Alam Shukla

alam@ethnopedia.co.uk

The Extra Mile

It's now almost a given that pharma companies, health charities and public sector organisations put the patient at the centre of their marketing activities. Patient-centric programmes are imperative and many of these organisations – and their agencies – make significant efforts to understand patients better and develop tailored communications based on patients' profiles.

Yet the reality is that the current composition of society demands a much deeper segmentation. By conducting micro social segmentation, companies can gain considerable actionable insights and a more in-depth understanding of their audiences and their cultural nuances. After all, these nuances have immense impact on the lifestyle, attitudes and behaviour of patients.

Medical research comparing health attributes between ethnic groups has a long history. For clinical trials, ethnicity has proved to be a critical factor for medical researchers. Genomic and pharmacological research in many clinical areas has revealed interesting differences between ethnic groups in the natural history of disease and the efficacy of medication.

However, when it comes to the marketing plan ethnicity is still not considered by many leading companies. Are they missing the point or are they simply not brave enough? Either way, they could be losing out on a massive opportunity.

Multicultural Britain
Everyone knows that today's Britain is highly multicultural. According to figures from the Office for National Statistics, the 2001 census, almost 8 per cent of the total population is from an ethnic background.

he data are now more than nine years old and considering the rate of immigration in the last decade, some experts believe that this figure may easily have risen to 12 per cent - amounting to more than seven million individuals with ethnic origin.

If you look at urban markets, the density of the ethnic population is much higher. For example, almost 45 per cent of London's population, 32 per cent of Birmingham, 35 per cent of Leicester's and 15 per cent of Manchester's population are multicultural.

Moreover, the prevalence of certain health conditions in the ethnic audiences makes this market too important to ignore for the healthcare sector.

Prevalence of certain conditions
The prevalence of certain conditions is ethnicity biased: this is due to genetic and physiological influences, as well as external factors such as lifestyle choices. Because of the correlation between ethnicity, socioeconomic status and risk exposures, it is, however, often difficult to isolate the relative impact of genetics and external risk factors.

Many medical researchers have highlighted the influence of ethnicity in medical journals and in the US the FDA approved a drug called BiDil that was specifically developed for the African American audience.

In clinical trials, BiDil reduced deaths by 43 per cent and decreased hospitalisation by 39 per cent among African American heart failure patients. It also reduced heart failure symptoms. Researchers are uncertain why the drug works better among blacks than other races.

For the UK market, the development of a race-specific medication may be much further down the line but marketing to ethnic audiences is surely a priority for now.

To put this in context, here are some statistics on how widespread certain conditions are among ethnic audiences in the UK:
• The occurence of type 2 diabetes is four to five-fold higher in the South Asian population (Indian, Pakistani, Bangladeshi, Sri Lankan), according to two research papers published in Circulation 2001;104: 2855-64 and the British Medical Journal 1999;319: 215-20
• The excess coronary heart disease risk in South Asians compared with the population of England and Wales is estimated to be at least 40 per cent (Journal of Public Health 2000; 22: 375-85)
• Black and ethnic groups are the highest users of primary care services (Office for National Statistics 1996)
• In the UK, black Caribbean and black African men are two to three times greater risk of being diagnosed with, or dying from, prostate cancer than white men
• South Asian women have 51 per cent higher coronary heart disease mortality rate than the whole population, for men the figure is 40 per cent, according to British Heart Foundation (BHF) figures from April 2004.

Multicultural marketing
Many government departments and charity organisations have already recognised the importance of ethnicity in the UK. The Department of Health and NHS have developed a number of marketing activities to reach out to ethnic audiences. Major charities like the BHF, Prostate Cancer Society and Diabetes UK have been running tailored campaigns for the multicultural market for many years.

BHF research shows that people of South Asian origin are up to 50 per cent more likely to die from a heart attack than the rest of the UK population. For the young the difference is even bigger: a young Asian is three times more likely to die from heart problems.

Consequently, the BHF develops bespoke multimedia campaigns for the British Asian audience. The campaigns are targeted at Indians, Pakistanis and Bangladeshis in the UK. In 2007-08, BHF released TV campaigns for this group; the ads were developed in Hindustani, a dialect used in Bollywood movies and therefore understood across South Asian countries.

One ad showed a father and son playing cricket (a passionate subject for all South Asians). It ran on popular South Asian channels like Sky's Star TV, Zee TV, ATN, Bangla TV and Sony. Print ads were run in Bengali, Urdu, Gujarati and Punjabi in the leading vernacular publications. The BHF also organises outreach programmes to spread the awareness of the emergency helpline for chest pains.

Another good example of multicultural marketing is the Co-operative Pharmacy. It runs a Ramadan campaign to help Muslim patients manage their medicines during the month of fasting.

The Co-operative saw that many Muslims on prescription medication continue to observe the fast – even though those who are ill can be exempted from fasting during Ramadan – resulting in patients often not taking medication at the correct time intervals which, in many conditions, alters the medicines, interaction with food and efficacy.

Many of the Co-operative Pharmacies are located in areas where there is a high Muslim population. Last year, staff at 79 Co-operative Pharmacies were trained to provide tailored 'medicine check' services for Muslim patients during Ramadan. The trained pharmacists discuss various aspects of the prescribed medicines to minimise problems and improve the patient understanding. The Muslim Council of Great Britain supported the initiative and recommended that the community make use of the service.

So it is clear that ethnicity is an important factor in healthcare, and one already recognised – and acted upon - by some organisations. That said, engaging ethnic groups requires significant investment in understanding cultural nuances – but surely this is not beyond an industry now priding itself on patient centricity?

A few things to remember when targeting ethnic audiences

1. Age is a critical factor to consider when understanding a patient from an ethnic background. There is a huge difference among first generation, second generation and the third generation in terms of language understanding, media consumption and overall lifestyle.
2. In many ethnic communities the younger generation takes the lead with regards to a parent’s treatment and, therefore, in many cases addressing the carer of the patients can be more effective.
3. The language barrier is one of the biggest issues in providing useful information. Key patient education pieces should be translated in various languages, especially for  populations where conditions like diabetes, heart problems and rheumatoid arthritis are prevalent.
4. Educational communications in the ethnic media have proven useful in spreading awareness.
5. Reaching a hard-to-reach audience is always a challenge. However, there are many well-established community networks. Working with such networks can be an efficient and effective way of engaging the audience.
6. Involving community leaders can also be very effective. The BHF trained Imams on raising awareness of heart health issues, particularly diet and smoking cessation.
7. South Asians are passionate about cricket and Bollywood. A cinema ad in theatres showing Bollywood movies or outreach activities at cricketing events can be good platforms to engage with this audience.
8. Community ‘Melas’ (ethnic carnivals) are popular events for black and South Asian communities and they are visited by thousands of people on a regular basis. Well thought out outreach activities at such events can be very effective.
9. Basic cultural orientation is always worthwhile acquiring, especially for healthcare professionals. Knowing a little bit about the culture can make a massive difference in the treatment delivery and outcomes.

Reality check

To maximise the therapeutic potential of massive recent technological advances, it is now essential that much fuller account be taken of the fact that healthcare has cultural and social, as well as biological dimensions.

Yet the reality is that a massive multicultural population of seven million – with much higher prevalence of various health conditions and a very high urban concentration – still remains a relatively untapped segment for pharma. These audiences may not be very easy to engage with but a bespoke and culturally sensitive approach has been shown to be successful in several cases.

Fundamentally, multicultural marketing is not about ticking the boxes or stereotyping but about engaging with the audience effectively to shift its attitudes and sometimes belief systems to influence behaviour. This can really only be achieved through long-term, focused, marketing activity.

It is vital that the industry learns to engage effectively with ethnic groups, and it may have to go the extra mile in order to do this. Addressing the needs of the ethnic population is not just a social necessity but a business opportunity.

Alam Shukla

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Multicultural audience - crucial market for mobile marketing

Sept 17, 2009

If you are involved in marketing activities that use mobile as a media channel for advertising or promotions, or if you work with a mobile company trying to sell handsets or network services, it is imperative that you include the multicultural audience in your marketing plan.

The recent Ofcom report says that the take up , interest in, volume of use and confidence with mobile is much higher among ethnic audiences compared with overall UK population. Mobile phone take up is higher amongst Indian, Pakistani, Black Caribbean and Black African adult groups (88-95% compared to 85% of the UK population as a whole) Research shows that Black Africans are the group most attached to their mobiles 37% saying that mobiles would be the most missed media activity (compared to 13% of the UK population as a whole).

Take up of mobile phone among C2DE households from ethnic minority groups is also higher compared with C2DE households in the UK in general.

 

Source: Ofcom Media literacy report – Sept 2008

Adults from the ethnic audience are more likely to be interested in, and confident about using interactive functions than the general UK population.

Almost all of the ethnic groups expressed interest in mobile phone functions, with text messaging, not surprisingly, attracting the most interest. Three in five Indian, Pakistani and Black Caribbean adults are interested in accessing their mobile operator’s web portal – significantly more than Black African adults.

Interest and confidence level of using mobile phone

Source: Ofcom Media literacy report – Sept 2008

What are the possible reasons for this high usage and take up in this audience?

The reason is very simple - research found that under-45s tend to be more engaged with digital media and the age profile of the ethnic minority groups is significantly younger than the overall UK population which is a key factor contributing to higher usage among them.

The other plausible reason is the cultural influences. Historically British-Asians or Black British population are highly community oriented audiences. They are closely connected within their own communities and usually tend to have larger and extended families. It is evident from the community events and various melas and carnivals. The need to be connected with each other is deep rooted in the cultural blueprint and probably therefore the usage of various communication tools including mobiles is so high.

Moreover, in the Asian countries, the usage and proliferation of mobile has been much greater than the UK. Therefore, the recent immigrants are already much more advanced in their experience and comfort levels with various functionalities of mobile.

So looking at the take up, usage, comfort and confidence level of using mobiles among multicultural market, it is likely that they are the drivers of mobile marketing or at least one of the main contributors for the growth. If you acknowledge this fact then you could appropriately tailor your marketing communication to reflect cultural insights to get more value from this audience.

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Are pharmaceutical marketers missing the obvious opportunity?
June 1, 2009

Almost all pharmaceutical companies insist on putting the patient at the centre of the marketing activities. Rightly so after all, it is a known fact that only a patient-centric programme can achieve success. But the question is, are you defining these patients profile effectively? Does your segmentation reflect the accurate composition of the total market? For example, have you included ethnicity in your segmentation process? If not, you could be missing out on a very crucial audience.

Multicultural Britain

It does not require complex statistics to prove that today’s Britain is highly multicultural. A walk on the streets or a few minutes in the waiting rooms of clinics, is enough for an experienced marketer to sense the significance of this audience.

According to the 2001 census, almost 8% of the total population is from the ethnic background. This data is more than 8 years old and looking at the rate of immigration in the last decade, many experts believe that the figure would have easily gone up to 12%. That makes more than 7 million ethnic people. Just to put this number in the perspective – ethnic population is much bigger than the population of entire Scotland.

It would be unwise for any marketer to not to include this audience in their marketing plan. But for pharmaceutical marketers, ignoring this market could be a catastrophic mistake.

Ethnic Population’s Health Condition

The prevalence of certain conditions is ethnicity biased. This is due to the genetic and physiological influences in addition to external factors such as culture, eating habits, lifestyle choices, etc. Here are a few facts:

  • The prevalence of type 2 diabetes is four to six-fold higher in people from South Asian origin (Indian, Pakitani, Bangladeshi, Sri Lankan) 
  • Currently 300,000 people from Black or South Asian origins across the UK have been diagnosed with diabetes and 70,000 more are not aware that they have diabetes
  • Black and ethnic population are the highest users of primary care services § South Asian women have 51% higher coronary heart disease mortality rate than the whole population, for men the figure is 40%
  • Bangladeshi men were three times as likely to visit their GP than men in the general population. They are 60% more likely to smoke
  • Renal complications are also far greater in patients from South Asia Many government and charity organisations have already recognised the need to provide ethnic-community-specific marketing communication.

For the last many years, Department of Health and NHS have developed a number of marketing activities to reach out to this audience. Big charities like British Heart Foundation, Prostate Cancer Society and Diabetes UK have been successfully running multicultural campaigns for this audience.

It’s time pharmaceutical companies made ethnic communication an integral part of their ongoing marketing activities. Ethnic audience is seen as hard to reach audience and this is because the same size fits all approach. It is not about ticking the boxes it is about engaging with the audience effectively to shift their attitudes and some times belief system to influence their behaviour. This can only be achieved through long-term, focused and sustainable communication activities.