3 strategic moves that can turn health campaigns into health impact engines

People-led campaigns, often leveraging the latest tech, can also help improve Americans’ awareness of public health issues. The 2014 ALS Ice Bucket Challenge drew over 28 million social media users to douse themselves with ice-cold water in support of ALS research and raised US$115 million in just six weeks.¹⁰ And in November 2024, social media platforms were full of millions of men sharing photo evidence of their growing mustaches as part of the annual Movember movement, which began in 2003 to raise awareness of men’s health issues like prostate and testicular cancers.¹¹ Prostate cancer death rates dropped by half between 1997 and 2013 and have steadied in recent years, potentially due to more consistent early-stage screenings.¹²

Examples like these show that a story, told in a well-chosen context, and with a mix of strong funding, creative reach, and behavioral insights, can bring national attention to health conditions and even flip everyday health behaviors.¹³

To further explore how campaigns can enhance the effectiveness of health communication, we reviewed the literature on health campaigns and conducted semi-structured interviews with leaders in government, academia, and industry (see more details here). These combined insights shaped the practical strategies that follow, grounded in what we have heard and seen work.

Here are three strategic moves that health agencies should consider in order to maximize gains from their health communication campaigns.

Goals can also set the stage over a longer time horizon: The Healthy People initiative sets 10-year, national science-based goals aimed at improving Americans’ health. The initiative then uses these goals to establish a set of specific, measurable objectives that can guide the country’s public health efforts over the next decade. The latest edition, Healthy People 2030, launched in August 2020, includes a total of 358 core objectives along with 111 developmental and 41 new research objectives.¹⁹ Throughout these objectives, Healthy People 2030 focuses on improving health communication so that Americans can easily understand and act on health information.

Don’t be afraid to define the destination. Objectives should flow directly from overall campaign goals. This is often the hardest step: agreeing on appropriate targets, publishing them, and owning the outcome. Though it can be nerve-wracking, publicly pledging campaign objectives in advance tends to create accountability, motivates teams, and may even save time, avoiding ever-changing goal posts.²⁰ The CDC’s Tips campaign set an ambitious but measurable objective of 500,000 quit attempts and 50,000 quitters before the first ad ran.²¹ The team managing the campaign worried they might miss the mark, but they surpassed it.²² Between 2012 and 2018, the CDC estimated that over 16.4 million people who smoked attempted quitting, with around 1 million successfully quitting.²³

Likewise, a Department of Health and Human Services campaign used this model of setting an objective in advance to remove “clearance barriers” for communication.²⁴ This changed the conversation from battles over process and lower-priority things like specific colors for football jerseys in the ads, which can delay a campaign and waste resources, to program accountability for achieving measurable objectives.²⁵

Both goals and objectives tend to be well-formed based on context, building on what already works. Some campaigns are meant to influence audience behaviors directly, whereas others might exist to foster supportive attitudes, build awareness, or simply to strengthen collaborations or spread the word.²⁶ If the goal is “get schools to help teach traffic safety,” a campaign objective might be “get safety kits into 50 priority schools.”

In some cases, influence may be limited by other actors in the marketplace, even when campaign funds are plentiful. And there are initiatives that require strategic, big, bold objectives to help them achieve their goals, like the CDC’s Active People, Healthy Nation campaign. It aligns the broad goal of helping 27 million people get physically active by 2027 with specific objectives, like moving 15 million adults from a state of physical inactivity to a habit of daily moderate exercise.²⁷

Collaborate, don’t compete. At the broader ecosystem level, when public, private, and philanthropic sectors align strategically, government funding can play a catalytic role in maximizing returns. As Claudia Parvanta, PhD, professor, Department of Health Policy and Systems Management, and director, USF Center for Social Marketing, frames it, “The most important thing is it doesn’t come from the federal government alone; it really requires partnerships.”²⁸

In practice, a single public dollar can unlock two, three, or even 10 additional dollars from philanthropy and business. The US Department of Agriculture’s Healthy Food Financing Initiative, for example, seeded US$40 million in 2024 grants that is projected to draw in 75 outside stakeholders to cofinance fresh-food projects in 20 states.²⁹ On the innovation side, Department of Energy’s ARPA-E shows how early-stage risk capital scales: US$4.21 billion in federal awards has catalyzed nearly US$15 billion in private follow-on investment.³⁰ In each case, collaboration is key: Government either lays the groundwork or builds on existing efforts so that every dollar, public or private, can be used where it can produce a positive impact. By having government serve as an anchor investor or as a reinforcing ally, the broader ecosystem can achieve a greater impact than a sector might on its own.

Coordinate, don’t duplicate. Public health agency campaign teams are often small. Leveraging resources across similar efforts and bringing in outside experience are key ingredients to coordinating well—and potentially can boost reach and impact. As Diane Beistle, retired chief, health communication branch, Office of Smoking and Health, CDC, experienced in managing the Tips campaign, “Our internal and external partners were instrumental in helping us leverage Tips and extend the impact of the campaign.”³¹ When like-minded campaigns aren’t working together, they can waste dollars or oversaturate audiences.³² But when campaigns work together, they can target broad goals and specific objectives more efficiently—and may even be able to seek bigger, bolder ambitions by pooling budgets, staff experience, and community connections.

Youth-focused initiatives offer one kind of template: Programs such as VERB and Truth embedded community-based advisory boards, hired peer educators from the target population, and ran formative research alongside community-based organizations.³³ Though joining forces can drive value, there’s generally room for different efforts to identify a piece of the pie and work on it. In the youth vaping cessation space, for instance, some groups work directly with youths to empower them, while other groups work within school settings to provide educators with tools for conversations with both kids and parents about the harms of vaping.³⁴

Shared ties within communities tend to offer a bonus, too; campaigns can use them to tap authentic voices and institutionalize health messages in schools and neighborhood groups. With schools increasingly requiring students to leave their smartphones at the door,³⁵ this screen-free school environment can also provide a window for getting kids’ attention live. Shape Your Future is a statewide health education campaign today in Oklahoma that promotes making healthy choices easier and more accessible, like better nutrition, more exercise, and tobacco-free living. The campaign collaborates with local coalitions, schools, and public health networks to institutionalize health messaging through accessible, local voices, including the Cleveland Elementary School.³⁶ Elementary students and teachers built their own school garden with support from Shape Your Future and the Whole Kids Foundation. Kids have a blast growing the food they eat, and even sell it at local farmers’ markets, which is intended to give them a sense of ownership over the cause.³⁷

Help program leaders see how campaigns can—and can’t—progress their program missions. Waiting for a national public health emergency to make a phone call about how to communicate can be too little, too late.³⁸ Campaign leaders can be clear with program officials from the get-go about overarching goals and likely targets for objectives to keep expectations realistic.³⁹ According to Diane Beistle, “It’s important to ascertain the expectations of funders or stakeholders up front through conversation or consensus-building meetings. Convene key stakeholders early to understand what they expect.”⁴⁰ This approach can help lay the groundwork for a paradigm shift in how leaders understand and value communication—and how it contributes to program missions.

Program leaders can ask: How exactly does communication advance the program mission, and what’s that worth? The National Council for Mental Wellbeing demonstrated this with its Mental Health First Aid initiative, combining a goal of making mental health training as common as CPR with actionable objectives such as educating the public on recognizing mental health risks. The council collaborated on the ground with schools, law enforcement, and universities, and expanded to launch high-visibility social media efforts such as the #1in1m campaign, which reached over 10 million people. By 2020, the program had equipped more than 15,000 instructors to train over two million individuals on mental health awareness.⁴¹

Strategic funding can beat spare change. Many communication offices traditionally operated on leftover funds. Even when funds are planned in advance, campaign budgets can vary widely by program—from the CDC’s youth-activity program VERB, funded at US$125 million in 2001 and US$339 million over five years,⁴² to a 2021 federal public-health information and education initiative capitalized by a US$1 billion appropriation to the Department of Health and Human Services (HHS) for the CDC,⁴³ to today’s State Physical Activity and Nutrition Program grants that average under US$900k each.⁴⁴ These wide variations underscore that health communication dollars can scale up or down according to how strongly decision-makers back the message, as well as the urgency at hand.⁴⁵

However, teams can pursue a budget that matches their specific objectives within a program goal. Mark Weber recalled an opioid-misuse campaign that delivered an outsized impact on a budget of a little over US$400k.⁴⁶ By working with pharmacies that work directly with patients in high-need states, it focused on a single outcome, safe disposal of unused painkillers. The campaign reached over seven million patients, and 85% of the point-of-purchase material recipients read some or all of the information, 48% of them kept the materials for future reference, and 6% shared the content with at least one other person.⁴⁷ The campaign earned national praise for its reach, relevance, and cost-efficiency, despite its relatively small budget.⁴⁸

Similarly, a federal partnership with a private sector leader in educational publishing delivered in-class alcohol awareness education materials for 5th grade students. The program sent home discussion tools for students and their families before underage drinking tends to begin.⁴⁹ Teachers recognized the value of the program, with 73% of the teachers who received the materials indicating they used or planned to use the materials for classroom use.⁵⁰ Of these teachers, 94% distributed or planned to distribute the family resource guide for students to take home and discuss with their parents.⁵¹ The quality of the materials and the results led to strategic program spinoff activities including the state governors’ spouses convening teach-ins across the United States with the materials and continued funding and expansion of the project for several years.⁵²

Today, of course, the public can consume and interact with online media anywhere, anytime, from any device. Consumers have come to expect information they want will be readily available to them, and in a format in which they can talk about it or act on it. If the consumer is not satisfied, they might move on, and the opportunity to deliver a satisfactory experience can be lost. The expectation of desired information available at one’s finger tips coupled with continued technological advances and the desire for rapid response may require a business model that continues to adapt to rapidly-changing realities. 

Unit-based purchasing can make that kind of fit-for-purpose funding easier. For instance, the HHS Digital Communication Team began to use a two-week sprint of 10 people, which cost roughly US$50k, so the campaign leaders can estimate how many sprints it would take to complete the campaign.⁵³

Linking campaigns directly to overall efforts can help position agencies to get the most value. Doing this involves a reevaluation of how and what to measure: from merely reporting how many dollars were spent after a campaign ends to setting clear, quantifiable objectives in advance—such as reaching 80% of the target audience or doubling website visits—and going a step further to link them to outcomes. Recognizing this, agencies can intentionally create a dedicated line item for communication right in the agency’s mission.⁵⁴

Agencies should also consider an often-underrated part of strategic campaign funding: Evaluation costs.⁵⁵ Outcome evaluations offer rigorous data but can be expensive.⁵⁶ Establishing evaluation needs up front and setting aside a dedicated share of the campaign budget can go a long way toward making investment proof of impact.

This move can underscore the role and value of health communication: That stable, prioritized funding can support clearer messaging, better leadership understanding, and increased public engagement.

Build a real-time measurement foundation to track progress. It’s important to create the infrastructure to evaluate how health aims are working and adapt if they’re not. There may be a tendency to want to assume that doing the “right” thing will get the right results. But health program and campaign leaders should be ready to see when the “right” idea gets the wrong results and adapt to save time and costs.

When it comes to selecting a particular evaluation method, established goals can serve as a north star for where to invest.⁶¹ Creating a logic model or theory of change up front can also help agencies select fit-for-purpose evaluation methods. No one method is superior, and different methods can help answer different questions.⁶² Mixed-method evaluations, for instance, offer the most rigor and comprehension, but can take longer to complete.

Collecting multiple process data points is key to showing Americans are not just exposed to a message but are also believing it and taking action on it.⁶³ As Claudia Parvanta, PhD, shared, “We have McGuire’s hierarchy of effects, which we sort of refer to as the ‘holy grail’ of theory, but very few evaluations are designed to assess things like were people exposed to [the campaign], did people believe it, do people try [the suggested behavior], and do they repeat it?”⁶⁴

One way to consider approaching this is through optimizing channel mix by calculating cost-per-action, which entails defining targeted events in advance and later dividing total ad costs by the number of times the event occurred. Using this data, campaigns can continuously evaluate how much each new behavior—like hotline calls, or website sign-ups—costs on each platform.

To further quantify exposure, campaigns often use gross rating points (GRPs), which is a standard way to measure the total exposure of an ad campaign to its target audience. As Diane Beistle shared, “We know that whenever our campaign is on air we see dramatic increases in calls to the quit lines. Our TV and digital video media buy aimed to achieve around 1,200 GRPs per quarter.”⁶⁵ In this case, the campaign used this information to obtain a media mix to reach the intended audience that included traditional television, digital video and display, and social and search channels.⁶⁶

In today’s always-on digital era, there is seemingly endless data to collect, but measurement standards are still in development,⁶⁷ and it can be harder to interpret behavior change via social media. Campaigns that connected with consumers via phone in the pre-digital days could hear directly from consumers themselves what they saw and remembered about a campaign. Currently, social media shares are a proxy data point to suggest consumer buy-in, as well as when a consumer hosts the message and uses it to convey accountability, like committing to going to the gym or quitting smoking.⁶⁸ Some stakeholders are actively working on a GRP-equivalent standard that can be used to assess social media marketing success.⁶⁹

When campaigns aren’t working, pause and pivot. Taking stock midstream might save money and improve outcomes. One of the benefits of digital campaigns is optimizing media buy in real time, so campaign leaders can know if their messages aren’t getting traction or community engagement. The algorithms can auto-shift resources to messaging that performs better when multiple messages are used at once.⁷³ This gives campaigns an opportunity to evaluate what wasn’t working and fix problems in real time.

When dashboards suggested Missouri’s opioid public service announcement was raising fear instead of action, campaigners hit pause. A US$100,000 Super Bowl ad in 2015 set to a ukulele line, “That’s how, how you OD’d on heroin,” drew 500,000 plus social media views, but opioid-related deaths continued to climb.⁷⁴ In 2019, the state pivoted: US$800,000 went to Time 2 Act and NoMODeaths ads featuring real recovery stories and a “Text for help” call to action, triggering a surge in website visits and helpline texts.⁷⁵ Seeing the results, leaders halved the media budget and shifted funds to naloxone, housing, and treatment—suggesting that course correction can both save money and save lives.⁷⁶

Sing it from the rooftops when it works. Funders often respond to explicit results based on metrics that matter. While taking time to demonstrate success does not guarantee additional resources, it’s an important part of being accountable for the goals set.⁷⁷ Sharing timely results can also reinforce public trust and strengthen the case for continued investment.⁷⁸ It can also help decision-makers recognize that communication can be a central strategy for advancing population health.

One example is the positive ROI shown by the CDC’s Tips From Former Smokers campaign. Research showed that from 2012 to 2018, for every US$3,800 spent on the campaign, an early death was prevented, saving US$7.3 billion in smoking-related health care costs over six years—a 15:1 ROI.⁷⁹ Likewise, the Food and Drug Administration’s Real Cost campaign yielded US$128 in cost savings for every dollar invested.⁸⁰ And the HHS’s We Can Do This campaign, which aimed to increase confidence in preventive health behaviors, delivered an estimated US$89.54 in societal benefits for every dollar invested, including avoided health care costs and productivity losses.⁸¹ Even though success does not guarantee future funding, it can help build the evidence base that other funders need as justification for further investment.

Wrap with a “hot wash” to reflect and refine. Taking a cue from the field of disaster management, campaigns should consider concluding with a “hot wash,” a structured debrief where members and stakeholders reflect on what worked, what didn’t, and why.⁸² This approach helps create space for accountability and shared learning, allowing insights to shape future approaches and fostering an environment of continuous improvement. In 2022, the National Association of County and City Health Officials convened a hot wash with local health department directors and staff following a major public outreach initiative. The three-hour session focused on success and gaps across key programs and led several jurisdictions to adopt hot washes as a routine practice to inform and update future response plans.⁸³