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One size doesn't fit all

The key to success is knowing which aspect of the brand should be expressed locally

missing image fileOne brand, one message, one world-wide audience, one advertisement. Sounds like a perfect world to anyone managing a global brand, in a global organisation, serving customers increasingly operating across multiple geographic markets. However, there is another world; where each market is riddled with unique regulatory, structural and social differences - making it necessary to develop specific campaigns for each very different markets. Finally, there is a third scenario oscillating between the other two. Welcome to the real world of healthcare marcoms.

Some global organisations take the "one-size-fits-all" approach because it's the easy option. They structure, market and communicate globally. This is, however, very unlikely to be the optimal approach. It may even be the wrong response to asking the wrong question. The paradigm is superficial. The question is not: should a brand take a global or local approach? The question is: which aspects of the brand are best expressed globally and which are best expressed locally? I'll limit this discussion to advertising execution. To cover all aspects of global versus local would leave little room for anything else in the magazine.

Not the only way
Most healthcare brands are the product of global R&D undertaken to meet needs in a universally understood therapeutic area. This should dictate that the brand must be positioned globally, yet this is not always the right response. The exception is generally thought to be where the prevalence, or perceived importance, of a particular therapeutic area differs markedly from market to market - or where the availability of specialist healthcare professionals is limited or non-existent.

Avoiding a knee-jerk "let's go global" response needs more subtlety than this and entails more than simply comparing advanced and developing markets. Although the quality of healthcare seems to be a universal concept, one study, published in the American Journal of Cardiology in April 2006, explored how physicians, patients and parents (in paediatric care models) differ in their perceptions of high-quality care and how their beliefs might vary by country.

Researchers found that: Overall, parents' responses differed more among countries than those of physicians; the magnitude of the difference between parents and physicians varied by country. This discrepancy highlights a potential mismatch between patients' and physicians' views about the desired components of healthcare delivery, in particular the application of American quality standards for healthcare to systems in other countries.

To put this in words too bold for the report's authors - people in different markets respond differently to the same stimulus. If you want people to respond in the same way across markets - for instance, prescribing a given pharmaceutical for a particular indication - you have to vary the stimuli.

Conformity from variety
When a global brand positioning is appropriate - and this remains most of the time - the local expression of that positioning may need to alter to cater for language, cultural and social differences, that is varying the stimuli to keep the response the same.

The reasons for this are illustrated well by KCI International and its global positioning of VAC therapy for wounds - the success of which is indicated by a 20 per cent growth rate per year in markets as diverse as France, Germany, Canada, the UK and the US.

Following extensive customer research across key markets, a core advertising message for KCI's VAC therapy was developed in English. Like most global pharma companies, KCI chooses to use English as its lingua franca. The phrase that best summarises the advantages of VAC Therapy is Better wound care. It is simple, clear, understated and, one would tend to think, universal. Literal translation however, would have resulted in some marked behavioural differences in different markets. Some Scandinavian markets actually wanted to see the phrase in English rather than in translation.

To the French that would be cultural imperialism. Indeed, in France, a literal translation sounded aggressive and assertive - not simple and understated - so the phrase was toned down. In Turkey, with its highly modified Latin alphabet, only the native speakers can be sure that the message is right. English speakers can only be reassured by seeing the appropriate reaction of Turkish healthcare professionals.

Of course sometimes mistakes happen. Famously, when Vicks first introduce its cough drops to the German market, they were chagrined to discover that to German ears Vicks sounds very like a slang word for sexual penetration.

Another interesting observation from the VAC therapy campaign is just how different the amount of information demanded by healthcare specialists in different markets is.

In the US, every possible benefit the therapy could provide must be listed, anything else would be under selling. In most European markets, it is better to limit the number of messages to a few key points, except in Germany, where you would do well to list every benefit, feature and physical or practical detail with as much precise supporting information as possible.

Universal understanding
One thing that KCI didn't change in its advertising campaign between countries was the creative execution. The basic concept: open a really up-to-date medical textbook and you ought to find a reference to VAC therapy, its efficacy and the rapidity of reaching therapeutic goals.

If you open that text book you would feel like alerting your colleagues to these advantages by way of marking the page with a sticky note. This tells us that it is indeed possible to discover themes that are more-or-less universal.

A Brit, Canadian, Turk and Norwegian react in the same way to the concept of a dictionary or a text book. Similarly, we all understand the concept of the Post-It note thanks to the global approach to marketing by makers 3M.

There are many things that are genuinely universal - we all love babies, we all have a fear of dying, we understand the importance of both competition and cooperation, we grasp the relevance of cost and value. That said, international campaign themes need to avoid some obvious pitfalls such as:

  • An idiomatic expression simply isn't going to work outside the host country. A pot can call a kettle black in England but don't expect an Italian to know what you are talking about
  • National heroes simply aren't heroic enough - Tiger Woods has global renown but Indian cricketer Sachin Tendulkar, despite his considerable talent, has not
  • Be careful with colours. Orange symbolises reform in Eastern Europe and conservative nationalism in the Netherlands
  • Be careful with symbols. The HSBC campaign shows the danger of assuming that symbols - from a thumb's up to a head shake - are global.

Oscillation is unhealthy
Oscillating between taking a global perspective and being locally driven is not helpful, yet it happens a lot and follows a three-year cycle:

  • Year 1 - new structures are put in place
  • Year 2 - the new structures bed-in
  • Year 3 - local markets and global markets fall out and go their own way.

This closed cycle creates no opportunity for learning. Oscillation can be minimised in three ways. First by agreeing clear roles for global, regional and local elements in the development of a brand and its communication campaigns. In general, positioning and core values are global tasks. Messaging and creative themes are regional tasks. Localisation and campaign delivery are local market tasks.

Second, by creating toolkits for local markets, not finished campaigns. Give local markets the creative equipment and marketing guidance they need to create campaigns that are on-brand and on-message and in-line with the activities of other markets.

Third, learn from every experience by ensuring a common means of evaluation and measurement across markets. In fact, measurement and evaluation may be the only things that absolutely must be one size fits all.

If you want people to respond in the same way across markets - for instance, prescribing a given drug for a specific indication - you have to vary the stimuli

Michael Dumigan is managing director of healthcare communications agency Brand Create (

19th June 2007


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