**1. Introduction**

The current art and science of social and behavior change (SBC) has benefited from the many lessons learned and documented over the years from a wide variety of disciplines and approaches—including anthropology, psychology, marketing, communication research, social marketing, and more recently behavioral economics and human-centered design. Over the years, SBC has accumulated a robust body of compelling evidence, consisting of both scientific research, and documented success stories that demonstrate how the tools and approaches of SBC have effectively influenced behavior change in almost every area of public health, as well as related sectors. The many creative products and events that have been developed within the field make it easy for us to see that art and creativity play an important role in SBC. However, the science behind SBC is less visible but has, arguably, been even more important to the field's success.

In what might be the birth of social marketing 1951, Weibe famously asked the question "Why can't we sell brotherhood the way we sell Coca Cola?" [1, 2]. As in Weibe's famous paper, SBC has, from its earliest days, sought to identify, document, and implement the most effective means of influencing individual and community adoption of improved practices, whether these were technological or behavioral innovations, to improve health status. Central to his inquiry was the search for an approach that could provide results at scale for good value. And these efforts have been successful. Working in concert with the introduction of innovations from the biomedical field, SBC has contributed to significant reductions in mortality and increases in lifespan in every area of the globe. In recent years, we have seen an accelerated effort to document the evidence for SBC's effectiveness [3]. For example, in 2013, the United States Agency for International Development (USAID), in collaboration with the UNICEF, hosted the *Evidence Summit on Enhancing Child Survival and Development in Lower- and* 

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*Middle-Income Countries by Achieving Population-Level Behavior Change* in Washington, DC. The goal of the summit was to determine which evidence-based interventions and strategies support a sustainable shift in health-related behaviors in populations in lower- and middleincome countries to reduce under-5 morbidity and mortality. The results—documented in a special supplement to the Journal of Health Communication—clearly showed the tremendous successes in behavior change programs while carving a path forward to identify the most significant challenges and gaps for further exploration and research [4].

care. As every marketer and retailer knows, consumers tend to prioritize subjective qualities such as convenience, friendliness, and appearance. Marketers naturally understand that it is important to be attentive to consumer experience and generally do this better than the public sector. Despite the advantages, this also has its drawbacks, for example, patients can be attracted to substandard care in the private sector, both formal and informal, avoiding more effective alternatives available in a public system fraught with long lines, limited hours, staffing problems, and poor customer service. However, increasingly, public health practitioners realize that, in order to achieve the ambitious health goals that have been set, such as SDG 2030 Goal 3, new tools will be needed and the consumer perspective will need to be featured more prominently [6]. In recent years, in order to bridge this gap, new tools, such as human-centered design (HCD) and nudging, are being adapted from the commercial sector and quickly taken up. Such approaches—that place the customers' experience at the center of their strategy—are being increasingly adopted and evaluated, in order to increase uptake of priority practices, reduce the gap between clinical and consumer perceptions of quality, and

Introductory Chapter: Global Health Communication - Focused Issues and Challenges

http://dx.doi.org/10.5772/intechopen.80674

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There are a class of diseases, often termed as "lifestyle diseases," which include atherosclerosis, heart disease, stroke, obesity, and type 2 diabetes and diseases associated with smoking, alcohol, and drug abuse. Most people are well aware that lifestyle changes—such as regular physical exercise combined with a healthy diet—can help reduce the risk of such serious diseases and lead to a longer better quality life, yet they do not act on what they know so well. Research has shown that these diseases can often be prevented by "simple" modifications in lifestyle behaviors such as eating a healthy diet, regular exercise, avoiding tobacco, and getting proper sleep. This begs the often asked question "why don't people do what is good for them," or why do not people act (more) rationally? If people acted rationally, we would not see these diseases at the levels we do. Nevertheless, changing such lifestyle behaviors has proven challenging, involving the full spectrum of SBC approaches to affect all of the factors that can influence decision-making. These include (1) internal factors such as knowledge, attitudes, and beliefs; (2) social factors such as social norms, traditional practices, and the influence of important others; and (3) structural factors such as policies, regulations, and changes

in the physical environment that determine access, convenience, and availability.

"Why won't people do what is best for them?" is a question that has challenged the field of behavior change since its origins and has led us to go beyond addressing individual factors (such as awareness, knowledge, and beliefs) to address the social and structural factors that can have such a powerful influence on individual behaviors. This fight has recently been joined by behavioral economists (BE) who have developed a new field that bridges economics and behavioral sciences to provide a fresh perspective on the seemingly irrational human decision-making and behavior. The field of behavior change has expanded and benefited significantly from the emergence and broad acceptance of this new field and the fresh perspective and tools it provides. Brought into the public spotlight in the past several years, through several best-selling books, as well as numerous podcasts, TED talks, and other popular media,

lead to better health outcomes [7, 8].

**1.3. Identify behavioral bottlenecks**
