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Who is responsible?

The AK-47,the most famous rifle, was developed by Lieutenant-general Mikhail Timofeyevich Kalashnikov, a Russian general, inventor, military engineer, writer and small arms designer.

When he died in 2013 he reflected on what he had created.  Although he took great pride inhis inventions and their reputation for reliability, he emphasised that hisrifle was a ‘weapon of defence rather than offence’, and in later life ittroubled him that he was the architect of destruction.  After his death, a letter which he had sent to the leader of the Russia Orthodox Church was published:

"I keep having the same insoluble question... if my rifle claimed people's lives, then can it be that I, Mikhail Kalashnikov, ninety-three years old, the son of a peasant, and a Christian, was responsible for their deaths?

The longer I live the more this question drills itself into my brain..."

This prompted a thought in me about who is responsible – the person who creates, or the person who uses?

The same question could be asked of the worldwide web.  Who is responsible for the positive and negative opportunities it has provided to users?

Who is responsible for reducing waste?

Who is responsible for safety in the workplace?

Who is responsible for engaging employees?

I am responsible.  You are responsible.

We have to take personal responsibility for our own behaviour.  To do that we have to think about the outcome that we want to achieve, and the behaviours we need to achieve it.

What motivates you to take personal responsibility?

Sandra Palmer

Consultant Director

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A&E = Anything & Everything

As winter rages on (or at least we have seen a few flakes of snow) a failing NHS has dominated the news again this month and, as ever, the list of its problems seems endless. Earlier in the month reports suggest that it has missed its four-hour A&E waiting time target with performance dropping to its lowest level for a decade. A number of hospitals have declared a ‘major incident’ due to unprecedented levels of demand on services, while it has even been suggested that one hospital has ‘closed its doors to A&E’. More recently as election campaigns begin to gather pace more and more holes are being pointed out – spending on care for adults over 65 falling by a fifth over last 10 years. And so older people being left ‘high and dry’ are now being blamed for the unbearable pressures on A&E.

So, where does the NHS go from here? How can the pressure on A&E be alleviated? The headlines are predictably, and quite rightly, focusing on the need for more investment and the need to revise ‘the system’ using quantitative models of performance. Yet, whilst this makes a great front page and an even more convenient opportunity for politicians to raise their profile ahead of the General Election, the discussion seems to have one alarming omission – people.

People deliver the services, they use the services and they plan the services. Individual decisions, interactions and behaviours have a huge impact on how the system performs. This goes beyond just the A&E department but across the whole of the urgent care landscape - pharmacists, walk-in centres GPs as well as A&E. Yet, it seems that many of the current touted solutions to ‘fix A&E’ are based on the simple assumption that ‘if you build it they will come’ and therefore ignoring the essential role of people.

So, without first considering the challenges from a people perspective, is it right to simply pump more money into the existing framework and expect it to work?

My view is no. People are integral to a successful NHS, and we must pause to understand why people are behaving in the way they currently do in relation to A&E. Only then, will it be possible to develop a robust and sustainable strategy for the future.

Patients need to understand what services are available to them, have the confidence in when to use them and know how to access them. I wonder if this could be achieved through a robust but (and this is the most important bit) consistent communications and engagement programme. One that supports patients to make the right choice i.e. Choose well! It must go beyond simple awareness raising and should be integrated with grass-roots actions to empower individuals to understand how to care for themselves effectively and which service to choose, should the need arise. For example, first aid training could be delivered to local communities to increase confidence in self-care, while simple communications and messages could be applied within the health-settings across signage, providing easy to understand and visual cues. Wouldn’t it be great if every hospital, walk-in centre, pharmacy, and non emergency phone line service had the same look and feel, messaging, labelling and/or way finding system so you could actually find your way to the service you need. Maybe the NHS could take a leaf out of the corporate world’s book and articulate their service offers in a clean and consistent manner. We all know our Tesco Express from our Tesco Direct or Tesco Extras.

The other people element that shouldn’t be overlooked is that the NHS’ own employees need to understand the system, how it connects and their role in it. Patients look to healthcare professionals for guidance on their care, for direction and confidence in navigating the NHS for the next steps in their care. Yet, if the professionals don’t fully understand where they fit in, or are disengaged with the direction of the system, then there is a risk they will further add to the problem. This may point to a need for a renewed and integrated approach to employee engagement across the urgent care landscape. Let’s make sure all those in the NHS have clarity over what, where, when and how.

So in conclusion I think if the NHS – a true public service tried to really understand both its own people and those it serves – how they engage, how they make decisions, how they behave it might uncover some answers and be able to simplify what at this point is a pretty confusing system. Then A&E might actually mean Accident & Emergency instead of Anything & Everything!

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The Illegal Trade in Ivory

The illegal trade in ivory, rhino horn and tiger bone are never far away from our news coverage. Whilst products made from these items are increasingly socially unacceptable in this country, in some countries they are regarded as a symbol of social status. Key to changing this is to understand the behaviour of those who buy ivory, rhino horn and tiger bone; why they do it and what would make them stop? We’ve been working with TRAFFIC to understand some of these issues in one of the biggest markets for these products: China.

Chinese business leaders are a key audience to influence in the changing of this behaviour, and a quick review of the marketplace reveals a confusing environment for the consumer.  We worked with TRAFFIC to produce a communications tool for Chinese business leaders that explained the facts and changing attitudes towards the purchasing of these items as corporate gifts. We focused on the fact that, far from being a welcomed gift, these items could be seen as disrespectful, with many leaders now choosing to purchase alternative items to set new trends in corporate gifting.

The tool provided ideas on what the reader could do next - a small but important step in what will be a long journey to change behaviours in the most populous country on the planet. 

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Our probable future: Top 10 reasons to be cheerful

It would be too easy to focus simply on the challenges we face in our shared future. There are many reasons for optimism. Here are 10 facts that show the real progress being made globally. 1. around 700m fewer people lived in conditions of extreme poverty in 2010 than in 1990 (UN MDG report 2013) 2. over 2bn people have gained access to improved sources of drinking water over the last 21 years (source as above) 3. over 200m slum dwellers benefitted from improved water sources, sanitation, durable housing or sufficient living space in the last 10 years (as above) 4. the proportion of undernourished people in developing countries decreased from 23.2 (1990 – 1992) to 14.9% (2010 – 2012) (as above) 5. the mortality rate for children under five dropped by 41% from 87 deaths per 1000 live births in 1990 to 51 in 2011 (as above)  6. the maternal mortality ratio declined by 47% over the last two decades from 400 maternal deaths per 100,000 live births to 210 between 1990 and 2010 (as above) 7. from 1990 to 2011, 1.9billion people gained access to a latrine, flush toilet or other improved sanitation facility (source as above) 8. between 2000 and 2011 the number of children out of school declined by almost a half from 102m to 57m (as above) 9. overall participation in higher education in the UK increased from 3.4% in 1950 to 8.4% in 1970, 19.3% in 1990 and 33% in 2000 (House of Commons Library) 10. adults in the UK are living longer; male life expectancy is up from 66 years in the 1950’s to 78 today and female up from 70 years to 82 years (ONS) The Copenhagen Consensus Center in consultation with economists estimates that the cost of global problems can be quantified and that it has declined from 100% of Global World Production (GWP) to 40% today. It estimates that this will decline further to 27% of GWP by 2050. If you don't know them yet check them out http://www.copenhagenconsensus.com/

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Our probable future: energy

There is a global challenge to supply the energy needed to provide heat and light. Global energy consumption is projected to increase by 56%. Half of the increase is attributed to China and India. (US Energy Information Administration, July 2013). In the UK electricity use is likely to increase by at least 30% and potentially by 100% (DECC). Globally 1.3bn people currently lack access to the electricity they need to raise their standard of living (UN). Even in the developed economy of the UK, it is estimated that £200bn will need to be invested up to 2020 to retain electricity security. The energy regulator Ofcom said this year that the risk of blackouts increased from a one in 47 chance to a one in 12 chance for the winter of 2014/15. In terms of sources, fossil fuels are projected to continue to supply almost 80% of world energy use through to 2040. EU gas imports will rise from 66% to 84% by 2035; the proportion coming to Europe via pipeline, mostly from Russia, will rise from 37% to 51%. Social unrest, as we have seen recently in the Ukraine adds to uncertainty. John Drummond June 2014

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Our Probable Future: Technology

Over 2.5 billion people use the internet worldwide. Almost half the population of the earth – 3.2 billion people - use mobile phones. A billion mobile subscribers were added in the last 4 years and current growth rates suggest the 4 billion users mark will be passed in 2018 (Source: GSMA Mobile Economy 2013).  In the UK, 94% of adults own a mobile phone, 97% have digital TV’s, 44.3% have access to a DAB digital radio (Ofcom). In 1972 total British TV was capped by law to 9,900 hours a year across three channels. In 2013 Ofcom licensed 2000 broadcast services many of which broadcast 24 hours a day (Ofcom). By 2020 there will be nearly 26bn devices connected to the Internet of Things. The Internet of Things will have an estimated value of £8.6 trillion by 2023. How people using technology is changing. In 2013 in the UK, 72% of all adults bought goods or services online, up from 53% in 2008. Half use the internet to access bank accounts, 43% to seek health information and 21% to buy groceries. (ONS and Ofcom)  We will use more technology for our personal health (the market is predicted to grow to $11.8bn by 2018: GlobalData) and to augment the real world (the market is set to grow to $5.2bn by 2017; Juniper Research).  If you want to know more about our probable future linked to the economy, employment, health, trust, food, water, energy and resources you may want to register your interest with my colleague Elaine Smith at elaine.smith@corporateculture.co.uk  John Drummond June 9, 2014

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Our Probable Future: Poverty and Wealth

The good news on global poverty is that it has halved from 1990 to 2010; from 47% living on less than $1.25 a day to 22%; China leads the way with a drop from 60% in 1990 to 12% in 2010 living in extreme poverty. H owever, 970mn people will still be living in extreme poverty in 2015. In the UK 23% or around 13m live in or at risk of poverty (2011 figures). Over 60% of workers in the developing world still live on less than $4 a day. The impact of the recession on each of us has been profound. Weekly family spending has been falling each year since 2006. The average cost of filling a car of petrol has gone up 43 per cent in the last five years, the average annual energy bill 57% and a loaf of bread 20%.  The cost of raising a child is £227k, up 5% in the last year alone and accounting for 28% of parents annual income (Cost of a Child report, Centre for Economics and Business Research, 2014). Citizens Advice services in the UK have seen a 20% increase in the past five years in the number of mortgage and secured-loan debt problems being reported.  At the same time, the number of people defined as high net worth increased from 9.2% from 2011 to 2012. These are people with $1mUSD in investable assets (CapGemini Global Wealth Report, 2013). The combined wealth of the richest 1000 people is almost twice as much as the poorest 2.5bn (Zygmunt Bauman, University of Leeds, Does the richness of the few benefit us all?). The average US CEO of major US companies now gets paid 531 times more than the average worker. This was 12 times in 1960. These are just some of the facts we share about the probable future in our coming new report. Do feel free to register an interest in receiving your copy with my colleague Elaine Smith at elaine.smith@corporateculture.co.uk Best, John Drummond June 2014

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Our Probable Future: Population

Our new publication "Reasons to Act: an executive guide to the probable future" will be released shortly.  If you would like to receive a copy please email my colleague Elaine Smith on elaine.smith@corporateculture.co.uk  It pulls together insight from authoritative sources to create the current picture of the probable future across 13 themes from food to technology. It's designed to help inform executives of future marketplace context as they seek sustainable success.  As a teaser this week, I will be sharing some of the key findings.....starting with Population. Here are the headlines:  The UN projects that there will be 11bn of us by 2100 with just 8 countries expected to account for half of all population growth.  Although birth rates are falling, people are living longer.  Average life expectancy is expected to increase from 69 to 82 (2095 – 2100). Globally, the number of older persons aged 60 years or over is set to increase from 810 million now to more than 2 billion in 2050.  Today more than a half of the world’s population live 
in cities, a figure expected to rise to 70% by 2050. By the same year, 64% of the developing world and 86% of the developed world will be urbanised.  The total investment in cities in the next three decades is expected to be $350trillion USD (Booz and Allen). Construction creates opportunity and risk. In China 500,000 die each year from air pollution partly caused by construction.  The business opportunity lies with the new middle classes expected to grow from 1.8bn to 4.9bn in 2030 (The Brookings Institution).  More to follow.  John Drummond June 2014

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Our Probable Future: Food

The Get Food Smart Campaign from UK businesses continues this week. For more information check out http://www.startuk.org/ By way of background on food.....here are some key facts from our coming executive guide to the probable future. A growing and increasingly well-off population is expected to increase the demand for food by 40% by 2030. The World Resources Institute projects a 69% increase in food calories needed by 2050 with major gaps between supply and demand.  The scale of this supply means that the impact of food production is massive. Around 28% of the world’s population is directly or indirectly employed by agriculture – that’s around 2bn people. About 70% of annual global freshwater resources are currently used for agriculture; 90% in some parts of Asia (2030 WRG). Around 24% of global greenhouse gas emissions are from agriculture (WRI). Today, 800m people are periodically hungry. Research by the Centre for Economic and Business Research commissioned by Kellogg’s shows almost 5 million people are in food poverty in the UK. And yet 32% of all food produced in the world was lost or wasted in 2009 (UNEP). Cutting this rate in half could close the food gap by about 20 percent by 2050. You can register for a copy of the report by emailing Elaine Smith at elaine.smith@corporateculture.co.uk The report is free. John Drummond June, 2014

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Light at the end of the tunnel

The publication last year of the King’s Fund’s alternative guide to the NHS  prompted a wide range of responses.

Overwhelmingly, as a piece of communication, this engaging animation had all the bases covered.

It was informative, amusing, and built to a crescendo in which the whole really was greater than the sum of the parts. Most observers were highly complementary, pointing out that, although a picture of mind-boggling complexity, as least each stakeholder could be seen – and could see where they fitted into the, admittedly very large, picture.

Our work wide ranging work in public health with a lot of these organisations, such as Clinical Commissioning Groups, Commissioning Support Units, health charities and specialist primary care services suggests that many are reacting well to change – and realising that to rise to the challenge they need to embrace the marketplace and shape themselves and their services to compete and win.  

Improving outcomes for patients and service users should be front and centre, driving strategy and informing products and services. Engaging with stakeholders, developing an evidenced based marketing strategy as well as a strong proposition and a recognisable brand point to a clear understanding of the need to be distinctive and to position themselves and their strengths prominently in a busy marketplace, patrolled by private sector businesses keen to move into their territory.

Organisations that are emerging and blossoming within the latest iteration of our national treasure carry vast reserves of priceless knowledge and commitment and an inspiring public sector ethos. The trick will be to harness this unique combination and to build on it by adding new commercial skills and know how across the organisations. However this will require a significant shift in mindset amongst staff, many of whom chose a career in the public sector to deliver positive change for patients, and not to be part of a commercial operation. This challenge is exacerbated further by growing concerns of low staff morale, as a recent Kings Fund report  highlighted.

So like the animation so skilfully illustrated, the picture remains complex, confusing even. But our experience tells us that there is definitely light at the end of the tunnel, for those organisations that are switched on at least.

We’d love to hear your perspectives.....

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Who’s chasing the waste? Finding the balance in food waste

The issue of food waste is shaping up to be one of the greatest moral dilemmas of our time. Charities, local authorities, waste management companies and even utilities are all chasing the waste at a time of dwindling resources and increasing hunger.

The scale of the problem is well documented and the facts are stark. Research from the Think Eat Save campaign from the Food & Agricultural Organisation of the United Nations (FAO) shows that one third of the world’s food is wasted from farm to fork, which is equivalent to 1.3 billion tonnes of food annually.  At the same time, population increases mean that there are more hungry mouths to feed than ever, with demand for food set to grow by 70% by 2050. The impact of our changing climate on energy and water needed to grow food adds yet more pressure. Demand for electricity is set to double by 2050 and water supplies will only satisfy 60% of demand – yet 70% of the world’s water is needed to grow food

Not surprisingly, reducing food waste is seen as the key strategy to increase food availability and alleviate poverty while reducing pressure on ecosystems, climate and water. According to the World Resources Institute, globally, food loss and waste accounts for:

-          roughly 3,300–5,600 million metric tons of greenhouse gas emissions -  almost equivalent to the amount of emissions from energy consumption by the United States in 2011.

-          approximately 173 billion cubic meters of water consumption per year, which represents 24% of all water used for agriculture.

-          198 million hectares per year of cropland and 28 million tonnes of fertiliser to grow -  an area about the size of Mexico

Policy makers across the globe are lining up in support of setting food waste reduction targets at national, local and organisational levels.  The EU 2020 “Roadmap to a Resource Efficient Europe” sets a milestone of reducing edible food waste by 50% by 2020 and is calling for 2014 to be designated the European Year against Food Waste, with food waste prevention targets set by member states as part of the Waste Framework Directive. In June this year, business leaders, academics and policy makers gathered at the OECD (Organisation for Economic Co-operation and Development) food chain network to discuss challenges in measuring reduction as there is currently no universal definition of food wastage and data is currently classified in over 150 different ways (loss/waste, avoidable/unavoidable, edible/ inedible, weight/ calories, value/volume at each stage of the supply chain).

Here in the UK, we are ahead of the game. WRAP has measured the scale of food waste for a number of years and is soon to release new data. In 2009/10, the estimated 18.4 million tonnes of waste generated within the UK food and drink supply chain and households cost around £17 billion, with almost 2/3 generated in households and 27% within food and drink manufacture.  Great progress has been made through the Courtauld Commitment and Love Food Hate Waste campaigns, preventing around 1.1 million tonnes of food waste (worth £2.5bn), changing the behaviours of over 2 million people and  saving local authorities at least £22m in disposal costs.

  Reducing waste in the first place is clearly a win-win all round, central to Government policy to drive action at the top of the waste hierarchy pyramid.  But what comes next? Therein lies the dilemma. There are increasing demands for food re-use which often conflict. The food use hierarchy advises that unavoidable surplus food, still in date and perfectly edible, should be fed firstly to people in need, then to animals, moving down the food chain to create renewable energy or bio-fertiliser from residual waste.   Instead, we’re witnessing a veritable food fight.

  At a time of severe cuts to welfare, food poverty has risen rapidly in the UK.  Research by the Centre for Economic and Business Research commissioned by Kellogg’s suggests that around 5 million people are in food poverty in the UK, while Tesco recently released data showing that 1 in 5 people “skip meals, rely on others for food or go without so children can eat”.  Around 500,000 people are now reliant on food aid from charities and numbers are rising fast.

This is where charities such as FareShare come in. FareShare is working towards an ambitious vision to use all food surplus in the supply chain to eradicate food poverty. As the UK’s only charity fighting the underlying causes of hunger and redistributing food waste to over 700 local charities across the UK, FareShare is in a unique position. By ensuring good food is not wasted, it turns the environmental problems associated with food waste into a solution, feeding thousands of people every day.

Yet despite the high profile and very welcome commitments of many leading retailers and brands, the amount of food re-distributed to organizations such as FareShare to feed to people is tiny compared to the amount that is diverted to feed the burgeoning demand for energy from waste.

Government policy has driven the growth of Anaerobic Digestion to help meet the target of 15% of energy from renewables by 2020. Since the AD Strategy was published in 2011, the number of AD plants has doubled and there are now 106 plants up and running (outside of the water industry) processing around 5.1 million tonnes of food waste every year

So whilst charities such as FareShare are trying to source surplus food waste to beat food poverty, many local authorities and waste management companies are chasing this same food waste to be fed into the plants they have built, creating a moral battle: just who has the right to food waste?

All too often, the overarching food waste hierarchy pyramid is being ignored. There are examples of local campaigns for food waste collections which show food waste bins adorned with stickers saying ‘Feed Me’; essentially encouraging food waste and twisting government policy away from getting the most energy out of waste, into getting more waste into energy recovery – two very different ideas. Indeed, it seems that behaviours we are currently seeing are actually encouraging consumers and businesses to put more waste into energy recovery, rather than the other way around.

Crucially, this focus on collection as opposed to prevention is actually the opposite of what residents want. As part of our work on WRAP’s Love Food Hate Waste initiative, research shows that people consistently want advice on how to prevent food waste ahead of food waste recycling and collection information. Nobody likes wasting food and the cost of wasted food at a time when people are increasingly squeezed, remains the key motivator for action to change food use behaviours.

Utility companies also play a role in food waste. Water companies such as Anglian Water and its ‘Keep It Clear’ campaign invest extensively to ensure people don’t dispose of food down drains, blocking sewers. But with waste reduction targets to meet, some local authorities are trialling waste disposal units in residents’ homes. These at-home ‘macerators’ cut out the cost of food waste collection and disposal, saving money and ensuring local waste reduction targets are met. These trials, which will run for two years and are currently at the halfway point, have brought local authorities and water companies together to determine what the long-term impact of macerators is likely to be. The fear is that schemes such as these will result in food waste being put back in the water system, causing blockages, and essentially shifting the problem elsewhere. Furthermore, these short-term tactics mean some council’s aren’t investing in behaviour change techniques to tackle the issue of food waste head on and create a long-term, sustainable solution.

The issue of food waste isn’t going to go away anytime soon and there are some scary consequences that we will face if changes aren’t executed quickly, at a local, national and global level. Charities, government, utility companies and local authorities alike need to work together to educate all levels of the food chain to create long-term sustainable behaviour change solutions. Short-term goals may help stakeholders reach targets quickly but just aren’t going to cut in a few years’ time as demand for food and waste grow. Action needs to happen now if we are to create a sustainable food future.

The challenge, to meet the rising demand for food in ways that are environmentally, socially and economically sustainable, and in the face of evolving worldwide markets and distribution mechanisms, let alone global climate and demographic changes, is a huge ask, but a vital task. 

  Belinda Miller, Director of Insight, Corporate Culture 

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Drugs in America: the wrong motive to achieve change?

The “war on drugs” in the US has cost over $1trillion and by adopting a zero tolerance approach, America now accounts for 25% of all people imprisoned around the world. At the same time the use of drugs remains largely unchanged. That’s the key point made in the social documentary: “The House I Live In”. The policy does not seem to be based on a policy goal of understanding and then acting to reduce the problem. It seems to be based on the fact that hard-talking political leaders attract more votes. In other words, it’s a policy for election not a policy for reducing drug-dealing and drug-addiction. As a result, the only assumed motive that people believe will achieve change is to threaten and then implement imprisonment. In other words, the assumption is that disincentive is the key motive for change. But it doesn’t work. There are other potential motives. There is a great charity called “Youth at Risk” in the UK which is based on a different approach. By focusing on the young people most at risk, and understanding them and their lifestyles they come much closer to exploring other potentially powerful motives – the beliefs that drive behaviour and individual goals and aspirations. Now I’m not an expert in crime or drugs. But I do wonder if because politicians and civil servants are not as well versed as they might be in behavior change, they become comfortable in proposing and implementing expensive policies that don’t achieve real change. Understanding and acting on what people aspire for themselves or the beliefs that have guided them to where they are may be much stronger motives to tap into.  John July 29, 2013  More about Youth at Risk at http://www.youthatrisk.org.uk/ More about “The House I Live In” at http://www.thehouseilivein.org/

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Power to the people: TED Global Highlights

A major theme at this year’s TED Global in Edinburgh was a crisis in the power we have as people. 

For some it was a problem of capitalism - author Chrystia Freeland said we live in an age of plutocrats who are using their power to manipulate markets and reduce social mobility. A very small number of business people have a very high percentage of wealth and power which they then use to help sustain their position and the position of their families. Former Greek PM George Papandreou made a similar point about government: “our democracies are undermined by the growing concentration of power and wealth” he says we need “radical reform in our democracies”. He said the “failure of (European) leadership is that we have taken you (the citizen) out of the equation”.  Another impressive speaker, Benjamin Barber agreed “when we look for solutions, we are faced with political institutions set up 400 years ago” we have “21st century problems and 17th century solutions….” But at TED Global, where problems are raised, solutions are never far behind….some of them surprising…. Professor of economics Mariana Mazzucato argues that we should not give up on the state; she argued that state innovation was supporting private sector progress eg GPS, the internet, touchscreen technology and SIRI have all emerged from the public sector. George Papandreou argued for the reawakening of democracy in Europe….“above markets, above governments is the democratic power of the people.” He asks if Europe can be an experiment in a new type of democracy where we engage the collective creativity of it’s people to solve problems. He advocated citizens juries, Europe-wide referenda and direct voting for a European president. International economist Dambisa Moyo argued for tolerance of a variety of ways to govern….and not to think that democracy was the only answer….. she says a lot of states believe the Chinese system can help them out of poverty. Investor and political thinker Eric X. Li agreed….he said that the Chinese system has an Organisation Department that is meritocratic and was successfully reducing inequality. For Benjamin Barber, the answer was to revive the City State; with over half of the world living in cities and cities responsible for 80% of carbon emissions, “maybe it is time for Mayors to rule the world” Collaborations already exist (like CityNet or UCLG) but what about a global parliament of mayors accountable to a parliament of citizens? For Michael Porter the Harvard Professor; the answer was capitalism as it was meant to be…the creation of shared value….he argues that governments and NGO’s can’t scale because they don’t have the resources….business has the resources…”the new thinking is that business profits from solving social problems….this is the largest opportunity for business today but we have to change how business sees itself and how others see business…if we can do this we can change the world”  For others the answer was active citizenship. There was however agreement that we face real global issues, that current institutions were anchors on progress and that there were a range of potential solutions – many of them already being applied at scale. John Drummond (Chairman) July 1, 2013

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Public Health and Social Marketing: helping Local Authorities walk before they can run

With responsibility (and a £5.45 billion budget over 2 years) for public health moving to Local Authorities from April 2013, I thought it timely to shine a spot-light on the chief executive of Public Health England.

Recent profiles of Duncan Selbie, chief executive of Public Health England, paint a picture of a modest, disarming leader, with a common touch that has been developed through a non-traditional rise up the NHS leadership ladder. Mr Selbie is not from the traditional medical or academic background that is common-place among his peers. It might be this practical nature that has allowed him to establish a track record of implementing change that is based on the reality faced by his patients and employees.

He understands that public health is related to other equality factors; that education, housing, age and social interaction can have a determinable affect on someone’s health. This understanding is good news and should encourage a joined-up approach by Local Authorities, community groups and health organisations to tackle public health issues.

However, what does he think about behaviour change and social marketing in relation to public health? To my knowledge he has not been probed directly about it, but a recent article I read in The Times might provide some information; in it Mr Selbie comments:

“I cannot be a super-nanny. Telling people what to do, directing them and ordering them, writing strategies and putting together toolkits are a complete waste of time. You create an environment where people feel able to do the best they can, to run towards problems and not be afraid.”

He’s right (partially). No one wants to be told what to do, but creating this ‘environment where people feel able to do the best they can’ is a big challenge. Let’s take the example of cancer awareness. Simply supplying people with information on what to look for and then telling them where to go assumes that they will act on a rational basis. This is, of course, incorrect. People can know what to do and still not do it. Information must be framed in a way that resonates with the target audience – this requires insight, targeted interventions, appropriate reassurance and timely reminders.

You’re never going to create a society where people consciously ‘run towards problems’. It’s within human nature to make things as easy as possible for ourselves; it’s hard-wired into our brains to help us process a deluge of daily information. However through incorporating social marketing techniques you can look to dilute the problem and provide easy, simple steps for people to resolve it.

With such a big change occurring in the public health landscape, my advice for Mr Selbie is to encourage Local Authorities to first of all understand the barriers local residents face in trying to lead a healthy life. After all, we want to ensure Local Authorities don’t run before they can walk

Alex Bone, Project Manager, Corporate Culture

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How small-scale behaviour change programmes can heal the pharma industry

For more than a decade we’ve been told the pharma industry faces a crisis. Due to the difficulty of developing new blockbuster drugs, companies can no longer rely on organic growth. The market’s saturated, the industry’s reputation has suffered and people are disillusioned, yet a viable solution is within the industry’s grasp.

Recent strategic changes by some of the pharma industry’s main players have brought improvements. For example, GlaxoSmithKline and AstraZeneca have adopted a focus on shared value – where success is viewed in terms of their ability to improve health outcomes – through macro-level projects, which are focused on productivity in the value chain and reconceiving products and markets. 

One of the key pillars of shared value is developing local markets by using behaviour change campaigns, empowering patients to make educated decisions about their health, thereby increasing the sophistication of demand for healthcare. Alongside the clear societal benefit that this provides, there are real commercial opportunities for businesses to leverage, creating shared value.

Whilst the recent macro-level projects by GSK and AstraZeneca have been hugely positive steps, local and smaller-scale behaviour change projects are just as important. A targeted £50k diabetes awareness campaign in London might seem small, but as a principle and a way of working, the potential of these types of projects to impact the wider picture is huge – they put the patient at their heart, which is the cornerstone for positive health outcomes.

Adopting a behaviour change mindset provides opportunity for the industry to step closer to patient-focused ideals. By placing a focus on healthy behaviours, the pharma industry can begin to develop a strategy that empowers people to make informed decisions about their own health and treatment options; the outcome may be as simple as someone proactively visiting their GP for an informed conversation about a specific health issue.

The results often speak for themselves. Trailblazing behaviour change programmes have led to people taking ownership of issues, creating their own ‘communities of interest’, and becoming advocates for the issues driving the programme.  A fantastic example of this was the recent breast cancer awareness programme in Northern England, which saw over 240 community-led events being delivered, engaging nearly 10,000 women, which ultimately led to a significant behaviour change in terms of 9% increase in women checking breasts and an increase in knowledge of risk factors. This is clearly likely to lead more women presenting to the GP, talking about their symptoms and hopefully earlier diagnosis.

Behaviour change techniques consider people in the round, with a wide variety of strategic options to engage them at different touchpoints, ranging from lower-cost interventions such as face-to-face engagement projects within local communities, through to collaborations with cross-sector partners.  Pfizer recently partnered with Liverpool Heart and Chest Hospital to deliver a programme focused on heart health amongst women in Merseyside. This was delivered via local hairdressers, based on insight which suggested that the only time that the target consumers had time to think about themselves was at the salon. The approach was therefore built around this, providing tangible and clear cut-through. This simple yet effective practice leads to new ways of engaging with individuals, offering alternative thinking, identifying different channels through which to start conversations about heart disease and as a result build trust.

It is crucial for any programme to be bold and specific about what health behaviours they are seeking to influence. In this way, strategies can be developed that are personalised and tailored to the individual. This allows the industry to focus investments in areas that are going to make a real impact against commercial objectives, with the confidence of having specific behavioural insight that guides decision-making. For example, a recent CRUK/Bristol-Myers Squib melanoma programme focused on driving men aged 50+ to visit their GP with moles that they were concerned about.  Targeted as a demographic group less likely to visit the surgery in the first instance, this tailored campaign  reached out to a seldom seen and heard audience and improved patient-doctor engagement. 

By using behaviour change practice, pharma companies can increase patient knowledge, confidence and ability to take control of their health decisions. There is an opportunity for the industry to align investment with the increasing focus on personalisation across the wider healthcare sector, and take approaches to build shared value into relationships with their consumers.

   James Kirk, Project Director, Corporate Culture 

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A nudge from government is not enough

Lord Krebs, the President Elect of the British Science Association has this week criticised the Government's reliance on 'nudge' approaches (or persuading people to buy / do things through subtle psychological manipulation) saying that 'nudging' alone does not deliver sustainable behaviour change and will not provide the answer to the array of societal challenges we face. 

The Government naturally likes 'nudging' approaches given they are a light touch alternative to regulation but unless these approaches can delivery sustained changes across the whole host of behaviours we need to alter (climate change to recycling to saving to health behaviours... the list goes on) then we need to see the Government adopting rounded behaviour change approaches that draw on the full range of behavioural sciences, psychology, neurology etc rather than taking the easy option. 

As Lord Krebs says 'a huge change in behaviour needed... we require a massive shove rather than a nudge'. We will have to wait to see whether there is any change in approach...

http://www.guardian.co.uk/science/2012/sep/06/nudge-government?CMP=twt_gu