width=256 One definition of insanity is doing the same thing, over and over again, but expecting different results. As we enter another era of change, will we continue thinking about and trying to solve social and public health issues using the same paradigms and tools, or will rediscovering social innovation lead to original and improved solutions?

Coping with the many challenges confronting our country and world requires, just like with individuals under stress, the development of new ways of coping with them. Economic and policy initiatives are only partial solutions to issues as diverse as safer neighborhoods, childhood obesity and poverty. Education and information campaigns only go so far in reducing the use of tobacco products, increasing the use of preventive health services and engaging parents in their children's education. Laws and regulations improve the safety of our food supply, reduce environmental pollutants and protect against unintentional injuries involving all types of consumer products - yet they too are only partial solutions.

The use of marketing principles and practices in the private sector has been demonstrated to be among the most important sources of success in solving the core business problem of achieving organizational success (generating profits) through satisfying consumer wants and needs. Marketing goes beyond advertising and sales. When applied as intended, it becomes a systematic way for management to structure its relationships with consumers and stakeholders from the products and experiences it offers, the structure of the incentives and costs associated with them, and their accessibility to how they are promoted in the marketplace with an ever expanding palette of communication tools. This same marketing management approach should be adopted in the analysis, planning, implementation and sustainability of programs aimed at social problems.

Social marketing, the application of the marketing discipline to social issues and causes, provides a framework for developing innovative solutions to social problems that have long perplexed and frustrated us. It has emerged from business marketing practice as a social change tool uniquely suited to achieve social profits by designing integrated programs that meet individual needs for moving out of poverty, enabling health, improving social conditions and having a safe and clean environment. Marketing principles are embedded in such success stories as the Grameen Bank enabling poor people to earn a sustainable income in developing countries, reducing teenage smoking rates in the truth® campaign, improving children's food choices and what they eat in schools through Team Nutrition and reducing childhood deaths from malaria though the distribution of insecticide-treated mosquito nets in endemic countries. Indeed, when we examine some of the more well-known and successful public health programs over the past three decades, the principles of social marketing are being applied by the US Agency for International Development, the Centers for Disease Control and Prevention, the National Institutes of Health and the Office of National Drug Control Policy among others.

Individuals in our society do not live in just a consumer or economic marketplace where monetary concerns and self-interest reign supreme and rational decision-making is believed to be the norm. People's everyday lives include exposure to all types of ideas and behaviors, whether through their family and friends or through television and the internet. The recognition that these marketplaces of ideas and behaviors also exist, and are subject to forces such as proximity and access, incentives and costs, role models and social norms, health and digital literacy and the quality of their communications environment illuminates how programs that focus on only economic levers, or education, or laws and their enforcement fail to achieve all the social good that is intended. Similarly, understanding that individual and social change are products of a marketplace of ideas and behaviors that are, in turn, constantly being shaped by the activities of public, private and nonprofit sector actors means that all of these actors must become part of sustainable, long-term solutions and not merely bit players (or partners) in short-term campaigns - if they are engaged at all.

To move society forward in developing new ways of addressing old problems, I suggest that policy-makers in all three sectors of society that agree on areas of common concern - recognizing that there are many different concerns that involve often different sets of actors - begin to adopt these premises of a social marketing perspective in their work.

There must be a set of integrated activities that analyze, design for, implement and evaluate programs that specifically address (1) products, services and behaviors that will improve individual and social well-being; (2) realign incentives and costs to facilitate behaviors for the individual and social good; (3) create opportunities and improve access to beneficial products, services and places that encourage and support behavior change; and (4) employ state-of-the-science communication strategies and tools to promote and support positive change at all levels of society - individuals, families and other social networks, organizations and communities.

Programs should be audience-centric; that is, based on understanding the people to be served by the program, having insights into how they perceive the problem and possible solutions in the context of their everyday lives, and engaging them to be co-creators and eventual owners of relevant solutions.

Audience engagement, from who is sitting at the policy table to who is sitting across from a teacher, is both a core value and outcome for success. It becomes part of a common framework for understanding and implementing programs with population-wide benefits.

And finally, I look forward to a time when marketing becomes a lingua franca for all agencies involved in social change activities rather than the current balkanization of efforts by agencies that are fueled by their own unique frameworks and theories for how problems exist and how they should be solved. Bringing together public, private and nonprofit (NGO) sectors face this challenge; so too do multi-sector approaches that attempt to bring together agriculture, education, environment, healthcare, health promotion, transportation, housing, law enforcement and other actors. Until people and agencies share common frameworks for understanding and communicating with each other, do not expect much beyond blind men describing an elephant.

I know that in some quarters marketing as practiced in the commercial sector is sharply criticized. Yet marketing as it can be thought about and practiced for social change may be one way to have the types of multiple sector, integrated collaborations that are needed to solve many of the wicked social programs that have been intractable for too long for so many.

About the Author:

R. Craig Lefebvre, PhD is an architect and designer of public health and social change programs. He is an Adjunct Professor of Prevention and Community Health at The George Washington University School of Public Health and Health Services. Most recently he was the Chief Maven at Population Services International (PSI) where he led PSI's technical teams in capacity-building, HIV, malaria, child survival and clean water programs, reproductive health, and social marketing as well as its research and metrics functions.