Toward A New Model Of Influence (short version revised April 21, 2009) HEALTH IN THE ERA OF PUBLIC ENGAGEMENT

2 Health = life’s most important asset and is everybody’s business

3 Media online and offline Consumers NGOs Retailers Influencers Government Employees Investors Sphere of Cross - Influence 21 st century Pyramid of Influence 20 th century We’re in an era of public engagement The model of influence has shifted dramatically Elites Company Mass Audiences Advertising

4 Public Engagement is the new way that influence happens, where disparate publics interact, talk about all issues (even ones not previously part of the public conversation) and do so across multiple channels

5 Behavior-related chronic conditions Populations aging Global pandemics Diseases of poverty Expensive innovations Loss of insurance or failure to pay People forgo or postpone essential health care Health behaviors erode Cost trumps quality Mental health issues emerge Health demands are mountingThe worst economic climate in decades exacerbates the problem Health is in crisis

6 The Trust Depression

7 Net Trust Less 62% of global informed publics trust corporations less now than a year ago Why? A60. Thinking about everything you have read, seen or heard about business in the last year, in general, do you trust corporations a lot less, a little less, the same, a little more or a lot more than you did at the same time last year? A61a. What would you say is the main reason that you trust corporations LESS now than last year? Informed publics ages in 20 countries The health crisis is further worsened by a trust deficit in business Most people trust companies less now

8 Trust in business, including health care and pharma, is shrinking Technology halo effect benefits biotech/life sciences N/A A [TRACKING] Now I would like to focus on your trust in different industry sectors. Please tell me how much you TRUST businesses in each of the following industries to do what is right. Again, please use a nine-point scale where one means that you "DO NOT TRUST THEM AT ALL" and nine means that you "TRUST THEM A GREAT DEAL.” (Top 4 Box) Informed publics in 18 countries

9 F146. The recent credit crisis and government bail-outs have led to debates on how much governments should intervene to regulate industry or nationalize companies to restore public trust. Please tell me how strongly you agree or disagree that your government should in the future impose stricter regulations and greater control over business across all industry sectors.(Informed publics in 20 countries) To restore trust, people agree that government should impose stricter regulations and greater control over business across all industries Disagree; 22% Neither agree nor disagree; 12% Don’t know; 1%

10 Trust drives business B74-78 Thinking back over the past 12 months, have you taken any of the following actions in relation to companies that you trust? Please answer yes or no to each action. B Still thinking about the past 12 months, have you taken any of the following actions in relation to companies that you do not trust? Please answer yes or no to each action. Informed publics in 20 countries Chose to buy their products/services Refused to buy their products/services Recommended them to a friend or colleague Criticized them to a friend or colleague Paid a premium for their products/services Bought sharesSold shares Shared positive company opinions/experiences online Shared negative company opinions/experiences online –+

11 License to operate hinges on trust Business trusters significantly more likely to support a company’s “license to operate” B Thinking now about how companies operate in your country, how supportive would you be towards a good and responsible company being allowed to… [INSERT FIRST]? Would you be not at all supportive, not very supportive, neutral, somewhat supportive or very supportive towards a company operating in your country taking this action? (Net supportive) Informed publics in 20 countries (Business trusters rate trust in business 6, 7, 8, or 9 on a 1-9 trust scale; business distrusters rate business 1, 2, 3, or 4 on a 1-9 trust scale)

12 Trust and Health Engagement Form a Virtuous Circle

13 29%69% 36 %58% More health engagement → more trust Adults Health Info-entials 33%61% 70%28% Please indicate how much you agree or disagree that you “trust what you hear from companies and organizations involved in health/…from health products and services?” (strongly/somewhat agree vs. strongly/somewhat disagree) Companies and Organizations Products and Services Distrust Trust

14 Thinking about companies and organizations involved in health that you are engaged with, which, if any, of the following actions have you taken in response to a company or organization? More trust→ more action in response to companies and organizations This same dynamic seen with health issues

15 The Public Has Rewritten the Rules of Health Engagement

16 Rule #1 Provide deep content In which of the following ways do you want companies and organizations involved in health to engage with you? People want to know the whole story—complete information that helps them understand the benefits and the risks of products, services and issues. Filtering information can be perceived as paternalistic.

17 Rule #2 Be transparent People will dismiss or reject an attempt at health engagement that seems one-sided, vague or evasive. They want organizations and brands in health to proactively convey important information and respond authentically to their concerns. In which of the following ways do you want companies and organizations involved in health to engage with you?

18 Rule #3 Inform in real time Which, if any, are the THREE most important ways that digital communications (e.g. , the internet, mobile phones) has changed how you receive or share information about health issues? Organizations and brands involved in health need to become more nimble in disseminating information. In the digital era, people expect organizations to provide information rapidly, and they view any delay with skepticism.

19 Rule #4 Join the conversations, online and off Information about your organization or brand is now freely gathered, shared and validated across multiple channels, both online and offline, and inside and outside the specific topic area. Participate actively in conversations across multiple channels so that you don’t cede to others how you and your business are defined. Which THREE of the following ways would you prefer that companies and organizations involved in health communicate with you? (Vary/Somewhat)

20 Rule #5 Engage in prevention, chronic health problems and access to health care These are priorities for personal and public health, and they are the “price of entry” to engagement—they are the top issues that people expect organizations and brands to address before engaging on other issues. Your engagement on these priority issues should be aligned with your business and content expertise. Personal Health Concerns Public Health Priorities 0 60 Base = Health Info-entials Thinking about these same health issues, which THREE do you believe are the highest priority health issues that need to be addressed today? Thinking about these same health issues, which THREE would you say you are most concerned about in terms of their personal impact on you?

21 These are priorities for personal and public health, and they are the “price of entry” to engagement—they are the top issues that people expect organizations and brands to address before engaging on other issues. Your engagement on these priority issues should be aligned with your business and content expertise. Should Be Company Priorities 0 60 Personal Health Concerns Base = Health Info-entials Thinking about these same health issues, which THREE would you say you are most concerned about in terms of their personal impact on you? Which THREE of the following health issues do you believe are the most important for companies and organizations involved in health to address? Rule #5 Engage in prevention, chronic health problems and access to health care

22 Rule #6 Take a holistic approach to health and well-being Thinking about your overall health and well-being, how important would you say each of the following factors plays in influencing it? (extremely/very important) Health and well-being encompass physical, mental, emotional and even financial health; personal appearance; and social connectivity. Remember that people who have a disease or health condition can still feel a sense of health and well-being.

23 Rule #7 Address the multiple stakes people have in health including their personal ones All of your publics are part of “the public,” so don’t view any of them through only one dimension of their engagement in health—for example, as “patient,” “regulator,” “payor,” “physician,” or “investor.” Factor in all of a person’s personal and professional stakes in health when engaging with him or her.

24 Rule #8 Get personal Base = Health Info-entials Which, if any, of the following best describes your typical engagement with the issue of …? (High engagement = actively seek out/share info or actively seek out//share info and advocate point of view) My Health Our Health People want to be engaged on the topics that matter most to their personal health and by sources and channels that enable interactions with individuals (e.g., doctors, researchers and pharmacists), not faceless entities..

25 Health companies’ Web sites TV News coverage Articles in magazines Web sites for specific brands of medication Films or documentaries Articles in newspapers Radio news coverage Personal blogs Social networking websites Corporate and product advertising Web-based video sharing sites Rule# 9 Engage through health-expert channels and sources Online message boards, forums or newsgroups Net becoming more important Net becoming less important Base = Health Info-entials For each of the following sources of health information, please indicate whether that source is becoming more important to you, less important to you, or remaining the same. (Net = becoming more important – becoming less important) While mainstream media and channels continue to be important, over time, health-expert and interactive ones will become more relevant.

26 Recognize the risks of not engaging, including having your message defined by others, squandering an opportunity to build trust (or worse yet, losing trust), or failing to motivate your publics to take positive actions on your behalf. Rule #10 Know the risks of not engaging

27 Join Edelman in advancing the conversation about health engagement at