Influencing Health

A Comprehensive Guide to Working with Online Influencers

Amelia Burke-Garcia

• Publisher: Productivity Press
• Year: 2019
• eBook ISBN: 9781000023350
• Topic: Business
• Subtopic: Business General
• Index: Business

The U.S., and countries around the globe, are facing an ever-evolving series of health issues, including obesity, food deserts, child hunger, poor maternal health outcomes, and the resurgence of communicable diseases. Traditionally, health communicators and marketers have talked about these issues in a vacuum, in which related information is only visible when people are specifically seeking it out.

If we are to give global health the attention it deserves, we need to weave it into our everyday conversations and experiences. Ultimately, we need to normalize the conversation around health.

The emergence of everyday online opinion leaders has created a whole new market for shifting consumer perceptions and behaviors. In fact, many of these everyday online opinion leaders, called influencers, have built such large-scale social media presences that they now have the voice, the platform, and the following to reach millions of people with personal points of view on any number of topics. There are great opportunities for engaging with online influencers to support health promotion programs.

However, navigating this online community is new to many people. Understanding how this online community works, the opportunities for paid and unpaid engagements, and the value that health programs specifically have with this community, is paramount to successfully working with influencers.

This book draws from research with over 400 online influencers, the latest industry data, and practical, real-world experiences working with influencers over the past ten years. An easy-to-read guidebook for marketers and health communicators alike, this book leverages storytelling as a means for sharing lessons-learned and providing readers with practical knowledge about the online marketing industry and influencer community, as they relate to health.

Chapter 1

Influencers: Old and New

in·flu·encer | /ˈinflo͜oənsər/ | noun

A person or thing that influences another.

Mad Cow Disease is one of the most salient public health crises that I can recall from my childhood that did not happen in the United States.

In case you are not familiar with Mad Cow Disease, it is a fatal condition that affects the brain and nervous system in animals and can be passed to humans who have eaten infected meat.

The outbreak that happened in the 1990s—the one that garnered all the media attention—actually started in Britain; and while it would eventually show up in the United States in the early 2000s, during the media frenzy the 1990s, there were, in fact, no cases of Mad Cow in the United States.¹⁰

Despite being a non–red meat eater myself, and despite there being no cases of infection in the United States at the time, I remember the Mad Cow Disease outbreak of the 1990s as being terrifying. I think this was in part because I was not really aware of outbreaks before then but also because I felt like it was being talked about everywhere—all over the media and in everyday conversations.

If you do not remember the outbreak itself, you may remember something that happened as a result of it. In 1996, during the outbreak, as the controversial practices within the beef industry were beginning to come to light within the media and among the general public, Oprah Winfrey featured the story on her show, interviewing rancher-turned-animal-rights activist, Howard Lyman.¹¹

During the interview, as Lyman talked about the subpar practices in the beef industry that were causing these public safety issues, Oprah exclaimed that such revelations had “stopped [her] cold from eating another hamburger!”

In response to this comment, beef prices plunged. And they would continue to do so, eventually reaching a 10-year low.

Thus, it appeared that with a single statement—one, of course, that was shared with millions of viewers—Oprah managed to sway millions of Americans’ willingness to eat meat.

But was she really able to sway popular opinion so quickly? Was it just a coincidence that Oprah made her comment and then beef prices plummeted? Or was there something bigger going on here?

At the time, many people thought that this decreased consumption of meat by American consumers could be directly attributed to Oprah’s hamburger comment. So much so in fact, that in response to Oprah’s comment and the apparent impact it had on the beef industry, a group of cattle ranchers in Texas filed a $10.3 million lawsuit against the talk show host claiming that her statement defamed the entire industry, caused the drop in price, and hurt their business.

What these angry cattle ranchers had identified vis-à-vis their lawsuit—whether they knew it or not at the time—was what has become known as “the Oprah effect.”¹² “The Oprah effect” refers to Oprah Winfrey’s ability to sway the opinions of millions of consumers about a subject, item, or person that she features on one of her many media platforms. And most often, “the effect” has resulted in positive outcomes for the subject, item, or person that is featured.

For instance, in 2015, “the Oprah effect” went into overdrive sending stock prices soaring when Oprah announced that she had acquired 10 percent of Weight Watchers stock. She has also helped launch the careers of numerous people including psychologist, Dr. Phil, health expert, Dr. Oz, alternative-medicine advocate, Deepak Chopra, financial adviser, Suze Orman, and lifestyle designer, Nate Berkus—all of whom have been featured on her show or across her other media platforms. Over the years, she has also single-handedly popularized numerous books, magazines, movies, television, fashion and lifestyle products, and political causes.

But the “effect” has also worked the other way—turning consumers off of something. This was the case with beef during the Mad Cow Disease outbreak. It was also the case for author Jonathan Franzen. In 2001, Oprah picked a Jonathan Franzen’s book for her book club and invited the author on her show. In response, he suggested that going on television to promote a book would lessen his standing in what he called, “the high-art literary tradition.” Oprah responded by rescinding her invitation, and as a result, many people, including those in the “high-art literary tradition,” rebuked the author.

All of these “Oprah effect” examples reveal how it only takes one person to have an impact on the opinions and perspectives of other people. In the case of Mad Cow Disease, it only required one highly influential person sharing a personal opinion about a topic that was top-of-mind for consumers to sway public opinion. And that ability to influence opinions so swiftly had substantial consequences.

Being influential about books or products, or even Mad Cow disease, does not necessarily equate though to being influential about all topics. And it certainly does not mean that you are influential when it comes to health. Health is very personal. Health is sensitive. Health is private. Health can also be highly stigmatized. So how does “the Oprah effect” translate into the health context more broadly?

Well, right around the same time that the Mad Cow Disease outbreak was happening in Britain, across the globe, Thailand was dealing with an outbreak of its own. Only, this one was an outbreak of HIV infections.¹³

Now Thailand has historically been a leader in the fight against HIV/AIDS. The country recorded its first cases of HIV in 1984. However, by the early 1990s, HIV infections were spreading across the country like wildfire.

Moreover, while this outbreak was affecting Thailand’s population as a whole, it was hitting certain subgroups harder than others. In particular, Thailand’s sex worker population was being severely impacted. Data from that time suggest that between 1989 and 1990, the percentage of sex workers infected with HIV tripled from 3.1 to 9.3 percent. Then, just a year later, in 1991, it jumped again. This time to 15 percent.

Of course, any subgroup being hit so hard with an outbreak is not good, but when a subgroup like sex workers is impacted this hard, it means ripple effects. Big ripple effects. It was estimated at the time that the average sex worker had about 100 clients per year. This meant that for each infected sex worker, approximately 100 other individuals were being put at risk for an infection, and then, those people, who had other relationships, partners, and families, were potentially infecting a whole other cadre of people.

Given the increasing number of infections within the sex worker population, and the fact that this group was central to this epidemiological social network, addressing the issue directly with the sex workers population became vital to Thailand’s ability to curb the outbreak.

It was with this acknowledgement that Thailand became the first country in Asia to publicly declare a serious HIV/AIDS problem and commit to dealing with the issue. And with that, they launched the 100 percent Condom Use Programme nationwide.

While Thailand’s public recognition of the outbreak and promise of a solution was both novel and progressive, as many of us who work in the health industry know, launching a campaign does not guarantee that anything will change. And for the Thai government, working with the sex worker population would indeed prove to be challenging.

A main challenge the Thai government faced was the fact that the commercial sex industry in Thailand is illegal. This meant that acknowledging the issue and implementing policies to regulate it would be difficult.

Related to this, the government received resistance from the owners of commercial sex establishments. The owners feared that forcing their sex workers to use condoms would be economically damaging to their business. In short, unless all businesses agreed to requiring their sex workers to use condoms, owners expected to lose customers who could just choose to go to another establishment.

There were also logistical challenges to making condoms easily and widely available that the Thai government would have to tackle.

And finally, the government would come to learn that some of the biggest barriers they faced were from the sex workers themselves. First, the Thai government came to understand that sex workers’ basic understanding about the benefits of condom use was limited. As well, they discovered that, oftentimes, sex workers did not possess the agency or negotiating skills required to be able to dissuade customers from wanting to have sex without a condom.

At the heart of all of these challenges was one central challenge—condom use was highly stigmatized within Thai culture. The 100 percent Condom Use Programme knew it was going to need strategies that addressed this stigma if anything was going to change.

Now, the concept of stigma is interesting because it is heavily related to communication. That is, if and how we talk about a health issue facilitates how we ultimately think about that issue.¹⁴ For instance, communication (or lack thereof) can lead to the spread of misinformation or a lack of understanding about an issue. However, communication also can lead to the eradication of stigma as dialogue about a topic enables increased understanding. In fact, there is evidence that suggests that the influence of interpersonal communication can aid in addressing stigma.^15,16

Therefore, and perhaps not surprisingly, a main strategy that the Thai government employed to address the challenges it faced was the use of opinion leaders who were highly influential in Thai culture. Specifically, the government engaged media spokespeople to include messages about HIV/AIDS and the importance of condom use in their television programs and shows, as well as Buddhist monks to bless condoms and sprinkle them with holy water.

These opinion leaders were selected because they were influential to many different types of people including sex workers and the general public. By involving these cultural opinion leaders, information about HIV was communicated to a large portion of the population by those they trusted and people could engage in a social dialogue about condom use.

And it worked! Creating such a social dialogue helped to reduce people’s resistance to condom use, and by 1992, use of condoms in sex worker establishments had increased to more than 90 percent. Moreover, the World Bank estimated that this campaign prevented nearly 200,000 new cases of HIV/AIDS.

This story evinces how it was not enough for the Thai government to recognize that there was an issue with HIV infections in the country. It demonstrates that it was not enough for the government to create a campaign. It showcases how it was not enough to just tell people to wear condoms and expect that they would do so.

Rather, the government had to recognize the key barriers it faced in trying to change people’s behavior. To overcome these, the government had to also find a way to start a dialogue about the issue. By leveraging influential voices, the government was able to jumpstart a social conversation that eventually reduced stigma, normalized the behavior, and saved lives.

Opinion leaders can come in many different shapes and sizes. The examples of Oprah and Thailand demonstrate this. Both of these stories also showcase how substantially opinions can be swayed by engaging people who are influential to the communities they reach.

At this point, you may be wondering why we are talking about Oprah and Buddhist monks when this book is supposed to be about online influencers. Well, in order to understand the world of online influencers, we must first talk about opinion leaders. And to do this, we must go back to the very beginning. This will be the focus of the rest of this chapter.

A Brief History of Opinion Leadership

The two stories this chapter opened with exemplify how influencers can change people’s behaviors—whether intentionally (as seen in the Thailand example) or unintentionally (as seen in the Oprah example).

But to talk about influencers does not always mean talking about celebrities or prominent spokespeople. It also means talking about the everyday people who inform our decisions, our choices, and our lives—whether we know it or not. And to talk about people who are influential to us is to talk about opinion leadership.

Opinion leadership is based on the premise that most people form their opinions under the influence of others whom they hold in high esteem.¹⁷ These could be people we do not know personally but know of due to their level of fame or position within a community. The media celebrities and spokespeople and the Buddhist monks (from the earlier stories) are examples of this type. They could also be people we know well like friends, family, teachers, or neighbors.

The concept of opinion leadership is a part of the theory of the diffusion of innovations (DOI), which refers to the spread of new ideas, or innovations, through different channels over time throughout a social system, e.g., a group of individuals or an organization.¹⁸ DOI has been studied as far back as the 19th century,¹⁹ and while there have been many researchers who have examined DOI, perhaps no one is more strongly associated with the concept than Everett M. Rogers.

Rogers suggests that there are five categories of adopters: the innovators (who are the first in a social system to try out something new), the early adopters, the early majority, the late majority, and finally, the laggards (who are the last group to try out the innovation). However, the diffusion process can be dynamic, rather t...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Foreword
• Testimonials
• Author
• Introduction
• 1 Influencers: Old and New
• 2 Understanding the Relationship between Influencers and Their Followers
• 3 The Business of Relationships
• 4 Influencers and Health
• 5 Perceptions of Risk
• 6 It Is Just the Great Unknown—Or Is It?
• 7 The Importance of the Message
• 8 The Importance of Great—Not Good—Creative
• Conclusion
• Notes
• Index