I was delighted to be asked to organise this series of events on non-communicable diseases, but I had a problem—I had no idea what NCDs are or were. So Kate Hoyland from UCL’s Grand Challenge of Global Health introduced an evening entitled “The NCD Makeover Show.”
We who live in the NCD ghetto don’t know how to get our message across. The person in the street has never heard of NCD and so will not demand global action or change their own lives. We can’t even agree on our name. We don’t like being defined by what we are not so we don’t like “non-communicable disease”; and we’ve abandoned the term chronic disease. So we’ve homed in on the acronym of NCD—but sometimes it’s NCDs and sometimes NCD.
So how can we do better? “Recognise,” said Fred Hersch from NCDFree, “that the solutions lie outside traditional thinking.” Thus we heard about branding and storytelling.
The importance of brand
Like most doctors, until recently I thought of branding as poppycock, an extravagant and narcissistic way of wasting money. But it’s slowly dawned on me that I was wrong. For many organisations, said Ed Gillespie from Futerra Sustainability Communications, their brand is their most valuable asset. (This may well be true of The BMJ. Lots of others do what The BMJ does, but lack the brand and so don’t do so well.) A good brand makes an emotional connection, evoking immediately a series of positive associations. A good brand will inspire and prompt action.
An effective brand, said Gillespie, has three characteristics: meaning and purpose, an exciting visual or verbal form, and a compelling narrative. Plus it must appeal. The traditional model of thinking—that if we raise awareness, action will result—doesn’t work. Humans are most of the time not rational creatures. We must appeal to emotion to evoke action.
This is very true of trying to create action on climate change. The message that we are facing Armageddon, which is sadly true, leads only to denial, an extremely powerful and useful human characteristic. Fear can be a useful motivator, said Gillespie, but people must be given some form of action. Fear without action leads immediately to denial. Fear must be used in the mix like seasoning: too much seasoning and the meal is inedible, too little and it’s tasteless. We have overseasoned our message on NCD.
In creating a brand we must think about Why? How? and What? The why for NCD cannot be because deaths and costs are mounting. It’s too negative. Rather the why needs to be a better and healthier life. Indeed, simply a “better life” may be superior because talk of “health” immediately creates ideas of the opposite: disease, pain, and death. The how is prevention, but again talk of prevention creates thoughts of disease.
Gillespie praised the Change for Life programme in that it had a positive message—have a better life—and simple messages on how: “eat well, move more, live longer.” It also has “sub-brands”: walk for life, swim for life, dance for life, and others. And it has lots of what—recipes, tips, and tools.
I couldn’t help thinking that, for doctors and The BMJ‘s readers, Change for Life is probably a “polluted brand” in that it’s associated with the private sector, particularly the drink trade, “corrupting” the messages and process. But the important thing is to get through to the public not doctors, although to achieve change in health you need to convince both doctors and patients.
The verbal form of the brand is important, said Gillespie, and he thought that “climate change” is an example of a bad form. It makes people in Britain think that summers will be a little warmer—not a bad thing. “Climate weirding” or “climate cancer” might have been better. (I tend to use “climate disruption,” which was recommended by a friend.)
Ultimately, concluded Gillespie, it’s about stories, good stories. He quoted one of the first advertising copywriters, from the beginning of the 20th century, who said that there were only three rules: be interesting, tell the truth, and live the truth.
Telling good stories
Frank Ash, from the BBC Academy, is a “formats and documentary guru,” and he realised how stories could be used for good purposes when he watched the BBC management botch one of the many episodes of change in the BBC. Hundreds of Powerpoint slides full of pie charts showing the financial problems of the BBC, which add up to many staff being fired, is not a good way to motivate people. Good stories are the best way to motivate people, and how, he wondered, could the world’s leading story telling institution be so useless.
From the moment we are born we are told stories, and once we can talk we tell stories. We are “hardwired” to hear and tell stories, and stories are how we make sense of the world. “Dogs sniff each other. We tell each other stories.” Stories are the best way to get over complex ideas, communicating messages by stealth. But stories must engage emotionally. Good stories have a “big message” and a clear purpose, and there must be a “perfect fit” between the purpose and the story.
He then showed us a film from Children in Need, a day each year when the BBC raises money for charity. The three minute film was about Sam, a boy with congenital deafness. One consequence of his deafness, his mother described, was that he couldn’t sleep—for fear that the house was empty because he couldn’t hear anything. One night he had to be taken back to bed 27 times. All he wanted was to live a normal childhood, like his brother and sister. How could this happen? The answer was a hearing dog. We saw pictures of how the dog goes everywhere with Sam and allows him to live like a normal child.
This film, said Ash, had a clear purpose: to get people to give as much money as possible. The big story question was “How can Sam live a normal life?” There are famously only a few stories, and the archetypal story is of a hero with whom we identify who overcomes impossible odds to triumph and return to lead his people. It’s the story of Beowulf and Nelson Mandela. There needs to be adversity, an “inciting incident.” With Sam it was his inability to sleep. The answer and the resolution was the dog, and for a British audience a combination of dogs and children is irresistible.
There need to be characters we care about, and in Sam’s story we care about him, his mother, and eventually the dog. There needs to be a seamless flow of events, and most important of all is structure. Good stories do not, said Ash, tell themselves. A good structure is “one story simply and elegantly told.” Once you have that you can embellish. The story must arouse us, sustain the arousal, and increase our anticipation so that we badly want to know what happens. “Great storytellers,” said Ash, “are arch manipulators.” And the beginning and the ending are especially important. I could almost say, said Ash, that if you get those right it doesn’t matter too much what comes in the middle.
Ash ended by getting us all to devise a story in a few minutes and tell it to the person next to us. As with anything the more you do it the better you get, but there are guidelines for improving branding and telling stories.
NCDFree, a global social movement, has taken up the mantle for the NCD world, and you can join the movement, watch films that tell stories on their website, and even join a bootcamp to learn more about advocacy and storytelling—with the ultimate aim of reducing the burden of NCD.
Richard Smith was the editor of the BMJ until 2004 and is now chair of the board of trustees of icddr,b [formerly International Centre for Diarrhoeal Disease Research, Bangladesh] and chair of the board of Patients Know Best. He is also a trustee of C3 Collaborating for Health.