Countermarketing – Can Outrage Improve Public Health?

By: P. Christopher Palmedo, PhD, MBA

Can outrage be used to improve public health? The simple answer is yes. Thirty years of research has shown that health communications campaigns generating outrage among teens against Big Tobacco helped lower teen smoking rates in the 1990’s and early 2000’s. The “truth” campaign was the exemplar of this kind of work and remains a source for some of the most effective countermarketing tactics we know today. 

But the complete answer is more nuanced. The youth of today are more savvy about marketing than they were at the turn of this century. And outside tobacco, there haven’t been many successful countermarketing interventions. One exception is a 2016 campaign convincing middle schoolers that healthy eating is a way to “stick it to the man,” by portraying junk food companies as deceitful and manipulative. This approach was found to be more effective than traditional health messaging dictating to kids which foods are healthy and which are not. But such campaigns are still relatively rare, even though there is clearly opportunity to make a difference in areas such as soda, alcohol, or vaping. 

Countermarketing can be defined as health communication designed to reduce the demand for unhealthy products by exposing the motives and activities of the producers and marketers of these products. Countermarketing goes beyond telling people that cigarettes, soda, processed fast food, or vaping is harmful; it explores the toxicity of these products in ways that is both intellectually interesting and emotionally alarming. A critical component of countermarketing is its peer-driven approach, and one overarching goal is to inoculate the world’s youth against the billions of dollars spent marketing unhealthy products to them.

In a 2017 review article, my colleagues and I identified key components of successful tobacco campaigns that may be transferred to other areas:

  1. Fully Address Health Consequences: Not merely glossing over the health effects but fully exploring them in interesting and engaging ways
  2. Appeal to Emotions: Commercial marketing appeals to emotions, but ineffective public health marketing tends to stick with facts. Emotional appeals are necessary to change behavior!
  3. Segment Audiences and Tailor Messages: As with any effective social marketing campaign, specific segments need specific targeting to reach them effectively. 
  4. Peer Engagement: This is important for any social marketing campaign, but with youth marketing it’s especially important.
  5. Address Product Formulation and Marketing: This includes discussing how food companies calibrate ingredients to make them more addicting. 
  6. Address Industry Racial and Ethnic Targeting: This is especially important in when this activity is happening, and important to call out as a separate issue beyond targeting the poor.
  7. Disparage Brands: Countermarketing is not afraid to call out brands and you might be surprised at what you can get away with under free speech protections in the U.S.
  8. Create a Countermarketing Brand: The “truth” brand is one example, as is the HHS “Fresh Empire” campaign.

Each of these items is explored in more detail in the webinar, and can serve as a checklist that you can run through if your community or institution is interested in designing and implementing a countermarketing-based health communications campaign.

One More Thing: Adding a healthy product

As with many effective campaigns, it is important to consider items that can be promoted as a healthy alternative to the unhealthy product. One example might be offering fruit-infused water as a replacement for soda machines for youth. Social branding is another approach to “selling” a lifestyle that is cool and hip but that does not include tobacco, alcohol, etc. Research tells us that social marketing campaigns that promote a tangible positive product, in addition to getting people to curtail other behaviors, can be more effective than “negative message” campaigns alone. 


As many of us continue to explore countermarketing campaign opportunities, I hope SMANA will be a safe space to share insights with each other. In my current work around vaping, for example, I am looking into an even greater level of youth engagement: bringing in youth on strategy, tactics, and message development, in addition to consultation and implementation. Looking ahead, we may also need to apply more sophisticated segmentation strategies to better apply countermarketing to those demographic or psychographic segments for which it can be most effective. Some segments are less receptive to countermarketing messages than others, and market research is needed to continue to identify these differences.

The many elements of countermarketing discussed here can be emphasized differently depending on the product, the setting, the audience, etc. But the overall approach is the same: exposing the truth and mobilizing emotions to adopt healthier behaviors. 

Chris Palmedo is an associate professor at the City of New York Graduate School of Public Health and Health Policy. He teaches courses in health communications, social marketing, and health advocacy. He serves as program director for the school’s new MS in Health Communication for Social Change program. He is also the co-author of a college textbook on personal health in a public health context published by Jones and Bartlett (2018). 


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