endorsed 12th edition of the National Health Data Dictionary.
This can be measured against the relevant age and sex of the child in the following table:


Table 1: Classification of Overweight and Obesity for Children and Adolescents
Age (years) BMI equivalent to 25 in adult BMI equivalent to 30 in adults
Males Females Males Females
5 17.42 17.15 19.30 19.17
5.5 17.45 17.20 19.47 19.34
6 17.55 17.34 19.78 19.65
6.5 17.71 17.53 20.23 20.08
7 17.92 17.75 20.63 20.51
7.5 18.16 18.03 21.09 21.01
8 18.44 18.35 21.60 21.57
8.5 18.76 18.69 22.17 22.18
9 19.10 19.07 22.77 22.81
9.5 19.46 19.45 23.39 23.46
10 19.84 19.86 24.00 24.11
10.5 20.20 20.29 24.57 24.77
11 20.55 20.74 25.10 25.42
11.5 20.89 21.20 25.58 26.05
12 21.22 21.68 26.02 26.67
Australia has one of the highest rates of childhood obesity among the developed nations. The percentage of
overweight or obese children varies from source to source. The Australian and New Zealand Obesity Society
predicts around 25 per cent of Australian children are currently classified as overweight or obese while the
Victorian State Government suggests the figure is closer to 30 per cent. It is estimated that childhood obesity is
increasing at a rate of 1 per cent each year (The Australian and New Zealand Obesity Society 2007). The
Sentinel Site for Obesity Prevention in Victoria found that in 2003, 26.7 per cent of 11 year olds were
overweight including 7.9 per cent who were classified as obese (The Australian and New Zealand Obesity
Society 2007). This is well above the international mean where it is estimated that 10 per cent of young people
aged 5–17 years are overweight including 2-3 per cent who are obese (Sweet 2007, p. 14). This equates to
between 30 and 40 million children.


2.3 The Notion of an Epidemic:
There has been a large amount of media coverage labelling claims of an obesity epidemic as ‘exaggerated’ and
in need of ‘debunking’.
The Weekend Australian recently published a study by Jenny O’Dea which found that overall levels of
childhood obesity had not increased between 2000 and 2006. The study found that the only statistically
significant increase was among children from low-income households “Children from poorer families were 2.5
times more likely to be obese than children from high-income families” (Stapleton 2008, p. 3). This suggests
socio-economics is the greatest risk factor of poor health in childhood and the complications associated with
obesity (Jennings & O’Dea 2008, p. 8).
Opposition Leader (as of August 2008) Brendan Nelson has referenced the findings of O’Dea’s study in an
attack on the Rudd Government. Nelson has accused the Government of over-sensationalising the issue of an
‘obesity epidemic’ (Stapleton 2008, p. 3). This view is supported by the June 2 editorial in The Australian
which argues that “An ‘epidemic’ is a condition that affects a large number of people in the same place at the
same time”. According to this editorial the fact that obesity levels did not increase overall in Australian children
between the years 2000 and 2006 makes the notion of an epidemic hollow.
While the idea of an obesity ‘epidemic’ is contentions, there is no denying that as a nation Australia has a
serious problem. More than nine million adults are now classified as overweight and four million of those obese
(Jennings & Steward 2008, p. 1). Australia currently holds the title of world’s fattest nation. 26 per cent of
Australians are currently obese compared to 25 per cent of Americans.
The term ‘epidemic is used in the ‘Go for your life’ Strategic Plan 2006 – 2010, the umbrella program of the
profiled Kids – ‘Go for your life’ program.


2.4 Causes of Poor Health in Children:
2.4.1 Socio-economic factors:
In his article, Playing field far from level on obesity, Stapleton (2008, p. 3) references The Association of
Australian Medical Research Institute President Garry Jennings who states that when finances are limited
people instinctively go for a maximum number of calories per dollar. This is usually found in “fast fatty foods
with lots of refined carbohydrates, sugars and salt” (Stapleton 2008, p. 3). Jennings and O’Dea state that food
choice is highly political. The foods that families are being told not to eat are the best value for money, while
items such as meat, fish, fresh fruit and vegetables are expensive. “Plot a graph of kilojoules a gram, vs.
kilojoules a dollar, and we find an inverse relationship” (Jennings & O’Dea 2008, p. 8). An article published in
The Age Online (Unknown 2008b) on 7 October 2008, references a recent study that examined the trends in
food pricing between 1989 and 2007. The study found that staple foods such as bread and milk had risen at a
much higher rate than unhealthy substitutes such as cakes and soft drinks. Tim Crowe, a lecturer in nutrition at
Deakin University believes price disparities to be one of the biggest causes of the obesity ‘epidemic’.
Globally, obesity has traditionally been seen as a sign of wealth however, currently Australia is seeing the
reverse of this trend. An Australian child who is obese is statistically more likely to come from a lower-income
family than a slimmer child (Jennings & O’Dea 2008, p. 8). Residents of lower socioeconomic areas are 65 per
cent more likely to eat fast-food each week than those living in wealthier areas. In order to provide enough food
for a low-income family, low cost and therefore high kilojoules foods are selected. Many families on welfare
spend over half their payments on food (Jennings & O’Dea 2008, p. 8). In many circumstances, if these people
spent an extra 20 per cent of their income on food (which they cannot afford to do) their diet would be
significantly healthier (Jennings & O’Dea 2008, p. 8). Access is a consideration. People who live in the suburbs
generally have relatively easy access to fast-food. Outlets selling healthy foods are scarce (Sweet 2007, p. 62).
2.4.1 Recommendations:
There is a consensus that socio-economic circumstance may be the biggest risk factor for child health. The bias is both
financial and geographical. This suggests that health campaign resources need to be directed to those in lower socio-
economic areas as priority, “limited health funds should be more carefully targeted towards at-risk groups” (Stapleton
2008, p. 3). Jennings and O’Dea suggested that the problem needs to be tackled through visual partnerships with childcare
centres and local councils. They also cite the need to increase the availability of fresh food in disadvantaged areas
(Jennings & O’Dea 2008, p. 8). However, many of the problems outlined in section 2.4.1 must be approached from a
macro perspective. Local and targeted social marketing campaigns cannot affect or influence food prices. Government
policy (example, taxing innutritious foods) that extends beyond state and national borders is necessary.


2.4.2 Effects of Technology:
The benefits of technology are numerous. Remote controlled gadgets, electronic devices and networked
systems such as the Internet have increased the ease and efficiency of gaining information. This growing
reliance on technology encourages parents to immerse their children in sedentary activities such as Internet
surfing to ensure they can compete in the modern high tech world (Fisman 2008, p. 13). In America, the
average young person currently spends more than a quarter of each day in front of a media screen. With the
exception of sleeping, this takes up more time than any other activity (Acuff & Reiher 2005, p. 1). In Australia,
screen-based activities are the most popular after-school cultural or leisure activity (Kids – ‘Go for your life’
2008). A Melbourne study found that 72 per cent of school aged (5 – 6 years and 10 – 12 years) children
watched in excess of two hours of television per day (Kids – ‘Go for your life’ 2008) Acuff & Reiher (2005, p.
1) note that increased inactivity and obesity are directly linked. They also cite a link between excessive levels
of the stress hormone cortisol and obesity, “Some researchers now believe excessive cortisol release is caused
in great part by the threatening and violent nature of much of TV, film and video game content” (Acuff &
Reiher (2005, p. 1). Garry Egger, Adjunct Professor in the school of Exercise and Nutrition at Deakin
University, believes that we need to look closely at the negative effects of technology (Sweet 2007, p. 24).
Small things such as using a remote control to switch television stations or open the garage manually instead of
using a remote device all contribute to weight gain (Sweet 2007, p. 24). Children have come to take such labour
saving devices as a given.

Fishman (2000, p. 13) argues that while there is a push for technologies to be introduced to improve academic
education, the same financial energy is not being invested into advancing physical education. He references the
One Laptop per Child program, “Federal subsidies in the US provide billions of dollars for computer access in
schools and libraries, and billions more may soon be spend in the developing world through programs such as
One Laptop per Child” (Fisman 2008, p. 13). He questions whether computers may serve as more of a
distraction then a learning opportunity.
The link between inactivity and obesity suggests the need to focus on replacing sedentary activities and the use
of convenience gadgets with exercise. If the amount of time allowed for sedentary activities is limited, children
are more likely to engage in activities that require physical activity (Curry 2000, p. 74). Sweet (2007, p. 24)
also suggests that parents and caregivers need to be educated about the negative effects of technology in order
to encourage children to reduce use of electronic devices or counter their impact with physical activities.


2.4.3 Neighbourhood Design:
The impacts of modernisation are not only being felt in a technological context. The rapid urbanisation of
communities and expansion of cities have been sighted by many children’s health professionals as a major
contributing factor to childhood obesity levels.
Sweet (2007, p. 15) uses the Chinese economic boom as a case study to illustrate the impact of rapid
urbanisation. Researchers found that in China those who gained access to cars (when otherwise they would
walk or cycle) gained weight. The Chinese economic boom has allowed for more roads and increased use of
automised transportation. Around eight per cent of children in China are overweight however this number
expands to 12.4 per cent in urbanised major cities (Sweet 2007, p. 16). A second study conducted by the
University of Maryland found that people who live in suburbs where daily services (such as banks and grocery
stores) can be reached on foot spend more minutes walking each month and weigh an average 2.7 kilograms
less than people who live in sprawling areas (Fittall 2008, p. 27). The study also found that the people in
‘dense’ suburbs have a 29 per cent lower risk of high blood pressure (Fittall 2008, p. 27).
Where you live can have a telling impact on how healthy you are. According to a study by the University of
Melbourne, “the more food outlets and fewer walking tracks or footpaths a suburb has, the more unhealthy its
residents are likely to be” (Fittall 2008, p. 27).
To carry out an intended activity one must have the means to do so (Kotler & Roberto 1989, p. 239). It is
illogical to encourage children to spend time playing outdoors if appropriate facilities such as parks and ovals
are scarce due to urbanisation. This is an area where government intervention and planning are necessary.
Stanley (2008, p. 12) calls for local councils to focus on children in their planning decisions stating, “Green
space, sports grounds, libraries and community art centres with good staff and outreach programs bring benefits
to all” (Stanley 2008, p. 12). Many communities are not designed in a way that facilitates freedom and exercise.
Attention should be paid to residential design to ensure that the perceived (or actual) supervision of children is
not diminished. Town planning needs to put residential, commercial and public areas in close proximity. Sweet
(2007, p. 34) notes that people are more likely to walk or cycle when they have a destination.


2.4.4 The Fear Factor:
Children are increasingly being seen as a social group in need of control and containment. According to Sweet
(2007, p. 31) guardians are engaging in ‘cotton wool’ parenting out of fear that something bad will happen if
they allow their children to engage in an array of unsupervised (yet often physically beneficial) activities.
Institutions charged with the care of minors’, such as schools and community groups, are putting limitations on
freedom in the face of a perceived safety risk (Sweet 2007, p. 31). The media may be, in part, to blame, “[The
media] has a huge impact in distorting the community’s perceptions of risk. Relatively uncommon events, such
as child abduction, are more likely to attract headlines than more everyday events such as traffic accidents”
(Sweet 2007, p. 30). The Australian Institute of Criminology supports this view stating many Australians
believe crime is becoming more common when the opposite is true (cited in Sweet 2007, p. 30).
This is a further (also section 2.4.3) area where government intervention is appropriate. Regulations ensuring
that neighborhoods are well lit and designed with a focus on safety can significantly reduce the fear factor.
People who worry about the safety of their neighbourhood have been proven to be less physically active than
the general population (Sweet 2007, p. 31). Sweet (2007, p. 31) argues that it is therefore not surprising that
people of lower socio-economic status (section 2.4.1) living in poor areas are more likely to be overweight. As
noted, the media also contributes to the populations perceived level of safety. Accurate, relevant, and statistical
reporting should be upheld and ensured through government regulation.


2.4.5 Shifts in Family Dynamic and the Role of Parents:
According to an editorial published in The Australian on 2 June 2008 (p. 9), prevention of childhood obesity is
primarily a matter for families, “It means parents taking responsibility for their children as well as for
themselves”. As a nation, Australia has 9 million adults who are classed as overweight or obese making us the
fattest nation in the world. As one journalist describes it, we are a “ticking ‘fat bomb’” (Stark 2008b, p. 1).
Stanley draws a link between soaring divorce rates and single parents having fewer recourses for healthy child
development. She also notes the impact of changing work schedules stating “jobs that are best for parents, and
therefore children’s development, hover around the 38-hour-week mark for secure employment. But instead of
this, more people are working 50 to 60 hours or zero to 15 hours with varying negative impacts” (Stanley 2008,
p. 12).
Shifts in the family dining schedule due to lifestyle factors such as increased time spent working and engaging
in extracurricular actives means that more meals are prepared outside the home. These meals are generally
higher in fat and of less nutritional value than those prepared in the home (Curry 2000, p. 72). Convenience
devices such as microwave ovens have also been shown to have a negative effect on health. They make it easy
for families to eat on the run rather than sitting down for a family meal, an activity which promotes healthy
food habits (Sweet 2007, p. 25).
A lead by example methodology has been shown to work in the areas of physical exercise and nutrition. Active
mothers are twice as likely to have active children. Active fathers are 3.5 times more likely to have active
children then inactive parents (Curry 2000, p. 139). The attitudes of one or both parents are often adopted by
their offspring both in childhood and later life, “there is evidence that reports of children’s dieting behaviour is
linked with weight concerns and dieting in the family, and that this process can start before the age of five”
(Curry 2000, p. 72). If a member of the family has a negative attitude towards food it is likely to be transferred
to smaller children (Curry 2000, p. 103). Parents who engage in extreme weight loss practices may be
mimicked by their children. Girls as young as seven have reported being dissatisfied with their body shape.
More than a third of girls between the ages of seven and 12 have tried to lose weight (Curry 2000, p. 80).
Workplaces need to be accommodating to the employees with children, Stanley (2008, p. 12) cites international
research which found that businesses that support their workers in their roles as parents have better financial
bottom lines.
A lead by example parenting approach is an effective strategy. It is therefore important that parents examine
their own philosophy towards exercise and nutrition. Food should be eaten slowly in an enjoyable and guilt-free
manner, rather than eating quickly and secretively. Designated sit-down meal times and the avoidance of ‘good’


or ‘bad’ food labelling are positive steps (Curry 2000, p. 79). Rather than giving child-specific instructions to
lose weight, it is more valuable to engage in a whole family initiative. This makes the process of eating and
undertaking physical activity more appealing. Weight challenged children are less likely to be self-conscious if
they are not the focus of the effort (Curry 2007, p. 79). However, while a lead by example method is an
excellent way to promote healthy lifestyles, it is important that parents understand that the needs of children
differ from their own. While a low-fat diet may be recommended for adults, such a diet is not suitable for
children aged five to 14 years who derive 35 per cent of their energy from fat (Curry 2000, p. 69). This is one
area where social marketing is likely to be effective. Education strategies are necessary before behaviour
change can occur. Due to the diverse and sacred nature of family lifestyles government policy may be viewed
as invasive and inappropriate


2.4.6 The Rise of Convenience Foods:
Eating behaviour is learned (Curry 2000, p. 109). This means that a diet high in fat and salt will condition a
child’s taste to those types of foods. The reverse is also true. Conditioning tastes toward more nutritious foods
such as fruits and vegetables provides the foundation for positive habits to be carried through to adulthood
(Curry 2000 p. 109).
Australia’s data shows that childhood obesity is most prevalent among children of particular ethnicities. Pacific
Islander, Middle Eastern and Aboriginal children are most at risk (Editorial 2008, p. 9). A suggested reason for
the increased risk of obesity in these groups is a move away from traditional cultural diets in favour of less
healthy fast-food alternatives. Jennings and O’Dea (2008, p. 8) highlight the fact that traditional diets have
evolved over centuries and have inherent protective qualities aligned with freshness, seasonable availability and
lifestyle (Jennings & O’Dea 2008, p. 8).
Marketing surveys show that around one third of the food budget in Australia is spent on meals prepared
outside the home. These meals tend to have a higher fat content than home-cooked meals (Sweet 2007, p. 27).
In 2004, 4.8 billion meals and snacks were eaten outside the home. This is an average of four meals per person
per week (Sweet 2007, p. 53).
There are now more than 58,000 commercial food outlets throughout Australia (Sweet 2007, p. 53). One in
three people eat out almost every day putting Australians among the world’s top ten fast-food consumers
(Sweet 2008, p. 53). Portion size is also increasing. A 2005 study by the NSW Centre for Public Health and
Nutrition around the supersizing fast-food meals found that on average a 12 per cent increase in purchase cost
correlated with a 23 per cent increase in calories, a 25 per cent increase in fat, and a 38 per cent increase in the
amount of sugars consumed (cited in Sweet 2007, p. 59).
A University of Sydney study found that between 1995 and 2003, there was a large increase in portion size of
pre-packaged foods sold in supermarkets (Sweet 2007, p. 59). A second element of the same study found that
people were ignorant as to what constituted appropriate portion size. As part of the study participants were
shown quantities of different foods and asked to estimate a standard portion size. According to Sweet (2007, p.
60), even the dieticians among the group struggled to correctly identify appropriate portion sizes. It was
concluded that the introduction of larger portion sizes by the food industry had influenced knowledge about
what is an appropriate amount to eat (Sweet 2007, p. 60). This view was confirmed by an American study


which found that under a third of participants believed that portion sizes in restaurants had increased over the
last three decades. Some single portions of fast-food have more than an entire days worth of calories and fat
(Sweet 2007, p. 71). Most of the participants in the American study described their standard portion size as
‘medium’, regardless of its actual size categorisation (Sweet, 2007, p.60).

As noted in the previous section, eating is learned behaviour. A child’ tastes can be conditioned to particular
flavours. This fact is testament to the importance of getting children into healthy eating patterns from an early
age. As recommended in section 2.4.5, the correlation between the weight of children and more meals being
prepared outside the home suggests parents should be encouraged to limit takeaway food consumption in
favour of home cooked meals. The shifts in family dynamic and busy lifestyles make this difficult; ways to
combat this should be investigated.
As stated, many schools do not see the provision of healthy food as their core business. A shift in focus is
necessary. Legislation has already been introduced to combat the amount of sugary and fatty foods in canteens
(Rout 2008). However, it would be draconian to have absolutely no sweet foods available. Education for
children, through schools and in the home, around healthy food choices and portion control is important. While
there is a legal requirement that food manufactures publish the nutritional information of their product on the
label, often this is misunderstood causing people to misjudge the nutritional value of much of the food they
consume. Portion size is also misjudged causing people to eat more. This confusion suggests the need for
unbiased and standardised information around portion sizes.
Given that certain ethnic groups are more prone to obesity, the editor of The Australian (2008, p. 9) suggests
that health authorities should work with community leaders (for example, aboriginal elders) to determine the
most appropriate campaigns through which to educate these groups. There is a need for community consultation
and specific approaches targeted to the traditional needs and modern lifestyles of at risk populations.


2.4.7 Advertising and Marketing:
When Victorian researchers asked parents about what influences the food choices of their five-six year old
children, the dominant answer was advertising, specifically advertising of junk foods (Sweet 2007, p. 45).
The relationship between marketer and child requires careful consideration. There is an unbalanced association
between a strategic marketer and a young child, the latter of which does not generally have the cognitive ability
to distinguish between ‘ad-speak’ and the language of a trusted adult (Sweet 2007, p. 41). A study from The
American Psychological Association found that less than half of all eight year olds understand that advertising
has a persuasive purpose. Children are unable to recognise commercial agendas within messages (Sweet 2007,
p. 41). Sweet (2007), cites American journalist Eric Schlosser who details how marketers regularly try to
understand the psychological motivators for children, “...marketers conduct surveys of kids in shopping malls,
hire children to run focus groups, and stage slumber parties where questioning goes into the night” (Sweet
2007, p. 43).
In America children spend around $36 billion of their own money and influence a further $200 billion in
household spending annually. It is therefore little wonder that in 2004, the fast-food industry spent close to $3
billion on advertising and marketing aimed specifically at young people (Sweet 2007, p. 44).
Primary school is for many children their first experience of independence outside the home. At this age
children are susceptible to a wider variety of influences. Of the 30,000 television advertisements children watch
on average annually, 12,000 are for food. 75-80 per cent of those foods advertised have marginal or low
nutritional value (Alexander, 2008). A Consumers International study which monitored television advertising to
children found that Australia (along with America and the United Kingdom), had between 10 and 12 food
advertisements per hour. This was six-10 times more than Belgium and Sweden (Sweet 2007, p. 45). Even in
health magazines print advertisements for foods high in fat and sugars outnumber those for grains, fruit and
vegetables (Sweet 2007, p. 53). According to Sweet (2007, p. 55), while the basic messages and physiology
about healthy eating have not changed for years, the proliferation of commercially fuelled nutritional messages
creates confusion among consumers over what constitutes a healthy diet.
In addition to print and digital mediums, marketers are using cyber space to reach young consumers. Websites
such as nabiscoworld.com, which attracts around 800,000 children a month, have developed ‘advergames’.


Some of these games revolve around a particular food being promoted. Children earn points by completing
marketing surveys (Sweet 2007, p. 45).
It has been suggested that some commercial food enterprises deliberately and strategically create confusion then
sells their product as an appropriate solution (Sweet, 2007, p. 55). Sweet (2007, p. 55), believes it is therefore
not surprising that “the explosion in the low-fat items coincided with widespread weight gain. People were so
busy worrying about their fat intake that they didn’t realise that many processed foods marketed as being low-
fat are also high in sugar and calories” (Sweet 2007, p. 55).
Health organisations, including the Obesity Policy Coalition (OPC), have been lobbying for restrictions around
food advertising to children. A 2003 study undertaken by The National Public Health Partnership concluded
that children would benefit from reduced exposure to food advertising on television (cited in ‘Go for your life’
strategic plan 2006-2010, p. 10). However, under the new draft standards (released by the Australian
Communication and Media Authority) no changes have come to fruition (Diabetes Australia 2008). The
Australian Greens leader, Bob Brown, has slammed the decision stating it is an inaccurate reflection of
Australian opinion, “A national ban on junk food advertising during children’s TV viewing hours is a sensible
first step in tackling childhood obesity” (Unknown 2008a). Because of the unbalanced relationship between
child and marketer and incidence of unscrupulous marketing techniques it would be wise and to place a ban on
all food advertising during hours when children most frequently view television (Unknown 2008a). According
to senior policy adviser of the of the OPC, Jane Martin, advertising and marketing to children should be
regulated by government, “For some time now the OPC has been calling for national legislation to ban junk
food advertising at peak times when children are actually watching television and to substantially restrict all
other forms of promotion of unhealthy food to children and adolescents” She continues on to say, “The federal
government needs to put in place legislation that protects children, supports parents, and does not undermine
campaigns to promote healthy lifestyles” (Unknown 2008a). Martin goes on to note a series of research
findings indicating that banning advertising of junk food was linked to improvements in childhood obesity
(Unknown 2008a). The concern of health authorities suggests the need for government intervention in order to
regulate ambiguous health promotion to parents. The popularity of websites such as nabiscoworld.com suggests
that children are avid online media consumers. Websites aimed at promoting sound nutrition and physical
exercising to children through games and interactivity are likely to be effective.


Chapter 3: The Kids – ‘Go for your life’ Program


3.1 Social Marketing a Framework for Analysis:
The primary motivators for selecting social marketing as a theoretical framework were the disciplines
measureable focus on behaviour and emphasis on social good. This makes critique highly systematic and issue
relevant. According to Lefebvre and Flora (1988, p. 301):
“Social marketing principles are especially well-suited for the task of translating necessarily complex
educational messages and behaviour change techniques into concepts and products that will be
received and acted upon by a large segment of the population”
Marketers in the weight loss industry use complex and conflicting messages to ‘educate’ consumers (Sweet
2007, p. 111). This makes it difficult to understand exactly what constitutes healthy eating (section 2.4.7).
Many foods and drinks are marketed as ‘healthy’ based on one criterion (such as fat content) may actually be
nutritiously lacking in another. Drawing further on Lefebvre and Flora’s above statement, there is a wide
academic consensus (section 2.3) that Australia is in the midst of an obesity ‘epidemic’ therefore it is critical
that any campaign reach a large collection of target publics.
An additional point to the relevance of social marketing is the extended nature of the case study campaign,
“Brief social marketing campaigns cannot be expected to result in substantial cognitive and/or behaviour
change” (Lefebvre & Flora 1988, p. 301).
A final factor in the selection of theoretical framework is the profiled Kids – ‘Go for your life’ programs stated
use of social marketing. The rationale behind this is the programs aim to increase the widespread uptake of
positive socially beneficial behaviours (healthy eating and increased exercise). Under the program engagement
strategy it is noted: “The social marketing plan will select promotional strategies that minimise risks of negative
outcomes such as increasing dieting practice, poor body image, and stigmatisation which are potential negative
outcomes of some health campaigns”.
The entire Kids – ‘Go for your life’ program will be considered during analysis, however, due to its wide scope
and progressive nature much of the analysis will be focused on the first component of the health message
campaign, ‘Tap into water every day – and limit sweet drinks’. Based on this case study critique,
recommendations, and conclusions for future childhood health campaigns will be presented


3.2 Analysis of Kids - ‘Go for your life’:
Information used for analysis has been sourced from: publically available documents on the Kids – ‘Go for
your life’ website (appendix 3 and 4), internal documents provided by Dr. Suzy Honisett, Manager of the Kids
– ‘Go for your life’ program, and an interview conducted with Dr. Honisett. Recommendations arise out of
discussion however they are not specific to the Kids – ‘Go for your life’ program. Many of the
recommendations are already present in the Kids – ‘Go for your life’ program.
3.2.1 Planning and Administration:
Kotler and Lee (2008, p. 27) highlight the importance of a detailed and strategically progressive social
marketing plan. This, they note, is often overlooked in non-profit campaigns. The Kids – ‘Go for your life’
program has a strong focus on planning. There is a generalised umbrella social marketing summary for the
wider program (appendix 3) as well as individual plans for each healthy message. As of September 2008, the
only publically available healthy message campaign plan (via the website) was for ‘Tap into water every day -
and limit sweet drinks’ (appendix 4).
The publically available Kids – ‘Go for your life’ social marketing summary was, at times, difficult to follow
from a structural perspective. It was hard to distinguish if objectives referred to the wider program or one
element of the program such as the ‘healthy message campaign’. From a content perspective, the majority of
information was clear and unambiguous.
After speaking with Dr. Honisett and reviewing the documents she provided, many of the areas that were
unclear from the publically available documents were clarified. Many of the programs objectives and strategies
are not publically available
The available social marketing plan summary for the Kids – ‘Go for your life’ program clearly states that it is a
summary of a more extended social marketing plan. A phone number is provided for enquiries about the
extended version. This number is incorrect or out of date. It leads to a private claims office that has no
relationship with the program. Having an out of date phone number provides a barrier for information
dissemination. Lack of direct access to the communications team may hinder the programs publically stated aim
“to promote the adaptation of targeted healthy eating and physical activity behaviours”. Kotler & Lee (2008, p.


10) argue that one of the fundamental principals underlying social marketing practice is identifying barriers
preventing adopters from taking up desired behaviours. Although target adopters are personally unlikely to
enquire about the plan (it should be noted that all other published program contact numbers were correct) this
incorrect phone number may be a barrier for the media as an outlet to disseminate key messages. When contact
was made with Kids – ‘Go for your life’ (via managing body The Cancer Council Victoria) it was advised that
the more in-depth version of the plan was an internal document and not available to the public. This gives the
impression that an extended social marketing plan either doesn’t exist, or the program does not want to be held
publically accountable to targets. The majority of objectives presented in the publically available document
were unspecific and unmeasurable such as “To achieve high recall of each of the healthy messages”. Objectives
(not publically available) that were discussed in the interview with Dr. Honisett were measurable (such as target
numbers of primary schools joining the awards program by set dates). As Kotler and Roberto (1989, p. 342)
state in section 1.1, social marketers should be accountable. It seems counterintuitive that the social marketing
plan of a program that is government (and therefore taxpayer) funded would not be freely available to members
of the public. It should be noted that relevant government ministers are likely to see internal documents upon
request and hold the program accountable to any internally published targets. However, while members of
government represent the interests of taxpayers, it would prove more transparent make final copy planning
documents public. For the purposes of this report it will be assumed that an extended version of the Kids – ‘Go
for your life’ program social marketing plan does not exist. All analysis relating to the Kids – ‘Go for your life’
social marketing plan will be from the Kids – ‘Go for your life’ social marketing plan summary (appendix 3).
• Ensure that all published contact details are up-to-date
• Publish a plan for the wider healthy message campaign as separate from the Kids – ‘Go for your life’
plan.
• Publish the extended version of the social marketing plan with measurable targets (or make available on
request).
• Publish the social marketing plans for each healthy message campaign (or dates when these documents
will be published)


3.2.2 Qualification as a Social Marketing Program Based on Key Definitions:
As noted in section 1.1, similarities arise in relation to popular social marketing definitions:
• A systematic planning process based in the application of traditional marketing principles
• The influencing of behaviour
• Intent to deliver a positive benefit for society
A Systematic Planning Process Based in the Application of Traditional Marketing Principles:
A detailed timeline provided in the ‘Tap into water every day’ social marketing plan shows a systematic,
progressive roll out. This includes milestones (“Draft plan completed”), influential dates (“School term 1
begins”), and key activities (“Stakeholders meeting”).
While there is no specific mention of the ‘4Ps’ (product, price, place, promotion) marketing mix, there is
evidence that it has been carefully considered. Based on the interview with Dr. Honisett, clear product
definitions are also present in the wider Kids – ‘Go for your life’ program. For example, with regard to
supportive environment target adopters:
Core Product Actual Product Augmented Product
The wider ‘Go for your life’ program (separate from Kids – ‘Go for your life’) has a section detailing the cost
of inaction which looks at global trends, statistics, and the elevating economic burden of complacency around
obesity. One of the measures of success for the ‘Go for your life’ program is “A reduction in the economic cost
to the community of chronic disease associated with poor nutrition and lack of physical activity”. Such a
measure is not present in the stated objectives or goals of the Kids – ‘Go for your life’ program. Lack of
funding is one of the biggest obstacles faced by many social marketers, especially in the non-profit sector
(section 1.7). Dr. Honisett notes that price is a big consideration around promotion of Kids – ‘Go for your life’.
• A reputation as a
facility that actively
promotes childhood
nutrition and exercise
• Schools becoming
qualified supportive
environment
• A recognisable
certificate or plaque


She advised that a limited budget meant that promotion is primarily limited radio and print and does not extend
to television. As mentioned in section 1.7, lack of funding is one of the biggest obstacles social marketers face.
There is no mention of price (to the consumer) in the ‘Tap into water every day’ campaign. It is not directly
relevant because unlike other behavioural change initiatives there is no direct cost to the adopter. Tap water is
generally freely available. Kotler and Lee (2008, p. 56) note the importance of highlighting the economic costs
of competing behaviours. In this instance, competing behaviour may be giving children ‘sweet drinks’ and the
economic cost may be a high dental bill. Emphasizing the cost benefit of a particular behaviour is also a
motivator for uptake of that behaviour (Kotler & Lee 2008, p. 56). The program could estimate and promote
how much an average family saves per year by providing bottled tap water for children to take to school rather
than giving money to purchase sweet drinks.
Place has obviously been considered with regard to the accessibility and promotion of tap water. Place refers to
where the product is obtained or where the target public puts their motivation into action (Kotler & Zaltman
1971 cited in Neiger & Thackeray 2003). The campaign appropriately draws on supportive environment target
adopters including primary schools, playgroups, local governments, sports organisations, and drink
manufacturers. It suggests that: local governments “make tap water available to families in parks and
playgrounds”. Drink manufactures and advertisers should “fluoridate bottled water sold to children”.
Playgroups should “bring fresh fruit and vegetables to playground instead of juice”, while primary schools can
“set up a ‘how much sugar in drinks?’ display”.
The final element is promotion. The campaign uses a range of promotional channels to get its message across.
Importantly the promotional tactics are in a format that appeals to primary target adopters. Novelty items such
as water bottles and magnets are provided for children, while information sheets and tip cards cater for families
and caregivers. As with placement, a large portion of promotion takes place in supportive environments. One
example Dr. Honisett provides is the creation of school newsletter inserts to reach families. In terms of media
promotion, Dr. Honisett advised there has been a grass roots approach, utilising local media outlets such as
regional Leader papers. The program liaises with stakeholders within the early childhood industry and
government. According to Dr. Honisett, this allows for the development of good relationships which create
advocacy for the program. Keeping stakeholders up to date with the program allows them to speak positively to
target adopters.


The elements of the marketing mix should not be considered in isolation (Hooley, Saunders and Piercy 1998, p.
52). It is evident from the healthy message campaigns that consideration has been given to individual the
elements fit together. For instance, promotion to children is done at the site of placement. Healthy message
campaign, ‘Plant fruit and veg in your lunchbox’ is designed specifically to get children (and families) to
change behaviour at school (supportive environment and placement site). Resources are provided for schools to
instil this key healthy message. This is appropriate because supportive environments are an integral medium
through which to reach target adopters. In addition to having a wide cross-section of the target audience
captive, the key messages of the campaign become associated with the trusted school environment and are
therefore more likely to be trusted (Sweet 2007 p. 46). Children (and parents) may be confused by key
messages if certain forms of promotion such as television advertising are utilised. For instance, a target adopter
may watch a program in which their favourite character is enjoying a sweet drink then be met with an
intermission advertisement suggesting they avoid sweet drinks.
The Influencing of Behaviour:
The title of each healthy message campaign makes it clear that they are concerned with behavioural change.
The stated aim of the of the healthy message element of the broader program is “To promote the adoption of
targeted healthy eating and physical activity behaviours”. Each healthy message is linked to a behaviour that
the change agent wishes to induce in target adopters. For example:
• Tap into water ever day – aimed at increasing water consumption
• Plant fruit and veg in your lunchbox – aimed at increasing fruit and vegetable consumption
• Turn off, switch to play – aimed at reducing time spent watching television and undertaking sedentary
activities
As Andreasen (2002, p. 8) notes, in addition to motivating behavioural changes within a target adopter, social
marketing can also bring about changes to secondary target adopter groups whose cooperative actions can
contribute to the success of a campaign. The Kids – ‘Go for your life’ program achieves this by providing
resources, funding, and information to allow supportive environment target adopters to espouse changes that
facilitate primary target adopters (children and their families) to make positive behavioural modifications. In
fact, it is noted that supportive environment target adopters are the main focus of the ‘Tap into water every day’
campaign. Resources provided to supportive environment target adopters include: tip sheets, poster pictures,
balloons and magnets, visits from mobile education vans, professional workshops, and a website.

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