Page 270 - The Handbook of Persuasion and Social Marketing

246 The Handbook of Persuasion and Social Marketing

recognition that most upstream changes require decisions made by elected
officials, and these officials can be pressured by public opinion (Coffman,
2002; Siegel & Lotenberg, 2007; Wallack & Dorfman, 1996; Winett &
Wallack, 1996). Both push and pull strategies are used to achieve environ-
mental change goals requiring the passage of public policy. The combina-
tion of these two approaches (including heavy media advocacy) is
particularly needed to achieve policy change related to controversial re-
strictive remedies.
Rothschild (1999) identifies three broad approaches an agent can take to
influence a person to not engage in self-destructive behavior: education,
marketing, and the law. Education includes both informative and persua-
sive communications. Education does not, on its own, alter the actual
positive or negative consequences of engaging in a behavior, but rather
seeks to change how people understand or value the consequences of their
behavior. Marketing changes the benefit-cost ratio associated with engag-
ing in self-destructive behavior by increasing the perceived benefits (or
reducing the perceived costs) associated with not engaging in the behav-
ior. This may be done directly (e.g., the cost of not driving home from a
bar while drunk can be reduced by providing a “party bus” to take home
drinkers) or it can be achieved indirectly by providing an attractive alter-
native (e.g., offering appealing campus activities can reduce the cost of not
going to bars and binge drinking). In contrast, a law uses punishment to
force an agent to engage (or not engage) in a behavior. The broad distinc-
tion drawn is that marketing increases people’s choices and laws restrict
their choices.
Education and marketing entail both downstream and upstream mar-
keting. The downstream dimension is the communication of the increased
benefit (or reduction in cost) that the customer will experience. The up-
stream dimension is the action that leads powerful agents to provide the
resources required to support the communication effort or provide the
added benefit (or cost reduction). Only upstream efforts focus on law and
policy change.
In summary, the shift from downstream to upstream is so prevalent that
Wallack and Dorfman (1996) have argued that influencing public opinion
to bring about support for regulations should be a critical feature of the
new public health. This assessment is consistent with the policy initiatives
advocated by government agencies such as the Institute for Medicine
(2007) and the World Health Organization (WHO, 2009); by nongovern-
mental organizations (Coffman, 2002, 2003); and by politicians (e.g., tax-
ing alcoholic drinks, Brooks, 2010; taxing stores that sell sugared sodas,
Knight, 2009). We are suggesting neither unanimity in the public health