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Monday, June 24, 2013

A failure of knowledge marketing: The example of obesity with physical activity

The failure of knowledge marketing: The example of obesity and activity

For the last six weeks, I've been on and off aeroplanes flying between Europe, Africa and the USA for a series of conferences on science, high performance, coaching and more science.  It's been a stimulating and challenging period, one which has entrenched a realisation about the value of sports science that I've been developing for a while now, namely that the effectiveness of science is primarily dependent on how well it is 'sold' to prospective 'end-users', be they coaches, high performance managers, policy-makers in government or athletes.

Today, reading through a few local papers, I came across a report that is the catalyst for some further thoughts on this subject, and below are some of my thoughts on it, which use the specific example of obesity and physical activity, but which are equally relevant to high performance strategies and the delivery of science to elite athletes.

The report described the recommendation of a review led by Baroness Tanni Grey-Thompson into the growing obesity problem in Wales, and its findings can be summarised into one sentence:  Give Physical Education a standing in schools that is comparable to maths and science in order to tackle the obesity problem.

First of all, I must say that I don't think any complex problem can be reduced to a single solution.  It certainly would be part of it, but I believe a similar action was taken in Australia without effect, and that's because changing people's behaviour is never a simple matter of introducing a compulsory change.  Simple solutions are desirable, but rarely effective by themselves.

Granting core status to physical education would apparently cost 5 million pounds per year, which the report argued is trivial compared to the current cost of 73 million pounds spent on obesity and related conditions (This assumes of course that the programme would save 5 million pounds per year on those costs to at least break-even - they may have done these projections, I'm not sure)

This is not a new concept - reviews have recommended prioritizing physical activity before, and I have no doubt they will do it again.  The removal of physical education from schools (as a subject, let alone a core subject) in South Africa is constantly bemoaned as one of the key moments in our own battle with obesity, yet change seems incredible slow.  Similarly, around the world, there is nothing revolutionary about the idea that growing levels of inactivity need to be addressed.  What is revolutionary is actually doing it, which few have.

A marketing challenge - why wouldn't you drink the iced tea?

The biggest challenge when attempting to change behavior and policy, be it high performance sport related, which is my primary interest, or physical activity, such as this illustration of obesity and physical activity, is bridging the gap between people's intellectual understanding and their desire to act upon it.  It is one thing to know a problem exists, and even how to solve it.  Another is making the decision to solve it, and then doing it, particularly when there is a cost attached, and that cost must be weighed up against others in terms of 'leverage', or return on investment.

Yes, one can argue for the potential financial savings when comparing the cost of promotional campaigns and policy changes compared to the cost of obesity and its associated diseases to health care.    Yes, we can provide data that shows how workplace productivity increases with increased physical activity (absenteeism and presenteeism, for instance).  Yes, we can even find relatively short-term success stories with which to inspire change.

But the fact that this debate keeps circling back on itself (the Grey-Thompson review is not the first, and nor will it be the last of its kind to promote physical education in schools) suggests that action rarely follows data or words.

Part of this is because decision-makers often have many interwoven problems to deal with, and they can't (or don't) view a solution to a particular problem in isolation.  Their decision-making process is tangled because of overlapping challenges and the conflict this creates for resource allocation.  Consider for instance the response to the Grey-Thompson report by one senior figure in Welsh education:

"Dr Philip Dixon, director of education union ATL Cymru, warned that literacy and numeracy was of most pressing concern in Wales and overloading the curriculum with core subjects could prove counterproductive"

In other words, physical activity is one of many concerns, and is a lesser problem in the larger scheme of things.  He has weighed up A vs B and decided which requires prioritisation   That is a fair concern, because adding physical activity means, in a 'zero-sum' decision-making world (which it often is), taking away from something else.  Unless an hour a day could be added to the school year, and unless more money could be found, implementation of one solution means another is overlooked or compromised.  This is, as an aside, why talent identification systems in sport are so complex - if you spend more on the selected individuals, it means less on the non-selected players, and vice-versa, making the balance and requirement for selection so important.

However, the case could still be made, and has been, for physical activity, that the benefits are not only large but essential.  With 36% of Welsh children obese (and it's even greater in other parts of the world), and with the cost of diseases associated with obesity sky-rocketing to levels that may cripple health care, you'd think the urgency would exist.

Yet still, decision-makers seem stuck in second gear.  They may know a solution, and even be intellectually aware of its value, but unable to act upon it.  And when I see that, it always strikes me that the likeliest explanation, here in SA anyway, is that the people who hear the message don't fully understand a) their need, or b) its value.  That is a failure of marketing, not science.

If I staggered into your house having been stranded in the desert for 3 days without water, on the verge of death, and you offered me a bottle of iced tea, which I've never tasted, the only circumstances under which I'd refuse it are:

a)  I don't trust you not to poison me with an unfamiliar drink, or;
b)  I don't understand what you are offering.  I have no experience with iced tea, I don't know what it does, tastes like, or why it may be of value to me.  Therefore I decline, because my perception of its value is lower than my awareness of my need for it.

Now, to return to the overlapping decision analogy, imagine you offered me a choice between iced-tea and a wet sponge.  The decision is more complex, because I have to choose between two options.  If you made me pay for it, then it becomes even more complex, because my decision depends not only on the perceived product benefit, but also the cost to me (we make these cost-benefit decisions all the time - early start to your day, running late for work, you might spend $6 on a cup of coffee because it's the only available option, where normally you'd balk at $4)

So it comes down to customer-perceived value, in that people will not 'buy' unless they perceive the value to be greater than the cost.  In a "competitive" market, where they have a choice of purchases, it is even more important to communicate the value (or reduce the cost, of course).

This is, in my experience, the biggest problem facing sports science and its application to high performance teams, coaches and the public.  We can argue with data all we want, we can promote the merits of our ideas, be they scientific analysis of performance, the health benefits of physical activity, the cost savings to health care, or the scientific monitoring of athletes in Olympic competition.  But until the potential customer genuinely recognizes the value, and establishes a deeper, almost emotional connection with it, the data will have minimal impact.  Sports scientists of course have this connection - they are already converts, and cannot imagine how anyone would not see the value.  But this is a little like me not understanding how anyone would prefer BMWs to Audis just because I drive an Audi.

In a competitive market, communication swings decisions, not 'truth'

Last year in September, I attended a conference at which Kenneth Cooper presented some of his data from decades of being involved in physical activity work in the USA.  He showed data that obesity had risen steadily since he founded his Cooper Institute.  Somehow he was claiming credit for helping combat obesity, even though the line of obesity over the years was snaking its way steadily towards the top right of the graph.

Then, a few years ago, the NFL partnered with a few campaigns to promote physical activity in children.  They made use of some recognizable NFL stars and sent the message out to get active, eat better.  The result was the first dent in the obesity growth rate.  And while causation is difficult to infer, Cooper himself acknowledged the impact made by this marketing campaign.  The message I took from that is that all our science, data, knowledge and educational campaigns can be matched by a creative campaign using a method of communication that children really value.

This is the power of marketing.  It is the reason that the 10,000 hour concept is so powerful even among coaches and high performance managers - Gladwell and Syed spun a story around data, not letting the facts get in the way of that story, and it was more effective than published research that said the opposite.  It's the reason Power Balance bracelets catch on like wildfire despite our best attempts as scientists to explain the fallacy in theory and practice behind them.  Conversely, the failure to creatively and accurately market sports science is the reason that so many coaches and high performance managers reject scientific support - they simply do not perceive its value relative to its cost.

My point is this:  As scientists, whether we are involved in sports performance, health and physical activity, education, even conservation of the environment and other scientific pursuits, if we cannot also market the knowledge, then we will be ineffective.  And we will always be vulnerable to decisions and people who do it better, even when their "product" is inferior and their truth, well, untrue.

So the challenge is not merely to know the truth, it is to sell the truth.  That is a difficult balance because salesmanship almost always compromises integrity, which is why I hate advocacy and extremism - it is often the sale mentality that drives it.  But if there is one thing that each individual can change, it is the method of communication of science and its value.

Sometimes, the value is purely financial, in which case the decision will be made based on income, expenses and profit - show the decision-maker how much money they will save by implementing athlete monitoring or physical activity.  On that note, be aware of who makes the decision because your compelling argument may be borderline irrelevant to the person you're talking to.  One of the problems for the advocacy of physical activity in schools is that one of the common arguments is the financial saving because it will reduce the cost of health care.  But education decision-makers are not obliged to care about this, it's not their incentive.  It's a health department issue, so the right message is being given to the wrong people!

Other times, the decision is emotive, bordering on folly, or its the high performance managers' desire to use technology, to do what nobody else can, and the level of evidence is less important than the 'glamour' and innovation behind it.  The challenge for all those reading this who are trying to find a foothold in sport and health as a scientist is to recognize the specific need of the person you are talking to, and offer the right thing to the right person at the right time.  We simply have to do better at marketing our own value.

Hopefully, the decision-makers recognize the value of physical activity.  It'll take a lot more than statistics, however compelling, about cost and benefit, however.  Forgive me if you are already a 'convert' and think all these concepts are self-evident.  I suspect that many reading this are, because it's why you're here!  But in South Africa, and dare I say it in many other places, the value is undersold and sports science scratches its collective head wondering why others don't see the world the way it does!