Michael L. Rothschild
Carrots, Sticks, and Promises: A Conceptual Framework for the Management of Public Health and Social Issue Behaviors The author presents a framework that considers public health and social issue behaviors and is based on self-interest, exchange, competition, free choice, and externalities. Targets that are prone, resistant, or unable to respond to the manager's goal behave on the basis of their motivation, opportunity, and ability and on a manager's use of the strategies and tactics inherent in education, marketing, and law.
Two million U.S. residents die each year; it is estimated that half of these deaths are "premature" and attributable to lifestyle and environmental factors (UC Berkley Wellness Letter 1997). Advances in biomedical sciences, mass immunization, and sanitation have resulted in a decrease in the incidence of infectious diseases (Matarazzo 1984), so that the health status of the population in economically developed countries now has less to do with acute illness than with lifestyle issues such as excessive drinking, unhealthy diet, or the use of tobacco products (Walsh et al.1993). Influencing lifestyle can do more to increase the health of the population and lower the cost of health care than can treatment of illness. In this article, a conceptual framework is proposed for the management of public health and social issue behaviors. The article relies on education, marketing, and law as its three primary classes of strategic tools. These tools will be considered with respect to specific targets and specific public health or social issues for which the targets may or may not have any motivation, opportunity, and/or ability to cooperate but that nevertheless have been selected for management (e.g. keeping preteen girls from beginning to smoke). The tools are considered with respect to targets who are prone, resistant, or unable to comply with the manager's goals.1 The relative appropriateness of the use of various
__________________________________________________________________________ 1 Manager used here as a generic term that includes, but is not limited to, various persons such as civil servants, nonprofit administrators, legislators, and/or private sector managers who attempt to direct the behavior of individuals for the good of society (as defined by the managers, the leaders, and/or the constituents of the society) ______________________________________________________
__ Michael L. Rothschild is Professor, School of Business, University of Wisconsin, Madison. The author gratefully acknowledges the financial support of the Rennebohm Foundation, the Robert Wood Johnson Foundation, and the Comprehensive Cancer Center, School of Medicine, University of Wisconsin. The author gratefully acknowledges the intellectual contributions of Alan Andreasen, Gary Bamossy, Jan Willem Bol, Robert Drane, Jan Heide, Marvin Goldberg, Amy Marks, Daniel Wikler, the reviewers, and many, many others whose input made this article better. Ultimately, any errors in fact or logic are the author's. 24 / Journal of Marketing, October 1999
combinations of education, marketing, and law will be determined by these states for the purpose of assisting managers in dealing with tremendously complex societal problems. These issues arc of societal concern when they tie to freely chosen behaviors that result in social costs for which other members of the society must pay either directly or indirectly (externalities). This article also considers the macro policy trade-offs between the free choice rights of individuals and the rights of others not to have resulting externalities thrust on them. The selection of issues for which the use of education, marketing, and/or law are appropriate will be determined on the basis of this trade-off of conflicting rights. Given the existence of these trade-offs, cooperation between parties may be necessary for the manager's goals to be met. As Ouchi (1980, p. 130) points...
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