Challenging Dogma - Fall 2009

Thursday, May 20, 2010

Live Healthy, Live Freely: A Critique and Reformation of Georgia’s Live Health Georgia Campaign – Sabrina Deveikis

I. Introduction
In the last decade a marked increase in obesity and other chronic diseases has become a cause of concern (1-4). Not surprisingly, the last decade has also shown a drastic decrease in some healthy behaviors, in particular physical activity (1,2). Studies have shown unhealthy lifestyles are an important contributor to chronic diseases such as cardiovascular disease (5,6).
In 2005 the Georgia Department of Community Health Division of Public Health sponsored a program called the Live Healthy Georgia campaign (7). The primary goal of the campaign is to encourage George residents to engage in healthier lifestyles to prevent chronic diseases (8). The program recognizes many challenges facing residents of Georgia in being able live a truly healthy lifestyle. Thirty percent of Georgia is classified as rural (9) and as a result, are more limited in their access to healthcare (10). Other factors include lower education levels, poverty, and race (8). Finally, already existing poor health behaviors are a challenge for any program. In particular, obesity, lack of physical exercise, and smoking present unique challenges (10).
The Live Healthy Georgia campaign adheres to the philosophy that prevention is the best method in preventing chronic disease and morbidity (8). The campaign is essentially an education program to teach the following messages:
· Get Checked (Receive appropriate health screenings)
· Be Smoke Free (Eliminate tobacco use)
· Be Active (Increase physical activity)
· Eat Healthy (Maintain a healthy diet)
· Be Positive (Maintain a healthy mental/spiritual outlook) (8).
The program hopes to promote Georgia’s Department of Human Resources as the best resource in Georgia for its messages and as the key resource in prevention of chronic diseases (8). With its website, outreach projects, and partnerships with other programs as part of the Take Charge of Your Health, Georgia! Georgia's 10-year Nutrition and Physical Activity Plan Georgians residents are to be provided with the educational resources to life healthier lives, less burdened with chronic disease (7,11).
This paper presents three critiques of Georgia’s Live Healthy Georgia campaign in Section II. In section III, an alternative campaign is proposed which takes into consideration of Maslow’s hierarchy of needs and marketing theory.
II. Critique of Georgia’s Live Healthy Georgia Campaign
The program launched by the Georgia Department of Community Health Division of Public Health to promote healthier lifestyles for Georgia residents is flawed for three reasons. First, the primary objective of the campaign is to educate or raise awareness of perceived susceptibility even though the campaigns own pilot studies have shown the majority of its target audience is already aware of the benefits of healthy living in terms of chronic disease prevention. Secondly, the primary tool the campaign hopes to instill into its target audience is self-efficacy but fails to address the larger environmental and social factors contributing to the unhealthy lifestyles. Finally, the program fails the basic concept of advertising and marketing theory of offering an attractive promise.
A. Raising Awareness When it Already Exists
The campaign appears to be very individual based attempts to spark behavioral changes through education by increasing awareness of risks and dangers of unhealthy life choices in relation to chronic diseases. The Health Belief Model defines four factors influencing individual behavior. Perceived susceptibility and perceived severity are weighed against the perceived benefits of the action and the perceived barriers of taking that action (12). The perceived susceptibility the campaign wants to education its target audience about is the increased risk of chronic disease and morbidity through unhealthy behaviors (7). The perceived severity would be a lifelong illness requiring daily medication and even mortality. The benefits of adhering to a healthier lifestyle would be fuller, healthier life, free from the burden of disease. The barriers in being healthy are both individual and environmental. The Live Healthy Georgia campaign was launched in March of 2005 and on April 1, 2005 the Georgia Department of Human Recourses released a report of findings of studies performed to serve as a baseline to evaluate the effectiveness of the new campaign (13). The study found that not only were Georgia residents aware of which health behaviors were the most beneficial to overall health but the majority of participants reported very frequent exposure to the very messages the campaign sought to convey (13).
In terms of the second message of the campaign, that of elimination tobacco use, the transtheoretical model is combined with the health benefit belief model in the campaigns approach in assisting people to quit smoking. The transtheoretical model defines the stages involved in a behavioral change and is usually applied to addiction interventions. The first stage is precontemplation when an individual is either not planning on taking an action or is unaware of the existence of a problem (14). In the second state, contemplation, the individual is weighing the perceived benefits and costs of taking a course of action (14). Preparation, or the third stage, marks the stage where a decision to act has been made and a plan for implementation is being formulated for the fourth state of action (14). The fifth stage is maintenance when the behavior has been changed but effort is required to ensure a permanent change. Finally, termination is when the change has been permanent and maintenance is no longer required.
On the campaigns’ website the only resource it provides for smoking cessation is a quit help line (7). The benefits of quitting are clearly outlined on the website and seem like the primary motivational tool to quit smoking offered by the campaign. The quit line offers information of the various cessation aides and even has a special intervention for teens seeking to quit (7). It merely attempts to walk smokers through the stages of change and does little beyond education of the benefits of not smoking and the aids available for quitting. It has been shown that the dangers of smoking are not only known by nonsmokers but smokers, themselves have had the dangers of their habit ingrained into their minds (15). Clearly, other methods must be utilized to cause more smokers to quit.
The campaigns goal of raising awareness of the benefit of healthy behaviors in the prevention of chronic diseases had been achieved before the program was even launched. In fact, the interventions target audience reported frequently receiving the program’s messages without any exposure to the program itself. The money and resources allocated to increasing the awareness of the benefits of a healthy lifestyle and trying to increase awareness in the susceptibility of its target audience can be better spent in ways that might illicit more of a wide spread behavioral change across the population of the target audience.
B. The Failure of Self-Efficacy
At least from the standpoint of the campaigns ads, the lesson instilled by the program to Georgians is, “You can do it,” (7). In other words, the intervention is attempting to give people the feeling of self-efficacy. Self-efficacy is a person’s belief that they can make the behavioral changes (16). The Live Healthy Georgia Campaign makes its target audience aware of all the benefits and makes it seem possible to achieve good health by following their simple guidelines to healthy living (2). Those guidelines are the five simple messages the program wants to convey. Unfortunately, it is one thing to say to get checked by your doctor regularly, it is another thing entirely if you’re in a rural community and the nearest doctor is twenty miles away and either cannot afford to take the time off of work or do not even have health insurance. These problems face many of Georgia’s residents and challenge the programs message.
Georgia faces several different challenges and factors, which can alter a person’s sense of self-efficacy. With thirty percent of the state residing in rural communities, the access to health care in those areas is less than in more urban areas (10). The level of education also plays a key role, and Georgia has the lowest rate of graduation in the country (17). Poverty is another important contributor. A quarter of the children in Georgia are living in poverty and 8% are living in extreme poverty (18,19). When faced with poverty, the cost and benefits of living a healthier lifestyle pale in comparison to the challenges of day to day life when perhaps even the means to get something to eat, not necessarily part of a well balanced diet, is a challenge, the messages of the program may fall on deaf ears.
C. The Promise?
The promise offered by the campaign may excite the insurance agencies more than Georgia’s general population because the promise is that prevention is more cost-effective and you can live healthier (7). Being healthier and saving the insurance company you have already given more of a portion of your paycheck than you were really willing to part with in the first place is not one of the core values in advertising and marketing theory (20). The one television ad available online is a cartoon character trying to walk up an incline with a second voice offering words of encouragement (7). The basic message is people can quit smoking, it will just take practice (7). There are no ads relating to the campaign’s four other messages, which undermines the efficacy of the campaign as a whole. The target audience of the ad is but a subset of the target audience of the Live Healthy Georgia intervention. Little branding has been done for the campaign itself and the ad has no indication it is part of a larger program, which promotes anything other than not smoking. Branding is an important part of marketing any campaign and the failure of this program to do so undermines the amount of success it can hope to achieve in changing the lifestyles of Georgia’s residents. (20).

III. A Reformulation of Georgia’s Live Healthy Georgia Campaign
Taking the aforementioned flaws into consideration, the following reformulation of the existing campaign is proposed. The proposed intervention takes more community based approach rather than the individual based approach currently being used.
A. Raising Access, Not Just Awareness
Where the current program sought to illicit behavioral changes through education, the new reformulation will promote greater access to the resources needed to live healthier lives. With the target audience being all adults living in Georgia, a more community-based approach will be more effective in generating a healthier population. The Socio-ecologic model will be useful in achieving the desired result. The individual and interpersonal results have already been seen thanks to the efforts of other state and national campaigns to raise awareness of the benefits of healthier living in relation to chronic diseases. Success in the upper levels of the model is the key to obtain a truly healthy Georgia.
Allocating the resources previously used at raising individual awareness will be diverted to create a means for the lifestyle changes necessary to becoming healthy to actually be possible. Incentives can be given to employers to have sports teams for their employees after work. High schools gymnasiums can be open after school hours for the public in a way that does not interfere with high school sports but provides a convenient and cost effective fitness option for working adults. Organizes sports or other physical activities can be offered by the local communities in parks. Finally, the state can provide funding and land for more parks and walking trails.
B. Increasing Self-Efficacy By Increasing State-Efficacy
In Maslow’s hierarchy of needs, if the lower, more basic human needs are not meet, an individual will not be able to allocate resources for the higher levels (22). Since Georgia struggles with poverty, low education, and restricted access to medical services, the more basic needs must be met before Georgians can start looking at their lifestyles and making changes.
The proposed intervention will promote, at the very least, affordable transportation in the rural communities. Other programs to try to draw more doctors away from the cities will need to be initiated, such as lower taxes on medical buildings in rural areas. Traveling doctors who make periodic visits to the larger employers will provide more options and convenience for both employer and employee.
To deal with the low level of high school graduation rates more money should be given to the schools. Programs to assist academically struggling students early on to help prevent the challenged students from slipping through the academic cracks and dropping out of high school out of frustration. More scholarships for both colleges and private high schools can help shift the level of education of Georgians in a more positive direction.
C. The Promise – Freedom
Clearly the promise of a healthier life does not promote many to action. For decades, the dangers of smoking have been widely known and still the tobacco industry is making billions off of a notoriously unhealthy habit. The promise has to appeal to one of our core-values, something we would be willing to pay or sacrifice for (27). The new promise of the proposed intervention will be freedom. Making healthier choices will not just make you healthier but will give you freedom. Freedom from the demanding toils of chronic diseases. Freedom to play with your kids without being sore. Freedom to run several blocks to catch the bus without a loss of breath. An hour doctor visit each year combined with a few simple choices can unlock the freedom to be all that you can be. The campaign to create a recognizable branding will also take place. Live Healthy Georgia will become synonymous with the promise of freedom offered in its advertising.
IV. Conclusion
In the campaign’s current incarnation, the Live Healthy Georgia program contains three flaws which interfere with it’s ability to effectively instigate changes in the behavior of its target audience. The first flaw is the primary goal of the intervention is to increase awareness of the benefits to healthier lifestyles but the resources of the program are being wasted on what has already been achieved prior to the launch of Live Healthy Georgia. The second flaw is the program promotes and encourages self-efficacy through its messages but the sense of self-efficacy falls flat when the extenuating circumstances surrounding the lives of many Georgia residences has them struggling to make ends meet. The final flaw is the program fails to take into account the tenants of advertising and marketing theory with making the promise of only a healthy life which is not a core-value most people will actively seek. A reformulation of the campaign seeks to amend the flaws of the current program by taking a more community-based approach and helping Georgia residents meet their basic needs giving them the opportunity to focus on being healthier. Finally, the message of a better promise, the promise of freedom will reach out to more people and have a far greater impact in changing the behavior of people in Georgia.
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