In 2002, the Public
Awareness Committee of the Justus-Warren Heart Disease and Stroke Prevention
Task Force in
Starting Out
The idea for this strategy came from a number of
sources. The Public Awareness Committee of
the Task Force was charged with publicizing the burden and preventability of
heart disease and stroke in
The NC CVH Program is implemented in part through funding a
lead county in each of six regions of the state, with regions loosely based on
the major media markets. In 2000, the
Regional CVH Coordinator in
Decisions made by the Task Force Committee and subsequent
planners were based on the same data that drove North Carolina’s proposal to
the CDC and the implementation design for the state CVH program. While tobacco is a particular problem in
Health Agency Roles
The enabling legislation that established the Task Force in 1995 had established two positions – an Executive Director and an Administrative Support person - and placed them in the State Health Department. From the earliest days of the state program, with a staff of two and an initial appropriation of $100,000 a year, internal and external partnerships have been vital to building a comprehensive statewide program and accomplishing program goals. Legislatively appointed Task Force members and resource persons and staff to the Public Awareness committee provide guidance as well as planning and administrative support for the SWYH campaign. Formative research, strategic planning, creative development, media placement and evaluation are managed by outside contractors selected through a competitive Request for Applications (RFA) process conducted under state rules for purchase and contracts.
The Campaign Planning Committee was initially comprised of staff from the Health Department and associated state agencies and some Task Force representatives, and all work was reported to the Public Awareness Committee. In 2003, Campaign Planning Committee responsibilities were assumed by the Executive Director along with members and staff of the Public Awareness Committee and contractors.
The Executive Director has had to learn about media strategies on the job, and completed a Social Marketing Institute to build her skills in this area. Future plans call for hiring a Media Intervention Specialist to support the Task Force Committee and administer the SWYH contract. This position will complement a Policy Intervention Specialist position and provide needed skills in Social Marketing, Media Advocacy, Media Relations and Earned Media, as well as strengthened health communications capabilities to the Heart Disease and Stroke Prevention Branch.
From the beginning of the SWYH campaign, developing partnerships with other stakeholders and private organizations was an objective as part of a well-designed social marketing program. Therefore, partnership development and maintenance was a key skill required of all involved. The development of public-private partnerships required new skills of staff, including development of a set of agreed-upon criteria for such partnerships.
Preliminary work toward forging a public-private partnership policy took place in 1999, when a SWYH statewide partnership was initiated with Subway Sandwich Stores, Inc. At that time the new set of criteria for acceptable public-private partnerships was created, reviewed by legislative members of the Task Force and the State Health Department attorney and approved. These criteria were subsequently applied in discussions with the Lowes Management team and fully accepted.
In 2001, the Surry County CVH Coordinator reported on the local Lowes partnership at a Start With Your Heart Planning Committee meeting. He suggested approaching the grocery store chain about the possibility of taking the local work already in progress and expanding it to a statewide initiative. The campaign manager took the next step in contacting the Lowes Foods Nutrition Manager who had been a key driver for the local campaign. Subsequent meetings were held in the summer of 2001 at Lowes’ Winston Salem headquarters with other executive management.
Lowes Management saw the benefits of working with the Task Force and the Start With Your Heart program, believing that a partnership would advance the positioning of the chain as a grocery source that cared about the health of its consumers and operated in service to their improved health. In addition, the partnership would help to promote sales of some food categories and brands, including the Lowes house brand. By calling more attention to the benefits of these products, purchasing was inherently encouraged in the shopping aisles.
Lowes Foods proposed changing the chain’s entire shelf-tagging system to integrate production and placement of tags featuring the Start With Your Heart logo. Informative brochures explaining the campaign were made available to shoppers as well, and Lowes initiated a public relations kick-off, as well as on-going promotion around the SWYH program.
The Task Force and SWYH Campaign Planning Committee saw obvious benefits from this program as well. Brand exposure in more than 100 supermarkets throughout the state, supported by the other communication strategies, would leverage the awareness impact by orders of magnitude, while at the same time creating an environmental change that would support healthy food choices.
The Planning Committee also was aware that studies of consumer buying habits show that in-store decision making (i.e. impulse purchases) accounts for nearly two-thirds of all purchases in supermarkets. By interacting with consumer consciousness through the shelf tags, in-store and window signs, and other in-store promotions, healthy food choices are more easily influenced. And consumers may adhere to a more healthy diet that will help to improve their cardiovascular health.
Implementing the Lowes Foods environmental program was somewhat daunting. The existing shelf-tagging system was revamped and redesigned in order to accommodate the new tag designs. The program was piloted in stores close to corporate headquarters in April of 2002, officially kicked off in June of 2002 and gradually expanded to include all 101 stores in the state within the next 12 months. By April of 2003, the Start With Your Heart brand was reaching more than one million consumers at the decision point of food purchase, with exposure to approximately 17,000 new customers monthly.
Lowes Foods funded and managed the entire shelf-tag change-over as well as all in-store promotions. The Start with Your Heart campaign supported Lowes’ efforts by including their brand on outdoor billboards in 35 at-risk counties, on minority newspaper advertisements in nine counties, and by providing information about both the Lowes program and healthy grocery choices in free-standing inserts distributed through weekly newspapers in 61 counties. The Lowes commitment to nutrition and the SWYH partnership was also featured in a Start With Your Heart newsletter sent to approximately 17,000 consumers who had requested inclusion on a mailing list to receive information about heart disease and stroke prevention. This database of names was derived from mail-back cards disseminated in the early years of the Subway partnership.
Matched funding from the North Carolina Nutrition Network partnership, initiated in 2000, provided additional budget support for the media program and in-store materials at Lowes. The NC Nutrition Network coordinates statewide programs of the US Department of Agriculture Food Stamp Nutrition Education Plan and the NC Food Stamp Office and provides federal matching funds for state and county nutrition programs.
Lowes management has reported that marketing data show that sales on the items tagged with the Start With Your Heart brand have increased consistently over time. In May 2005, Lowes Nutrition Specialist, Cindy Silver, reported that sales of SWYH items over the previous 52 week period had increased by 4% over the previous year. In addition, the number of food items now tagged has grown from several hundred to 3,000 in 110 stores. The tagging program was extended to the chain’s bakery and produce departments in 2004. Managers have reported excellent customer comments about the new easy identification system and growing sales of tagged or now-stickered items including produce.
Some concerns were expressed at the health department about
the selection of one grocery chain over other, potentially larger ones. But Lowes essentially selected itself by its
interest in being positioned as the grocery chain to shop for healthy food
choices. The fact that Lowes was
NC-based and had a Registered Dietitian on the management staff in nearby
The most daunting part of rolling out the program statewide was the development of the shelf-tagging system and ensuring that the tagged items met the inclusion criteria. This proved arduous and time consuming, but the Lowes Nutrition Manager bore the brunt of the effort, and once in place, the system has worked well enough for Lowes that they have maintained and expanded it over time.
The lessons learned during this on-going initiative have included:
As Lowes has expanded the program to include stickered items such as produce and bakery products, new materials have needed to be produced and printed, and the Task Force has assisted with the costs of printing those materials on an as-needed basis.
With the increasing availability of funding for physical activity and nutrition for obesity prevention, State cardiovascular health (CVH) programs have been asked to shift from an early focus on physical activity and nutrition to work on high blood pressure, cholesterol and secondary prevention of heart disease and stroke. State programs have also been asked to change their names from CVH to Heart Disease and Stroke Prevention (HDSP). What has not changed is the focus on working at the policy and environmental level. Since nutrition impacts blood pressure and cholesterol and is an important part of secondary prevention, this partnership will be on-going as long as Lowes remains interested and pleased with the results.
Elizabeth M. (Libby) Puckett
Head, Heart Disease and Stroke Prevention Branch,
NC-DHHS, Division of Public Health
1915,
Phone: 919-715-3342
Fax: 919-715-0433
e-mail: libby.puckett@ncmail.net