On July 5 the National Health Service will be 50. In that half century the language of health has been adapted to create new markets for magazines, food, insurance and a whole host of other sectors.
“Health” now permeates every aspect of people’s lives. It is not just about how long we will live and how medicine can keep us alive longer but what we do while we are living and more importantly how much money we can be persuaded to spend.
It dictates what we eat, how much we drink, how much we exercise, where we go on holiday. It surrounds us on television from dramas such as ER and Casualty to documentaries on invasive surgery and young doctors. There are single-issue magazines devoted to the pursuit of health and most newspapers carry enough sections to keep even the biggest hypochondriac happy.
The advertising and marketing worlds have not been slow to exploit our obsession. Whole new markets have emerged – others such as condoms have had a dramatic renaissance – and the images have moved away from stethoscopes, hospital beds and illness to security, comfort, prevention and long life. The affluent are the target audience.
Our obsession has been partly fuelled by health scares in the past 15 years – from listeria and BSE to Aids and heart disease. But also from a desire for empowerment and the fact that we no longer accept what a doctor says as necessarily true.
The Health Education Authority, now ten-years-old, has been at the forefront of changing these attitudes with campaigns ranging from immunisation to anti-smoking and more controversial areas such as Aids and drugs awareness. Its approach is all about prevention and encouraging people to make decisions for themselves.
“The NHS was born to bring health treatment to everybody who needed it,” says HEA head of advertising Charles Gallichan. “There is now a realisation that while that is good, it has to be even better if you can avoid or prevent illness in the first place. That general interest in health is to be applauded.”
But Tim Lang, professor of food policy at Thames Valley University, and a campaigner for improved public health is less convinced. “I am nervous about the commercialisation of health messages, there are too many health claims made that remain unsubstantiated.
“Claims that say brand X is good for the heart make me nervous. No one food product can be a guaranteed fix for good health – it is not that simple. It has to be a combined approach. But the company behind brand X does not want to promote a general picture, it wants to concentrate on the specifics of its product with a ‘this product is good for you’ type message.
“These companies are in business to boost sales but delivery of health is a population-wide issue. They play on neurosis and a lack of information,” claims Lang.
Gallichan admits that some health advertising, especially in private health insurance, has dwelt too heavily on fear but says the Advertising Standards Authority (ASA) has controlled the area.
Underlining the development of the “health” market there will be a consumer show, the Ideal Health Show, in London in July to commemorate the NHS anniversary. The exhibitors range from Heinz to Procter & Gamble and Bupa. Other high street names, including Boots and Marks & Spencer, are also expected to attend.
Dave Arnold, the show’s marketing director says: “Health is not just medical and so it is being taken away from the doctor’s surgery or health centre to the high street. The language of health has become a modern currency and the commercial interests are catching up to the fact that everybody is interested in health.
“Most organisations will not want to position themselves as a distress purchase and so will try to make a positive impression. Health is more about corporate positioning than individual brands.”
Arnold, who spent eight years at the HEA, admits there could be a downside. “There is a danger that there are health cowboys out there who see it as a trendy bandwagon and are looking to make a quick killing. There needs to be quality control.”
The commercialisation of health also extends into the primary healthcare arena. On the one hand the NHS has been moving from general to specialist hospitals with, for instance, heart and lung units.
A spokesman for the NHS Executive says the public supports the idea in principle but feels cheated when it actually comes down to having to travel greater distances to reach specialist hospitals.
On the other hand, those who don’t require specialist, highly-skilled treatment are being farmed out into primary healthcare – into GP’s surgeries or increasingly into pharmacies which are being encouraged to take an advisory role for minor illness.
The 1.1bn private health insurance market is proof of the vast amount of money to be made from offering healthcare services. That both Bupa and PPP have considered developing 24-hour high street walk-in surgeries – they already have private hospitals – underlines where future growth has been identified.
Sinclair Montrose opened its first Medicentre in 1996 and now has seven branches nationwide, including sites in Victoria and Waterloo train stations. In March it appointed Galloway & Co to a 500,000 advertising account.
And last December, Sinclair signed a deal with Boots the Chemist to set up NHS GP surgeries on a trial basis in a handful of Boots outlets. But the medicentres came in for criticism last week from the Consumers’ Association following one of its undercover investigations. It found that the centres did not ask for sufficient medical history on their patients and consequently made incorrect prescription decisions.
For the majority of the population, the NHS remains the mainstay of their health needs. Accident and emergency cases head for the nearest NHS hospital and it scoops up all the sufferers of chronic illness whom private health insurers wish would not apply.
Ironically for an organisation that is available to 100 per cent of the population, an NHS insider says the institution is crying out for a marketing spend. “There is great scope for the NHS to talk to people about the services they want.”
It may be both difficult to justify the spend and also compete with those who can discriminate in their marketing. The NHS is looking its age, but the “health” word has never been so popular.
The NHS, Bupa and PPP Healthcare all came into existence within eight years of each other. But not necessarily in the order you might expect. PPP was first – launched in 1940 – followed by Bupa in 1947 and finally the NHS in 1948.
Today, more than 6 million people in the UK prefer to pay twice for their healthcare. The first time through taxation and then, a second time, by paying into the 1.1bn private healthcare market.
Employers first began to provide private healthcare as an incentive to employees in 1950. The next surge in subscribers came in the Seventies when the Labour Government began to close private wards in NHS hospitals. Bupa, which opened its first private hospital in 1981, now has 36.
Both PPP and Bupa enjoyed a rush of new customers in the Eighties when subscriber levels doubled. However, the boom also attracted new entrants to the market with traditional insurers such as Norwich Union, Legal & General and Standard Life jumping on the private healthcare bandwagon.
But private healthcare seems to have peaked in 1990, with 6.6 million people covered for private treatment. Membership of the two private company schemes has remained virtually stagnant ever since.
There is a growing emphasis on healthcare, with high-street walk-in surgeries among the proposals which have been discussed, as opposed to insurance.
When PPP chief executive Peter Owen took over the company in 1995 he relaunched the brand. Research had shown that a large proportion of subscribers were unaware that they were using PPP because policies were often organised by their employers.
PPP has spent 30m on marketing since 1995 with a high-profile TV ad campaign through M&C Saatchi. Bupa spends about 7m a year on advertising through Ogilvy & Mather.
No area of the health world has been more controversial than food. According to Mintel, low-fat and slimming foods now bring in combined annual sales of almost 1bn, having grown 39 per cent and 63 per cent respectively to 836.6m and 93.9m since 1992. But at the same time the level of obesity in the UK has never been higher, suggesting that an education campaign for healthy eating and balanced diet would be more effective.
The market for vitamins has also come in for criticism, partly from supermarkets claiming that the branded variety are over priced and also from those who question their health value over fresh fruit.
Advertising claims for slimming products, functional foods, like Yakult, genetically modified soya or even breakfast cereals often have people queuing up to contradict them. Both the ASA and the Broadcast Advertising Copy Clearance (BACC) seek specialist advice on health claims. But pressure groups such as the National Food Alliance and the Baby Milk Action Group are very active.
Most recently the Advertising Standards Authority has upheld a complaint against Kellogg for claiming that eating cereal could aid memory. It is also investigating a press ad from Kellogg’s Serving the Nation’s Health campaign which showed a fat schoolboy and suggested a bowl of low-fat cereal could help him slim and avoid the bullying he was suffering at school.
However, the number of complaints made to the ASA about food and drink ads almost halved between 1996 and 1997 to 175, of which 11 were upheld. The ASA itself says it received 91 requests for copy advice last year and believes this may account for the drop in complaints.
USER FRIENDLY PHARMACIES
It is ironic that the role of the pharmacy in the UK is growing at a time when more than 2,000 local pharmacies face closure due to competition from supermarket and chemist chains.
Initiatives from the Department of Health, the National Pharmaceutical Association (NPA) and the British Medical Association are attempting to shift some of the workload of GPs onto local pharmacists.
John Darcy, chief executive of the NPA, says the importance of the pharmacist in administering medical advice has risen steadily since 1948, but has gathered pace since the Eighties. In 1981 it launched its Ask Your Pharmacist ad campaign targeting mothers, pregnant women and the elderly.
The British Medical Association and the Department of Health launched the Doctor Patient Partnership in 1995. Each month a new campaign encouraging the responsible use of GPs is distributed to doctors’ surgeries and pharmacies through local health authorities. Last September, the campaign encouraged people to treat cold and flu symptoms at home, saying that a doctor is not necessary.
The Medical Controls Agency has played an important part in increasing the role of the pharmacy and reducing pressure on GPs by switching the availability of some medicines from prescription only to over the counter.
A good example of this is Zovirax, which until 1992 was prescription-only. Although pharmacists were able to identify a cold sore on a patient, the individual would have to go to a GP and secure a prescription for the remedy. Darcy says: “This enables the NHS to save on the drugs bill directly through the products, and indirectly through the GP’s time.”
Chains such as Boots are also monitoring the Primary Healthcare Bill, which could make walk-in GP surgeries on the high street a reality as it passes through Parliament.
At the end of March Frank Dobson, Secretary of State for Health, launched NHS Direct – a scheme offering the public 24-hour phone access to nurses. The service, being piloted in Buckinghamshire, Lancashire and Northumbria, is designed to prevent unnecessary call out of ambulances and GPs.
THE ROAD TO RECOVERY
The dual messages of preventative medicine and self diagnosis led to the birth of the healthy living “industry”.
It now stretches from the food we eat and where we exercise to alternative medicines and the plethora of magazines that feed our voracious appetite for news on health issues.
Marketers have been quick to take the lead. Kellogg signed a three-year deal with the Cancer Research Campaign last autumn to raise 1m for the charity. One million of its All Bran packs have been used to promote the CRC’s Healthy Lifestyle Initiative – a programme which suggests that a high-fibre diet can prevent bowel cancer.
Meanwhile, Van den Bergh’s Flora margarine brand is sponsor of the London marathon.
The success of health magazine titles is another indicator of the riches to be had from tapping the nation’s obsession with longevity. Men’s Health’s sold 225,126 copies between July and December 1997, an increase of 41.6 per cent on the previous period. Top SantÃ© Health & Beauty’s circulation rose 6.7 per cent in 1997, while the National Magazine Company’s Zest witnessed a 3.6 per cent increase in the same period.
Holmes Place – the private health club with ten branches in Greater London – is advertising on peak-time television to attract new members for the 15 gyms it plans to open in the next two years.