2.2.1. Social marketing

effectiveness of a given health program—in this case, the Pink October at the Brazilian Federal Senate. Additionally, although there is literature to corroborate the idea of social marketing as the use of marketing theory, skills and practices to achieve social change, especially through the use of online social media, we believe this should be treated simply as marketing on social media. We focus on this at the end of this chapter, with a practical approach on how this concept is used by the Brazilian legislative house. To start with, we shall go over the main concepts of social marketing and its internal use in institutions, especially regarding the

The case study involved literature review, analysis of internal and external media articles and focused interviews with the organizers and partners to create a short overview of the initiative

This section aims to discuss the present status of breast cancer cases in Brazil, the basic definition of social marketing and its relation to health communication, as well as the field's best practices. Another main goal here is to bring up a discussion on internal marketing as a powerful tool to achieve an effective health communication, which may influence behaviors and attitudes toward other potential health issues, and finally, to present the Pink October case

According to the Brazilian Ministry of Health, breast cancer is the type of cancer that mostly affects women countrywide, accounting for about 25% of the new cases each year. It is the second leading cause of cancer-related death in developed countries, falling only behind lung cancer [5]. The National Cancer Institute (Inca) reported that there are about 60,000 new breast

According to the gynecologist Doctor Daniele Carvalho Mendes, the causes of the disease are varied, ranging from genetic mutations that might occur during a person's own lifetime up to certain changes to genes that control the way our cells function, especially how they grow and divide. Also, it can be caused by the habits that are proper of a social and/or cultural environment. Examples of such causes include alcohol abuse, overweight and a sedentary lifestyle. Doctor Mendes points out that clinical examination of the breasts should be performed annually by a gynecologist for women from the age of 25. Mammography should be done periodically after the woman reaches 40 years old. When necessary, the doctor may refer the patient to a mastologist for detailed examinations. As Doctor Mendes sees it, the possibility of having cancer is not cause for panic, since the treatment evolved to be increasingly individualized and

cancer cases per year in Brazil, of which 15,000 lead to death.

based on the genetic profile of the tumor.

2. Social marketing and health communication on breast cancer

employees and their families.

58 Selected Issues in Global Health Communications

in detail.

2.1. Breast cancer

and its future potential improvements.

prevention in a public institution

A well-established definition of social marketing, is "[…] the use of marketing principles and techniques to influence a target audience to voluntarily accept, reject, modify or abandon a behavior for the benefit of individuals, groups or society as a whole" [8]. For Wilkie and Moore, social marketing originally developed itself as an area that would focus on "the work of nonprofitable groups and government agencies that dealt with effective intervention in areas of social problems," especially in public health programs as seen in Ling, Franklin, Lindsteadt and Gearon [9, 10].

This perspective of social marketing as a tool to encourage planned social change has been successfully used in different programs [11]. Nevertheless, although social marketing aimed at greater social welfare, the agents of such social change (governments, institutions, public policy makers) face complex ethical challenges [12, 13]. For Brenkert, the point goes beyond the moral issues faced by other forms of marketing such as accusations of manipulation and dishonesty and issues of intrusiveness [14].

The implementation of social marketing initiatives implies several challenges, as seen by Kotler and Lee, such as asking citizens to give up a pleasure (such as having to bathe more quickly), to be in a situation of eventual discomfort (such as wearing a seatbelt on buses and cars), resisting peer pressure (not starting to smoke), embarrassing situations (prostate examination), coping with sensitive situations (testing for AIDS),—challenges that may be added to asking citizens to reflect on issues that, at first, are difficult to grasp of are far from their immediate reality, such as the conservation of the oceans, among many others [15, 16]. For example, Peters et al. have demonstrated the low effectiveness of private sector initiatives in sexual and reproductive health campaigns in emerging countries for a number of difficulties [17]. Concerning health communication itself, Haider also enumerates several difficulties to face, for instance, the evaluation issue [18].

Hastings advocates that social marketing can take advantage of both external relationships among the stakeholders, and internal relationships such as the "domestic partnerships" of employees and functional departments of the organization [19]. In this context, we would have something that could be called a "social endomarketing" that could benefit from generic branding strategies, as referenced earlier. As the saying goes, "There is no better means of promoting another person's change of heart than allowing our own heart to be changed." (C. Terry Warner) [20]. In social marketing, that assumption remains true.
