Bulletin of the Transilvania University of Braov Vol. 4 (53) No.

2 - 2011
Series V: Economic Sciences

BRANDING IN HEALTH MARKETING

Anca Ramona PRALEA1
Abstract: Branding is one of the major positioning elements of commercial
marketing. The whole marketing mix should be, and it usually is, adapted to
better serve the needs of well-established brands. Public health is one field in
which the persons system of Knowledge-Beliefs-Attitudes (KAB) is very
important. That is one of the main reasons why branding should be
considered by specialists in the field. As evidence shows it can make the
difference between a successful health marketing campaign and a nonsuccessful one. The key elements of commercial branding can be successfully
translated to the social sector. This is the case for the Truth campaign but,
unfortunately, not for some public health campaigns in Romania.

Key words: public health branding, brand equity, the Truth, health
behaviour, social imagery.

1. Introduction
The brand has been one of the key
concepts in commercial marketing in the
past decades. It has played a key role in
marketing strategies and it has been
defined by the American Marketing
Association as it follows: a brand is a
name, term, design, symbol, or any other
feature that identifies one seller's goods or
service as distinct from those of other
sellers. The legal term for brand
is trademark. A brand may identify one
item, a family of items, or all items of that
seller. If used for the firm as a whole, the
preferred term is trade name."[14].The
definition is not an over encompassing
one. According to the literature [4] it lacks
one key element without which the
implementation of any brand strategy
would be in vain. That element is
association.
There are three underlying constructs to
branding in general. In order to increase
the value of your range of products,
services or even health behaviours the
1

consumer has to feel connected with the

brand. A relationship has to be build
between the consumer and the brand by an
exchange of value [4]. In order to adopt
a brand the producer or seller has to bring
it into the consumers lives and not just
through some information into the market.
First of all, this paper will discuss the
importance of applying branding principles
into public health marketing. The
similarities and differences between the
commercial sector and the public one will
be then addressed. Thirdly, two separate
public health campaign will be analysed
considering their branding efforts. These
will be then linked with their success in
influencing their targeted health behaviour.
2. Differences and similarities between
commercial and public health
branding
According to Hastings (2007) [4] a
research of UKs National Institute for
Health & Clinical Excellence stated that
branding can be an effective way to

Department of Doctoral School in Marketing, Transilvania University of Braov.

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Bulletin of the Transilvania University of Braov Vol. 4 (53) No. 2 - 2011 Series V

influence health behaviours. Moreover,

their usage in health marketing campaigns
could be accounted for creating long term
relations between the consumers and the
entity that initiated the public health
campaign.
Considering the aspects mentioned above
together with key findings from practice
Evans et al. (2007) [4, p 6] defined public
health brands as: the associations that
individuals hold for health behaviours or
lifestyles that embody multiple health
behaviours. It is interesting to pinpoint
the fact that commercial and health
branding are similar in motives and
outcomes [4]. They are both concerned
with changing behaviours. The main
difference lays in the principles and
methods that they use to reach the desired
change. This clearly proves to be simpler
for the commercial sector that can rely on
the products benefits in its endeavour.
Both commercial brands and public
health ones can be assessed considering the
three pillar structure mentioned before.
Nevertheless one of the key problems that
health brands encounter springs from the
essence of the last pillar. In order to build a
long term relation that will influence a
persons health some benefits have to be
given to that individual, through an
exchange of course. In the commercial
sectors it is fairly easy to pinpoint these
benefits (e.g. the special flavour of an icecream or the easiness in writing to
someone that is far away instead of
phoning them if you use Internet) while in
its public health counterpart it proves to be
really difficult. Therefore the value
proposition of a health marketing
campaign should be defined in far more
rigorous terms than commercial ones.
Moreover, considering the negative aspect
of the demand for health behaviours, that
characterizes
most
public
health
campaigns,
the
exchange
should
nevertheless appear beneficial to the

consumer. This would mean that the key

benefits or long term benefits should be
presented in such a way as to convince the
target audience that they are gaining
something from the exchange.
In fact, the difference between branded
and not branded health marketing
campaigns often lays in the lack of
ambiguity in defining the benefits.
Contrary to some experts beliefs, the
beneficial results of not smoking are not
self-evident and can be difficultly gauged
on a long term horizon. This could be also
noted as a key difference between
commercial and public health branding.
While the former are really good at
establishing realistic time frames for
assessing the effect of a change in
behaviour, the latter are rarely doing it [4].
Another key-aspect of the branding
initiatives of both commercial and health
branding are the tactics that they use. In
both cases one can observe the existence of
four main tactics [4]: competition;
recognition; promise and delivery.
Nevertheless, public health branding is still
in the process of developing these tactics
in practice, in a manner that would
enhance their chances to provoke longterm changes in ones health behaviour.
While the competition tactics, also called
the value proposition statement, is being
applied to a greater extent in health
marketing, the other three stumble upon
great challenges. Most often the budges are
not as large as in commercial marketing.
This influences greatly the recognition
tactics. The strategy, together with the
delivery one, is relying most on the
financial aspect of a campaign. Moreover,
the latter one is also influenced by the fact
that the effects of adopting new health
behaviour are rarely visible on the short or
medium term.
The value of branding a campaign,
product or service can easily be measured
by using the term of brand equity. While

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Pralea, A. R.: Branding in health marketing

commercial marketing is constantly using

these concepts or constructs to evaluate
and model their branding activity, public

health rarely uses them. Nevertheless the

structure is similar for both areas.

Fig. 1. The brand equity structure( Source 2)

In fact, it can be said that each of
commercial brand equity has an analogue
in public health[ 4, p 13]. The structure of
brand equity is presented in the graph
above.
These elements can be really useful in
determining whether a public health
marketing campaign is branded or not.
To sum up, there are still huge difference
concerning the degree with which the
commercial sector and the public health
one are using branding. In spite of the fact
that there are both similarities and
differences between them, both sectors can
use branding as a successful tool for
changing behaviour.
3. Public health branding in practice
Public health is a field with great
prospects for applying branding techniques
for changing behaviours. In order to
support this statement, two relevant casestudies will be presented.
One of them is a success story in which
public health branding was used, while the
other is a traditional drug campaign
implemented without branding and with
scarce results.

3.1. The truth

The most well-known and appreciated
antismoking campaign world-wide is the
Truth. It was initiated by the Legacy
foundation in the winter of 2000. The
Truth was first thought to be a
continuation of an existing anti-smoking
campaign. Nevertheless it gradually
became one of the biggest and, at the same
time, the most successful public health
campaign. Most of its success was due to
the branding perspective approached by its
developers. Instead of adopting the same
preaching position as other campaigns did
and still do, they opted out for a rather
different approach.
The first part of a brand that comes into
the consumers mind is the logo. The
Truth has a distinctive and significant
logo. Moreover, the meaning of the brand
names is highly significant and allows
several relevant associations to be made.
Evans (2010) [6] offers some interesting
examples:
Id like to help truth get the word out
The truth ads are always honest
Kids in the truth ads are just like me
etc

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Bulletin of the Transilvania University of Braov Vol. 4 (53) No. 2 - 2011 Series V

These associations that teens make

pinpoint the key brand-strategy used by the
Legacy Foundation. First of all, the fact
that kids would like to help is indicative of
their approval of the message transmitted
by the campaign. This was accomplished
by involving youth in the designing of the
campaign.
Secondly, the promise that the brand
holds is real. This is mainly due to the

involvement of the target audience in the

implementation of the campaign. They
influenced the tone of the communication
and positioned the brand in the right place
at the right time.
The positioning of the public health
brand plays an essential role in this case. It
is presented in Figure 2.

Empowering
Tobacco
Brands
Preachy

The Truth
Rebellious

Controlling

Fig. 2. Brand positioning of the Truth (Source Evans 2010)

It can be easily seen that The Truth has
a similar positioning relative to the strong
tobacco brands. This means that it can
offer a satisfying option to teenagers. It
appeals to their desire to rebel and it
empowers them to do something. This
would also mean that it delivers the
promise it holds.
A very important aspect is the high
empowering level of the campaign. This is
in line with the social theories that
constitute the fundamental background of
every
health
marketing
campaign.
Nevertheless, few of them manage to
design and implement Banduras construct:
self-efficacy. Being a promoter of change
this construct is operationalised here
through giving youth the possibility to
actually engage in changing the behaviour.
In fact this is the fundament of the third
key branding strategy used by The Truth.
The campaign encourages teenagers to

become a part of a social movement. This

makes them feel important, motivated and
strengthens the bond between them and the
campaign/brand.
As one considers the strategies discussed
above it is fairly easy to pinpoint some
very important elements of branding.
The brand awareness level was very high
[7]. The indicator, derived from a
longitudinal study is close to 90%.
[7, p 24]. This points out toward a strong
relationship of the brand with its target
audience. The fact that the brand managed
to construct and develop such a bond is
highly indicative of its success. This is also
linked with other key factors such as the
promises it holds.
The Truth offers an alternative lifestyle
to smoking. This, in itself, is not relevant
to teenagers. That is why the bonding
between the brand and teenagers was
settled on the promised benefits this

Pralea, A. R.: Branding in health marketing

lifestyle offers. It provides them with the

chance to rebel against something, at the
same time empowering them to fight this
war. It gives them self-confidence and
therefore makes the non-smoking lifestyle
more appealing.
The exchange, that is vital to the
branding process, is actually voluntary,
which is very important. Being a win-win
situation the results are far better and long
lasting. This also means that the delivery
condition is also satisfied. Teenagers are
offered the possibility to engage in a social
movement directed against the tobacco
industry with the price of giving up
smoking.
Considering the evidence presented
above, a final point should be made. As
Evans et al. point out very precisely, the
matter of changing ones health behaviour
is often related to social imagery ( Evans,
2008) [6]. The discussed campaign is
managed to promote a social image that
fits the teenagers ideal perception. This
condition could be met only due to the
teenagers influence in designing the
campaign.
Overall it can be said, without any doubt,
and relying on solid research results
(Evans, 2008) that the public health brand:
The Truth is a success story. From my
point of view the most important feature of
the campaign, the one that ensured its
success, is the well documented formative
research. This was supported by the social
marketing skills of its developers which
was central to the way in which they
managed to translate the key branding
elements from commercial marketing to
public health marketing:
Brand recognition;
Brand promise;
Brand delivery ;
The brands strong relationship with its
target audience;
The promised value;
The exchange;

69

Social imagery.
This is not the case of the next public
health campaign that will be discussed.
3.2. Spune nu drogurilor
The public health campaign Spune nu
drogurilor is one of the most visible
initiatives of this kind in Romania.
Nevertheless, most of its brand awareness
was relying on the participation of some
well known Romanian singers and TV
stars. As it proved out, in the end, the
results in the long and medium term were
not significant. This was mainly due to its
superficial design. One can easily say that
it was mainly a health communication
campaign and not a well grounded public
health marketing initiative. This statement
can easily be supported if one analyzes the
campaign from the branding perspective
used before.
Some of the key-elements that made the
Truth campaign so successful are clearly
missing. Starting from the very beginning
the brand awareness is rather low. In spite
of the fact that no scientific research was
undertaken to account for this, the
empirical analysis of the literature should
be significant.
The campaign enjoyed some recognition
in 2009, due to the association between its
name and the name of a song. This is one
positive aspect since the song was created
in order to support the campaign by a
famous Romanian pop band. The positive
association that was created in this way has
lost its power because of its being misused.
The tours and concerts around the country
have raised the awareness level but they
havent been followed by something
concrete. In order to support and further
develop the strong relationship [16]
between brand and target audience,
achieved on the short term, some
additional activities should have been
considered.
In my opinion, the weakest point of the
campaign is the lack of an achievable

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Bulletin of the Transilvania University of Braov Vol. 4 (53) No. 2 - 2011 Series V

promise or of a value proposition.

Considering the fact that the campaign is a
preaching one it mainly focuses on
negative messages. These do not support a
promise that something will change for
the benefit of the teenagers if they
undertake
the
desired
behaviour.
Nevertheless, in the early stages of the
campaign it seems that initiators had
something similar in mind. This might be
the reason why they attracted the support
of some famous singers. They wanted to
communicate the fact that if you do not
take drugs you might have a chance to
become as famous as them. Still this
promise or value proposition was not
followed by any indications on how one
could achieve that. In addition, teenagers
are aware of the fact that there is not a
strong causality between not taking drugs
and being a star.
Finally, there is no exchange taking
place between the brand and its target
audience. The teenagers cannot see any
promised
benefits
therefore
their
motivation of changing the behaviour is
really low. This is linked with the passive,
one-directional characteristic of the
campaign. It does not offer a genuine
solution for engaging in the healthier
behaviour. This traditional approach was
criticised in North America, starting with
the campaign Just Say No that share a
striking resemblence with the one analysed
here. It is not enough to transmit the
message that drugs are not good for your
health. One must also offer solutions to
teenagers so that they can choose not to
consume drugs or to stop consuming them.
In most cases a simple no is not enough.
By focusing on the singers (Animal X, 3
Sud Est, Cristina Rdua) the developers of
the campaign wanted to project the image
of a successful young person that enjoys
life without taking any drugs. It is easy to

understand that most of the teenagers

would have enjoyed being like that. Until
this point the social imagery tool would
have worked. Nevertheless, the initiators
did not offer any solutions for engaging in
such a world. They projected the ideal,
gave some outlines according to which if
you say no to drugs you could become a
star, but did not offer practical solutions
for achieving that. From my point of view,
this is a mistake that diminished greatly the
impact of the campaign. It has been
proven, also by the case study before, that
teenagers do need and enjoy when given
concrete facts and solutions. They pay no
or little attention to campaigns that score
high on the preaching scale, even though
they do not intend to control them.
In my opinion if one would consider the
four distinctive features of public health
campaigns used to analyse the Truth
positioning the situation would look rather
different for Spune nu drogurilor. This
last one would score high on the preaching
characteristic without any relevant score
on the others. There is no empowering
involved in this campaign. In spite of the
fact that they want to communicate the fact
that you have an alternative to taking
drugs, and that you should follow that
road, they lack consistency by not offering
concrete solutions.
There is nothing rebellious in just saying
no to the drugs. The initiators of the
campaign did not manage to transmit the
fact that it could be, indeed, cool to refuse
to take drugs. From my point of view their
commercials were not appealing.
The campaign scores low on two main
components identified by prior research as
being essential to young people. In my
opinion, formative research should have
prevented that from happening. The
situation described above is very well
depicted in the graph below.

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Pralea, A. R.: Branding in health marketing

Empowering

Preachy

Taking drugs

Rebellious

Spune nu
drogurilor

Controlling

Fig. 3. Spune nu drogurilor positioning (Source Evans et all 2010, own calculations)
In my opinion, the anti-drug campaign
Spune nu drogurilor is a classic example
of a traditional health communication
initiative. Considering all the elements
discussed before together with the lack of
social marketing tools one could say that
the campaign has failed to reach its
purpose. The importance of using
marketing techniques and strategies in
public health becomes obvious. Applying a
branding perspective to this campaign
would have brought about great benefits.
To sum up, one can say that the Romanian
anti-drug campaign Spune nu drogurilor
has failed to reach its intended objectives.
This was mainly because of an inefficient
design that failed to meet the branding
criteria in public health. Moreover, its
positioning was also ineffective. This
could have been easily avoided by taking a
health marketing approach to the issue,
including a formative research.
4. Conclusions
Public health branding is a rather new
but highly important approach to public
health campaigns. It offers a good
perspective on the profile of the target
audience, therefore enhancing its chances
of success. The presence of the three pillar
structure of public heath brand can be
indicative of a campaigns success.
Nevertheless the relation between these
three pillars has to be a strong one and one
that is understandable and reachable by the
consumer.

There are some obvious differences

between public health brands and
commercial ones. In spite of that they do
resemble a lot if one considers the starting
point and the final objective. They both
intend to change behaviours by creating
brand awareness, brand loyalty etc. The
main difference lies in the way in which
they do that and furthermore in the scope
of doing it. While commercial brandings
main purpose is that of changing behaviour
in order to increase sells, public health
branding is mainly concerned with having
a healthier population.
The importance of public branding was
revealed by t he two case studies
presented. It was demonstrated that
applying branding elements in public
health campaign could prove to be highly
efficient. The Truth campaign is a
relevant example. The manner in which
they understood, applied and later
developed the three pillar structure of
commercial brands was a success. By
understanding and researching upon their
target population they managed to come up
with a value proposition or promise that
was relevant. Moreover, they managed to
live up to their promise and develop a
delivery mechanism that facilitated the
beneficial exchange.
By comparison the Romanian campaign
has failed to apply public health branding.
Starting from the very begging they did not
design their campaign based on formative
research about their target audience. This

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Bulletin of the Transilvania University of Braov Vol. 4 (53) No. 2 - 2011 Series V

led to an inefficient design that was later

on translated into an unsuccessful antidrug campaign. In spite of the fact that, in
a short term, a certain brand recognition
was developed in the medium and long run
this completely vanished. By the failure of
creating brand awareness and getting
involved into a strong bond with their
target audience they also missed out the
following steps. The value proposition or
promise they made was not supported by
any exchange or delivery mechanism.
Moreover, the tone of the communication
and the message were wrongly positioned
in the area of preaching.
All in all, public health branding does
make a difference when it comes to the
success of a public health campaign. By
using to its full extent the commercial
branding tools and researching upon the
target audience the changes of designing
and implementing a successful campaign
increases a number of times. Moreover the
literature also pinpoints the important role
of public health branding in monitoring
and evaluating the results of a public
health campaign.
Acknowledgment:
This paper is supported by the Sectoral
Operational Programme Human Resources
Development (SOP HRD), ID59321
financed from the European Social Fund
and by the Romanian Government.

Marketing
Conference
Brighton
September 29-30 2008.
4. Evans, D., Hastings, G.: Public health
branding-Applying Marketing for
Social change Oxford University Press
2008.
5. Douglas Evans, W., Gerard Hastings
Oxford University Press 2008.
6. Evans, D.: Public Health brand
research. The George Washington

University, Global Branding in

Social Marketing Symposium 13
April 2010.
7. Evans,
D.,
Wasserman,
J.,
Bertolloti,
E.,
Martino,
S.:
Branding Behaviour: the strategy
behind the truth campaign. Social
Marketing Quarterly Vol VIII, no 3
Fall 2002 pp. 17-29.
8. French, J, Blair-Stevens, C.: Social

9.
10.

11.
12.

References
1. Blair-Stevens, C., Allison, T.: Social
Marketing for Health and Specialised
Health Promotion, Royal Society for
Public Health, 2008.
2. Donovan, R., Henley, N.: Principles
and Practice of Social Marketing: An
International Perspective Cambridge
University Press, New York. 2010.
3. Evans Douglas, W.: How Brands
Work in Public Health World Social

13.
14.
15.

Marketing and Public Health: Theory

and Practice. Oxford University Press,
2010.
Glanz, K. et al: Theory at a glance.
United States Cancer Institute 3rd
edition, 2005.
Kotler, P, Zaltman, G.: Social
Marketing: An approach to Planned
Social Change Journal of Marketing
35, 1971, pp. 3-12.
Kotler. P. et al: Social Marketing:
Influencing Behavior for Good. 3rd
edition Sage Publication, 2008.
Weinrich, K. N.: Hands on Social
Marketing: A Step by A Step Guide to
Designing Change for Good. Sage
Publication, Thousand Oaks. 2011.
www.truth.com [accessed 08.06.2011]
www.spunenudrogurilor.com [accessed
10.05.2011]
http://en.wikipedia.org/wiki/Brand#cit
e_note-0 [accessed 21.02.2011]

16. http://www.youtube.com/watch?v=

ltef-FMQcws
2011]

[accessed

01.07.

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