Rapid changes in dietary habits, coupled with a decline in levels of physical activity, have led to an increase in the prevalence of overweight and obesity in the US and around the world. The consequence of these changes has been an increase in noncommunicable diseases (NCDs). The challenge for health authorities is to benchmark their efforts to slow and eventually reverse these trends. What to benchmark to? I suggest to what has been found to work, not what fits into rhetorical frameworks.

Broken lightbulb innovationIn reviews of over 300 studies on the use of health communication, social marketing and community-based approaches to address health risk behaviors, especially poor dietary habits and increasing levels of physical activity, across a wide range of socio-demographic groups around the world, a number of lessons have been learned about what constitutes the more successful programs (Carins & Rundle-Thiele, 2014; Garcia-Marco et al, 2012; Snyder, 2007; Wakefield et al, 2010). I have added to their findings several other features that more recent experiences suggest can improve program effectiveness. Note that while many of these studies have focused on nutrition and physical activity behaviors, the ‘Ideal Features’ list below could be applied relatively well across efforts to change many different behaviors and address other wicked problems.

For your consideration and comment:

The Ideal Features of Social Change Programs (with links to previous posts)

  1. Select and concentrate on priority groups
  2. Identify the value each priority group finds in adopting healthier behaviors
  3. Understand and address the incentives and costs of change – financial, opportunity, psychological, social, scarcity, etc
  4. Design products, services and behaviors that fit people’s reality
  5. Position the new behavior as more compelling, relevant, and potentially more valuable to people when they practice it, in comparison to the alternatives
  6. Test program strategies and elements before implementation
  7. Not rely only on mass communication campaigns
  8. Increase access to information, places, food choices and services that reinforce desired behaviors
  9. Locate a service, distribute a product, and create opportunities for members of our priority group to engage in healthier behaviors
  10. Utilize community-based programs and citizen engagement to facilitate collaborations and create healthier environments and policies
  11. Consider policies that include incentives and disincentives for specific dietary and physical activity behavior
  12. Explore how social networks and social media can influence norms about, and diffusion of, healthier behaviors and lifestyles


Carins, J.E. & Rundle-Thiele, S.R. Eating for better health: a social marketing review. Public Health Nutrition, 2014; 17(7):1628-1639. 

Garcia-Marco, L., Moreno, L.A. & Vicente-Rodriguez, G. Impact of social marketing in the prevention of childhood obesity. Advances in Nutrition, 2012; 3:611S-615S.

Ogden, C.L., Carroll, M.D., Kit, B.K. & Flegal, K.M. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA, 2014; 311(8):806-814.

Snyder, L. (2007). Health communication campaigns and their impact on behavior. Journal of Nutrition Education and Behavior; 39(Suppl.):S32–S40.

The GBD 2013 Obesity Collaboration, Ng, M., Fleming, T., et al. Global, regional and national prevalence of overweight and obesity in children and adults 1980-2013: A systematic analysis. Lancet. 2014;384(9945):766-781.

Wakefield, M. A., Loken, B., & Hornik, R. (2010). Use of mass media campaigns to change health behaviour. Lancet; 376:1261–1271.


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