Changing Behaviors to Improve Public Health

Jeff Jordan is President and Executive Creative Director of Rescue: The Behavior Change Agency. Rescue offers a broad range of marketing services for government agencies (public health departments, state and federal agencies) and non-profits seeking to promote positive changes in public health related behaviors.

Jeff started his agency when, as a high school student, he volunteered for his local health department's youth-targeted anti-tobacco program. He transitioned from volunteer to contractor, tweaked the anti-tobacco program to approach teens in an innovative way, and grew the agency through "a lot of referrals." He opened his first office while he was in college and continued his focus on behavioral change for social good.

In this interview, Jeff tells us that marketing tactics that are used to sell products don't necessarily work in changing "fundamental behavior." His team has to be expert, not just in marketing, but also in behavior change theory, psychology, and sociology . . . and know how to appeal to different subsets within targeted cohort groups. Jeff says that it can take years for a consistent message to bring measurable change, and although there is nothing equivalent to "sales data" to gauge message impact in "real time," he has found there are some measurable interim "markers" on the path to behavior change. Tracking and measuring specific behavior-related attitudes or beliefs or pieces of knowledge over time can predict subsequent behavior changes.

About 7 years ago, Rescue won a $150 million FDA youth tobacco prevention contract. These funds allowed the agency to increase in size from 50 to 150 employees in 3 years. Today, Rescue's 175 employees work out of 6 offices around the country. They serve government agencies and nonprofits in 30 states. Rescue creates programs for these organizations, but also has a library of campaigns that can be licensed.

Over the years, Jeff has learned to say "no" to opportunities that are not right for his agency. Budgets that are too small can limit a campaign's success . . . . and blame for poor results will invariably fall on the agency . . . not on the tight budget. The smaller a client is, the more they tend to demand. Jeff has observed that agencies end up over-servicing smaller accounts to keep them, tie up senior personnel in servicing these smaller clients, and underservice their larger accounts. Jeff warns that really small accounts can hold an agency down.

Jeff applauds the move away from condemning people who choose unhealthy behaviors and the increasingly broad awareness of underlying lifestyle situations that contribute to these behaviors. Jeff's agency attracts employees who want to do something good in their careers. He describes the agency as "responsibly rebellious," and explains that is manifested in the way the agency encourages clients to take risks in a responsible way.

Jeff can be reached on his company's website at: Rescueagency.com. The agency runs what Jeff describes as a "pretty robust YouTube Channel" at: youtube.com/rescueagency.

Transcript Follows:

ROB: Welcome to the Marketing Agency Leadership Podcast. I'm your host, Rob Kischuk, and I'm joined today by Jeff Jordan. He's the President and Executive Creative Director at Rescue: The Behavior Change Agency. Welcome to the podcast, Jeff.

JEFF: Thanks so much, Rob.

ROB: It's excellent to have you here. Why don't you kick us off by telling us – it's right there in the title, a little bit – Rescue: The Behavior Change Agency. But tell us a little bit about Rescue and where you excel.

JEFF: We are a public health behavior change-focused agency. What that means is that we exclusively work for campaigns that strive to change health behaviors for social good. Almost all of our clients are public health departments, state and federal agencies.

When we say behavior change, we refer to actually changing a fundamental behavior that a person is performing. So rather than changing what we would describe as a brand preference of someone who drives one car, changing them to drive a different brand of car, we're looking to change that fundamental behavior of actually driving the car and converting them to ride a bicycle instead. Or in other health arenas, things like quitting smoking or eating healthier, etc.

ROB: Perfect. Is that something you've actually engaged in? Encouraging people to ride a bike instead of driving a car?

JEFF: Not that one. [laughs] But it's an example people tend to understand.

ROB: What are some examples, digging a little deeper, of campaigns? You mentioned smoking cessation. There's probably some other interesting things you've worked on. What are some examples?

JEFF: We work from simple behaviors like quitting smoking or not using drugs or not vaping and things like that to more complex behaviors like healthy eating, where we're actually promoting specific types of foods, specific changes to what they eat, as well as mental health behaviors that are even more complicated – trying to get people to reduce stigma and recognize when to seek help, when to do something about the feelings they're having, and whatnot.

ROB: Very interesting. You mentioned brand preference; in some cases, I think people think of brand preference as being kind of pliable. Maybe it is just as difficult to change as some health behaviors. How do you think about, or how do your clients even think about, measuring these behaviors over the long term? I imagine the feedback loop on one of your campaigns might be rather long in some cases, given the research required to gather those results. Or maybe there's something unexpected I'm not thinking of.

JEFF: You're absolutely right. Behavior change, we usually say you need a couple years at least of consistent campaigning to really see a measurable change. Unfortunately, we don't have sales data to look at to see what's happening in real time, so we rely on self-reported surveys and things like that that either our clients perform or that we help them perform to see what people are saying about the behavior.

You do have some interim steps that you can measure on the path to behavior change. Whatever your underlying theory is of what you think is changing in order to change the behavior, such as specific attitudes or beliefs or pieces of knowledge about a behavior, you can measure those, and then those can be pretty predictive of a behavior change later down the line.

ROB: One benefit it seems like you might have in your industry – is the behavior change industry perhaps a little bit more open about what works and what doesn't than maybe some particular vertical market, like marketing soda or something?

JEFF: I think it's a double-edged sword there. It's more open in the sense that you can survive on theory for a longer period of time. In the commercial world, you can have a great theory, but if it doesn't turn around sales in a quarter, you're kind of out of luck there. In public health, you can survive on theory for a few years. So that does allow you to explore more options.

But that also allows bad work to remain for a long time. We see that there's a lot of mistakes and common pitfalls that clients fall into, usually when they work with traditional agencies, that just happen over and over again because it works to sell a product, but it doesn't work to change a fundamental behavior.

ROB: What about openness in terms of tactics? In some cases you have organizations like the UK's famous – I may be misattributing it, but their Nudge Unit there. You have probably published research in some cases around behavioral change. How much of your work is synthesizing and adapting those things to a community and to availability of resources versus cooking up something completely out-of-the-box and new?

JEFF: There's a lot of theory and approaches already within public health behavior change. I think the UK is interesting in that they tend to have movements that occur there within behavior change. 10-15 years ago, they were really social marketing, and then it switched to Nudge, and they seem to all move a little bit more cohesively, maybe because it's a smaller country.

Here in the U.S., we don't see as much cohesiveness in the approaches. The latest and greatest CDC strategy or FDA strategy, those do have a big influence on the work, but a lot of states are making decisions for themselves and applying the theories and approaches that they're comfortable with – everything from states that might still be using hardcore scare tactics like the '90s in their drug prevention work, all the way to other states that are more open-minded in realizing things like adverse childhood experiences influence how people make decisions about risk behaviors later in life. That's something that the state of California is really looking at.

You have a really wide range of approaches and comfort level with those approaches. One of the things that we have to do that is kind of unique to our industry is we often have to share some of that education and some of those case studies from other states with potential clients so that they can understand, these are your options. You don't have to just do the scare tactics. That's not the only thing out there, and actually it often doesn't really work.

So, we have to be the experts not just in marketing itself, but in behavior change theory, psychology, sociology, all these things that go into it.

ROB: It sounds like there's a difference of tactics, a difference of outcomes. Are you seeking cessation? Are you seeking some sort of treatment? Are you just seeking a reduction of use in something that is now legal in certain places? It sounds like you are able to pool that expertise and help – in the ways that many agencies are, but you don't think about it so much in public health – bring those best practices and learnings from other clients.

That makes me want to pull back and dig in. You're in a very unique area of focus. I think we've done probably 120 or so episodes right now, and we have not been in a conversation with an agency owner who is in public health and behavioral change. You mentioned you've been in the agency, at least, for 20 years. Did you start off with that area of focus? How did Rescue come to be?

JEFF: We are definitely a unique agency. I actually started the agency when I was in high school. I was a volunteer for my local health department's anti-tobacco program. That was a youth program.

They worked with a local agency, and after volunteering for about a year, I noticed that the kids we were reaching, the teenagers we were appealing to, were not current smokers, and they were never going to be smokers, whether we existed or not. These were good kids. They were leaders. They wanted to put this on their college application. There was really no change I could see that we were causing, even though we were successful from the sense that there was a lot of youth involvement and we were doing a lot of things.

Fortunately, we had an advisor at the health department that was also pretty savvy in terms of youth culture. I like to joke that she was a break dancer when she was in high school, and she was maybe 7 years older than me. So, she was still pretty connected with what high risk youth culture might look like versus low risk youth culture. I said, "Why are we spending all our money on these youth?" She was open to allowing me to move from being a volunteer to being a contractor to start to provide some of these services that would change who the program appealed to.

That continued for the next year or so in high school, and very quickly we started to innovate in a way that just wasn't happening in public health, particularly with teens. That turned into a lot of referrals. While I was in college, we grew a lot through referrals and got our first office when I was in college and things like that. So, we really grew organically, and from Day 1 have been exclusively focused on public health.

ROB: What does the team look like today? What are some of the scale points and key hires to where the team of the agency is now?

JEFF: Today we have about 175 employees, six offices around the country. We are the largest marketing agency in San Diego, but most San Diego businesses can't hire us. [laughs] Our work, though, is spread around the country. We don't have a specific geographic footprint. There's not one place where our clients are clustered. We work with about 30 different states and with the federal government, with the FDA, as well as Veterans Affairs and others.

Some of the big scale points that have occurred – there's been a few. The biggest one was about 7 years ago, when we were about 40 or 50 people at the time and we won a contract with the FDA to do youth tobacco prevention. That contract was a $150 million contract for an agency of 50 people. We very quickly grew thanks to that contract. We brought on our CEO, Kristin Carroll (who's still with us today), at that time, who helped us grow quickly. Within a matter of 3 years, we went from about 50 people to 150 people.

But in that time, we've continued to grow with other clients as well. Some other notable wins are the California Department of Health's nutrition campaign as well as some other states that have brought on larger contracts.

ROB: You mentioned that many San Diego businesses probably can't work with you. Does that reflect a change in the overall deal size that you've pursued?

JEFF: No, no, that's just mainly because we don't do commercial marketing. You have to be a public health oriented campaign. We work with the local county health department, we work with the local school district, and we also work with the district attorney's office. So, we work with a lot of local government agencies, but we don't have any commercial customers here or anywhere else.

ROB: I see. Once many agencies scale, and especially north of 100 people, I think a lot of times they become very focused on just the FDA size deals. How do you manage that different granularity of client size within one organization and not become really fixated on hitting those homeruns?

JEFF: That has definitely been a problem of scaling up. There aren't that many FDA size deals in our space, so we're forced to continue our more modest deal size – which we're very happy with.

But I think the biggest challenge that has occurred is being careful not to try and apply universal lessons to the entire agency. Some things that we do for our largest client don't necessarily apply to our smallest clients. We've gotten in trouble sometimes in starting to do things for our smaller clients the way we do it for our larger clients and then going over budget and overcomplicating things when they don't need to be. And vice versa, also making sure we don't get too simple with our biggest accounts. We have to operate in this limited budget standpoint for some of our accounts and then a more open budget to explore different things with our largest accounts.

That's probably the biggest thing we have to remind ourselves of and be cautious with. Really, we're operating like two different agencies within one.

ROB: We are chatting here right in the middle of the spring 2020 COVID-19 epidemic. How has that changed your mix of business? Do you have clients that are working within – do you have some stay home campaigns running and that sort of thing as well? I imagine any work you've done, you've had to learn very quickly.

JEFF: Surprisingly, we haven't gotten into any stay at home work, mainly because we tend to focus on long-term campaigns so that we can measure these long-term changes. It does affect COVID because a lot of the reasons that people are passing away because of COVID is because of preexisting conditions that we're trying to prevent with some of our other behaviors. So in a way, they're all connected.

But when there's an emergency like this, communications get out pretty quickly and go viral pretty quickly. You don't really need the traditional long-term campaign to figure it out.

The one thing that has changed the most for us is the production of new creative and new messages. Right now we're focused almost exclusively on creating animated work and infographics and things like that. Our clients still want to produce the work, still want to put new messages out there. Right now, people are consuming media more than ever before, so we're still cranking away new stuff.

ROB: That's excellent. Jeff, you've been at this for a little bit; you've built the largest agency in San Diego, which is quite a thing. What are some things that you've learned along this journey that you might do a little bit differently if you were starting Rescue all over again?

JEFF: There's so many lessons you learn, but you almost need to learn them in order to grow from them. I think that one of the things that we learned was not to be afraid to say no to an opportunity if that's not the right opportunity.

I have to teach this lesson to every new business development person we bring on or client service person we bring on. It might feel weird to say no to a small client, but keep in mind that if they don't have enough funds for us to do a good job, they won't blame the budget; they will blame us for not doing a good job. And without fail, the smaller the client, the more they ask for.

Oftentimes I've seen a lot of agencies get stuck in this world where they are over-servicing smaller accounts to keep them and underservicing their larger accounts, and it's usually top-heavy. It's usually more senior people that are servicing these smaller accounts, who are now not able to go out there and pursue bigger work. So, you really have to be careful of the really small accounts holding you down.

ROB: How do you think about positioning and communicating the scope with the small accounts so that their expectations are aligned? Or have you found it's hard to manage them and you just have to pick the right ones and let someone else have the ones that are going to ask for the full buffet for 5 bucks?

JEFF: We definitely let someone else have those. [laughs] It's about being transparent upfront and saying, "Look, this is what it takes to do good work, and this is why. These are all the components that need to go into something."

We have found ways of being able to accept smaller accounts with different strategies. For example, something that's completely unique to our space is we actually license campaigns. We have about four different preexisting campaigns that governments can license from us and that are reused over and over again across the country.

That has allowed us to open the door to some smaller – not the smallest, but some of the smaller accounts that don't have the funds to create new campaigns, but do have enough funds to implement a licensed campaigns. That's something that could never happen in the commercial world; no one would ever want to share anything. But in our space, the government loves to share, and they actually love the reduced risk that comes with knowing this has already run somewhere else.

ROB: Right. I can see you coming with some results, and they can see what the campaign looks like out in the world. They can probably even go and visit and see in some other place how this campaign looks in the wild, which you can't do, to your point, for most businesses. Maybe you could get away with it in – I don't know, if you were just serving one lawyer per market, or one plumber, or something crazy like that. But even then, they probably wouldn't want to share.

JEFF: Right, exactly. There's so many things that we do here because we are focused on this space that would just not be possible if we were a generalist agency. And that's part of our argument for potential new clients: look, you can hire your local ad agency that everyone has heard of that has done all the car dealerships and local banks and things like that, or you can hire a specialist in public health. What's going to happen if you hire a specialist in public health is you're going to get all this institutional knowledge about how public health marketing is different from commercial marketing and be able to be more effective, more efficient, and have all this research and tools at your disposal.

ROB: Jeff, at 175 people, you're up above that 150-person Dunbar number that many people talk about as that maximum number of people you can be in relationship with, or people might phrase it differently. How have you thought about structuring, organizing, and persisting culture as you break through dozens and then triple digits and then over 150?

JEFF: We had a pretty strong culture before I knew that company culture was a thing. It comes from the culture being embedded in the work. A lot of times, folks try to put this layer of culture on their organization that doesn't really have anything to do with anything. That's where culture tends to fail or feel shallow.

Where culture is really strong and real is where it manifests through the work. For example, one piece of our culture is that we describe ourselves as "responsibly rebellious." What that means is that we want to push our clients to take risks within a responsible way. That is manifest through a lot of decisions that we make for our clients, things that we present to our clients, ways that we approach how we work with our clients.

Then, when we say that's a part of our culture, it's true. It is a part of our work. It's part of what we do. When we talk about being science-based, we have a giant in-house research team that does presentations for us that is then infused in the creative and in the strategy. So, I think the best way to maintain culture is to just have an identity that is real and that you truly apply every single time you do the work.

ROB: It almost seems like some of the culture would be self-selecting. Not to say that people might not view Rescue as a very attractive place to work, but it seems like an odd company to sign up for unless you have a real interest in messages of public health and in helping people and helping communities. Do you find that in the interview process?

JEFF: Yeah. This millennial generation that's now dominating our workforce, we are the ideal kind of company to work for. They want to cause social change. They want to have an impact, and we can allow them to have that impact. So, definitely the people that come in are people who have an interest in doing something good with their career.

And that helps. Everybody in the agency wants to have a good outcome from that campaign on a deeper level than just simply delivering for a client.

ROB: That makes sense. Jeff, what's coming up for Rescue that you are excited about? Or maybe it's even something in terms of either broad messages that you're seeing trends in, or even tactically?

JEFF: One thing that's pretty exciting is that we're seeing a broad awakening of the underlying lifestyle situations that lead people to choose unhealthy behaviors.

The best example of this is what's happening in California with the new – California has a Surgeon General for the first time, and she is focused on infusing adverse childhood experience understanding, which is this area of health research that talks about if you had these really, really big things happen to you when you were a kid – things like divorce or a parent dying or domestic violence or mental health in the family, these heavy things – those things set you on a trajectory to take on much higher risks later in life. And if you can embed an understanding of who people are and where they come from in your work, you can be more effective with these populations.

So, an understanding of that, an understanding of mental health, an understanding that people don't do risky things in isolation. They do them from a complicated equation of everything that's happened in their life. That was just not existent for the past 20 years, particularly in things like drug and alcohol prevention, where it's like "people who use drugs are just making a bad choice, they're just stupid, they're just bad and they need to be told to stop doing bad things." [laughs] That's just not how it works.

It's really nice that a lot of public health is moving away from that perspective and instead moving towards a deeper understanding of the complexity of human identity.

ROB: Absolutely. It brings to mind for me – you have a responsibility; the messages you're putting out there are not messages for any particular – you probably work with governments of every political party possible.

JEFF: That's right.

ROB: But we live in a world where – what you're saying even hearkens back to partisan politics. How do you think about putting messages out into the world that have to transcend politics and party?

JEFF: I think we all suffer, across industries, across topics, from talking to ourselves and not understanding someone who's different.

One of the things I like to say that I feel makes this so different is applied empathy. It's not just that we have more empathy than someone else, but that we actually apply that empathy to how we create our messages and can articulate, when we're going to create a campaign for rural men, why that campaign has to be so different from a campaign, for example, for African American women. What is different about their life experience, their attitudes, their worldview, their values that will change the way we communicate to them – but also change what we're saying.

A great example of this is that we do a ton of tobacco prevention work, still, with teenagers, and you can talk to an alternative teen in an urban area who listens to rock and things like that – you can talk to them about the evilness of the tobacco industry and all the horrible things they've done, and they will get fired up. They'll say, "I don't want to support an industry that's destroying the world and manipulating people." So, you can motivate them not to smoke just by talking about the tobacco industry to them.

But then you take a rural teen, a country teen who maybe is a younger version of the right side of our political spectrum, and you talk to them about the tobacco industry and it just doesn't even faze them. They're like, "Well, that's their right as a company and you have the right to choose what you're going to do, whether you do that behavior or not. It's all about personal responsibility."

If you don't know that difference and if you don't know that they are processing information differently and caring about different things, then you're just speaking to yourself. You're just speaking about what you care about. And that can apply to so, so many different things. Within politics, its' so interesting to see people just yell within their bubbles about things that they care about and are baffled by why no one else cares about them or why the other side doesn't care. All you have to do is just spend a little bit of time on the other side and you'll understand why they don't care about what you're talking about.

ROB: It's a great thought for all of us on meeting people where they are instead of where we think they are. Jeff, when the audience wants to get in touch with you and with Rescue, where should they look for you? Where should they find you?

JEFF: Yeah, definitely. Rescueagency.com is our website. There's contact information there for different folks. But also, if you're just interested in what I was talking about and learning more about public health marketing and behavior change and things like that, we have a pretty robust YouTube channel, youtube.com/rescueagency. Lots of actual workshops and videos that we've done explaining our approach and research and some examples of the work.

ROB: Perfect. Jeff, thank you for joining us. Thank you for the thoughtful work that you do. We're grateful for it, and look forward to a lot more of it in the future. Congrats on all the success.

JEFF: Thank you. Thanks for having me on.

ROB: Thank you for listening. The Marketing Agency Leadership Podcast is presented by Converge. Converge helps digital marketing agencies and brands automate their reporting so they can be more profitable, accurate, and responsive. To learn more about how Converge can automate your marketing reporting, email info@convergehq.com, or visit us on the web at convergehq.com.