Multicultural audiences are increasingly important to pharmaceutical companies, but some are slow to reach out to them.For some time, it's been said that the healthcare industry has been slow to catch up with the other consumer industries when it comes to marketing to multicultural audiences. Some companies, however, appear to be ahead of this curve, illustrated partly by the fact that three of the five finalist campaigns for PRWeek's Multicultural Campaign of the Year, to be awarded this week at the PRWeek Awards 2004, were created and implemented by healthcare corporations and their agencies. Are the three shortlisted healthcare companies - AstraZeneca, McNeil Nutritionals, and Pfizer - really ahead of their competition in their marketing efforts, aware that addressing multicultural audiences is imperative to optimizing the effects of communications outreach? Or, conversely, is the healthcare industry - in particular, the pharma companies - just starting to catch on to what other sectors have been doing for decades? Sheila Thorne, president of the Multicultural Healthcare Marketing Group, believes the answer to those questions lies somewhere in the middle. She says, "[Pharma companies] are doing a lot more than they did before. There used to be complete resistance because the attitude was, 'those people are sick because they are poor, and they don't have insurance.' Even those that were not of that mindset thought of [addressing multicultural audiences] as part of a growth phase, not part of the launch when you have more money. By the time you get to the growth phase, you are trying to squeeze out remaining dollars. The multicultural component was always an appendage - it didn't fit into their one- size-fits-all, mass-market mentality." Despite what Thorne describes as an explosion of multicultural campaigns in the past ten years, as more clinical data about mortality rates of ethnic communities has emerged, she says, "For pharma to succeed in the new millennium, it needs to reinvent itself on a number of levels." Getting a drug company to admit to what percentage of its marketing budget goes towards multicultural programs is almost as difficult as getting them to reveal the molecular structure of one of its pipeline drugs, but few contest that a void exists. Laura Schoen, president of global healthcare for Weber Shandwick, is currently working on a campaign for Gilead's Hepatitis B drug Hepsera for which "more than 50% of the budget" is being spent on minority outreach. Even she says, "I don't hear the words 'ethnic communities are a priority.' We always include it, but it's never the focus." Dangers of not prioritizing ethnic groups In her speech about the topic at last November's PRWeek healthcare conference, Thorne presented data to demonstrate the business opportunity lost by pharma companies that choose not to make targeting non-whites a priority. Currently, according to Thorne's presentation, 27% of the US population is made up of Hispanic/Latinos, African Americans, Asian Americans, Pacific Islanders, American Indians, and Alaska Natives. She went on to explain how those groups already make up a majority of the population in California (60%), and will be the majority in Texas within the next decade, and New York and Florida within the next two decades. The collective buying power of Africans, Hispanics, and Asian Americans, said Thorne, has reached $1.3 trillion - up from $647 billion in 1990. It's projected to reach $4.5 trillion by 2015. As this relates to healthcare, Thorne said, "Although advances in biomedical research have improved the overall health and longevity of the majority of Americans, racially and ethnically diverse populations have benefited less." That's unfortunate, since "African Americans and Native Americans have the highest infant mortality in the nation," Thorne continued. "The prevalence of type II diabetes is two times higher in Latinos than non-Latino whites. African-American men have the world's highest rate of prostate cancer. Asian women have the highest rate of cervical cancer of all women." So why are pharma companies hesitant to invest properly in marketing products to these audiences? According to Thorne, it stems from the pharma companies' intense focus on ROI. Says Thorne, "Because so much of multicultural marketing is relationship development, the programs are not realistic in the time frame that pharma companies want to see results." She calls this "counterproductive to the goals of multicultural marketing." There is also the issue of coverage. Despite the fact that, according to Thorne's presentation, 60%-85% of African Americans, Hispanics, and Asian Americans have health insurance of some sort, there is an incorrect assumption that they don't. Julia Amadio, VP of multicultural marketing for Aventis, says, "[Pharma companies] look at the market segments and recognize the difficulties that many of the people are facing economically, and jump to the conclusion that there is not coverage." She calls this "one of the biggest fallacies" in getting pharma companies to give genuine consideration towards marketing their products to ethnic communities. Further reluctance, even among management teams that don't buy into the coverage fallacy, to invest in multicultural pushes persists because of the way dollars are commonly allocated. Often, the bulk of the money that pharma companies put towards marketing, and particularly PR, go to new therapies because there is pressure to make back the hefty investment that was put into researching and developing the drug. Unless it is a medication for which there is no other available alternative, competing or generic, government-funded healthcare programs such as Medicare or Medicaid often do not cover the newest drugs. As a result, ethnic communities, which make up a high percentage of Medicaid and Medicare recipients, are unlikely targets for pharma companies' marketing efforts. Streamlining comms efforts Another internal issue that has prevented significant dollars from being spent on targeting multicultural audiences is an industry-wide trend towards streamlining marketing efforts in an attempt to deliver consistent messages in a cost-efficient manner. Last November, for example, Aventis handed all marketing responsibilities for its global oncology franchise to Team Aventis Oncology, a network created by Omnicom's Diversified Agency Services. Similarly, Pfizer last month picked WPP's newly formed WPP Health Success to handle PR for three of its biggest cardiovascular products. In both cases, there is a multicultural component and dedicated people from the agencies to address those audiences. The decision to bring everything under one umbrella, while useful for delivering consistent messages across multiple audiences, eliminates the possibility of hiring smaller, multicultural boutique firms that often have the most expertise in catering to the specific cultural needs of different ethnic groups. Several pharma companies have been translating materials, mostly into Spanish, for many years, but steps towards presenting marketing materials in a way that accounts for differences in culture have lagged. Familial relations in other communities, particularly Hispanic/Latino, are generally much more important than they are among whites. Similarly, what Hispanics consider privacy is different to the conditions that commonly exist in American healthcare facilities. Ana Rita Velazquez, head of Fleishman-Hillard's Hispanic healthcare practice, recently addressed this issue of privacy when her team was hired by a Miami-area hospital to perform a cultural audit. Velazquez's group assessed the facility's signage and procedures for welcoming patients, and then made recommendations for what changes had to be made. They worked with architects to explain what privacy means to Hispanics, and suggested having chairs for at least two family members in the doctors' offices. Velazquez suggests pharma companies do a similar kind of auditing of their marketing programs. She says, "There are things companies can do to see how culturally friendly they are. Translating materials isn't enough." In addition to the concern about having the resources to address cultural nuances, making multicultural efforts part of the larger picture, while clearly better than nothing, can sometimes result in generalized, corporate approaches, opposed to product-specific marketing. Says Thorne, "Because [the people working on multicultural issues] are not connected closely enough to the brand teams, they end up doing inside what I do outside - knocking on the door for money. You need a designated person on each brand team who focuses on multicultural marketing. It must be on the budget so it's counted as a line item." Velazquez agrees, "Whatever a company is doing in terms of abiding by principles" by which addressing ethnic communities is a priority "is extremely important. It does not substitute for directly marketing products, but it is a good blanket." Donna Henry Wright, senior account supervisor from Hill & Knowlton and one of the people assigned to work on the multicultural component of WPP Health Success, notes the importance of incorporating both corporate and brand-level ethnically diverse strategies. "There need to be people at the brand level to make sure multicultural messaging is part of every product plan, but also at the corporate level because it keeps the efforts important to the C-suite," says Wright. "Morally, being able to say that you're giving full access to your products is where you need to be, and from a bottom-line perspective, it's where you need to be." Thorne agrees, "It's not about black and white. It's about green."