It was 9.30pm on a Wednesday evening and Steve McGrath was returning home on his motorcycle from his teaching job when he entered one of Saigon’s busy intersections.
“I was really tired and not concentrating as intently as I should’ve been,” recalls Steve, an Australian who has been living in Ho Chi Minh City for almost a decade. “The lights had been green for about 10 seconds and I wasn’t paying enough attention to the traffic stopped on my left.”
A young woman’s scream was the only warning he got before she ran into him on her motorcycle. She had run a red light and hit Steve while he was crossing the intersection at around 30km/h.
“She hit my front wheel which spun my motorbike around and threw me onto the road,” says Steve. “I landed on my backside first but then I hit my head twice on the road.”
Although he was wearing a helmet, Steve was dazed after which he remembers bystanders coming to his aid. “By then the young woman had left the scene and I was left thinking that I’d cracked a hip bone.”
Steve chose not to seek medical attention, instead waiting to see the extent of his injury. It turned out to be only deep bruising.
“In the end I was okay, but I only use my motorbike during the day now,” he says.
Although Steve hadn’t sought medical assistance, he was covered by health insurance provided by his new employer. Had the accident happened just six months earlier and the injuries been more serious, he wouldn’t have been covered for the cost of medical attention.
“I’d never had health insurance before I started with my current company this year, other than the basic stuff Vietnamese companies must give by law,” he explains. “I was put off by the costs and caveats associated with taking out health insurance of my own.”
Doing Dumb Stuff
Steve’s decision not to take out his own health insurance isn’t an isolated one among the more than 82,000 foreigners living in Vietnam; surprising given motorcycles are the most common form of transport and 9,000 lives are lost annually to traffic-related accidents.
It raises the question why seemingly rational, well-educated people who choose to live in Vietnam, take the risk and opt out of buying health insurance in such a high-risk environment.
“We all do dumb stuff,” says Neil Doyle, the regional director of DeltaMV Knowledge Solutions, an Australian company that helps marketers overcome challenges in consumer behaviour by developing behaviour strategies. “It’s about understanding the biases at play that drive human behaviour. I call this the science of dumb stuff.”
According to Neil, humans are “sub-standard decision makers.”
“We are predictably irrational,” explains Neil, at his District 7 office in Ho Chi Minh City. “Why else would so many doctors smoke?”
Our irrationality, he says, explains why people try to economise on health care, even when it should be a fundamental thing to have in their lives. This irrationality is also exploited by marketers, as understanding human behaviour is central to devising effective campaigns.
“If you want to influence behaviour, you need to make it emotional, you need to make it social, and you need to make it easy,” he says. “If you like, that’s the new marketing mantra.”
Most of the work in which DeltaMV engages is in the healthcare space, but Neil also has extensive experience with companies who market fast-moving consumer goods (FMCGs), a field where something called moments of truth are fundamental to the success, or failure, of a product.
“In FMCG land, it’s when you walk into a supermarket and you’ve got Kellogg’s and you’ve got Nestlé, and you have a moment of truth,” explains Neil.
Neil is referring to the moment when consumers choose one brand over another on the supermarket shelf. Although a seemingly simple decision, it has been influenced by a number of factors over time, like price, brand awareness, and brand loyalty, and is the work of marketers who try to nudge you towards their product.
“A marketer will talk about the power of brand, and how it’s important to build strong, emotionally compelling brands,” adds Neil.
In the public health sector, a moment of truth might be when someone is torn between seeking medical attention or not. This may be for a host of reasons, but one of the main ones is the potential cost involved in seeing a doctor for something that may turn out to be minor anyway.
In Vietnam, it might be deciding whether or not to eat food from a street vendor on a night out, or allowing a complete stranger to drive you home on the back of their motorbike.
Making Better Choices
To make marketing campaigns emotional, social and easy, marketers work on choice architecture. As generally poor decision makers, humans will almost always choose the easier option, especially on impulse. This explains why EOA and POP (End Of Aisle and Point Of Purchase) displays are fiercely contested spaces among brands in supermarkets. Research has found that shoppers are likely to throw that last-minute chocolate bar or tabloid magazine into their shopping basket as they check out.
In public health, it’s more serious. Choice architecture is about equipping the public with the right tools to make the right decisions when they run into a moment of truth in their day. It could be the difference between accepting the offer of a recreational drug at a dance party, or choosing to abstain from sex with a stranger without a condom. Whatever the situation is, it’s important that people are not only better educated to make the right decisions, but that the resources are in place to help them follow through on positive decision making.
“What we know is that humans always have an emotional response before a ‘thinking’ response,” explains Neil, whose doctoral thesis investigated how the construction of gender and identity in the south of Vietnam impacts sexual health communication. “The thinking bit of your brain is slower than your instinct, or what some might call your gut feeling. Then your prefrontal cortex, the area of your brain responsible for decision making, catches up but it doesn’t work nearly as well because it’s biased to whatever the visceral response was.”
While marketers have used this knowledge to great effect to boost sales — perhaps to the disdain of consumers who may sometimes feel cheated or deceived into purchasing unwanted items — it has been beneficial to public health, including safe sex campaigns.
Breaking Down Barriers
“Choice architecture is about shaping the environment in a way that allows people to make positive choices,” says Dang Nguyen, an associate lecturer in Professional Communication at RMIT Vietnam, whose study in 2011 investigated the barriers consumers in Vietnam confront, both physical and cultural, when purchasing condoms. “It’s about eliminating all the choices that aren’t desirable, and making that standard practice.”
In her study, Dang and her colleagues observed how readily available condoms were at condom boutiques, like Gunshop and Golden Boy, pharmacies, convenience stores, and street vendors, often women on the street who sell condoms along with cigarettes.
“We found that convenience stores are the best at making condoms readily available to customers,” explains Dang, who holds an MSc from Oxford University. “They don’t lock them away so people have to ask for them, rather they are conveniently placed at the counter so they can discreetly mix them in with whatever else they’re buying without even having to talk to the shop assistant.”
While stores like Gunshop have largely been successful, one of Dang’s findings highlights the complications involved in implementing strategies for safer sex in a society that feels uncomfortable discussing it openly.
“From talking to people who sell condoms at places like Gunshop, we discovered that couples would go into these shops together, but they would always keep their air-pollution masks on,” says Dang, whose study was called Understanding the Condom Landscape in Vietnam. “Then, if they went to a particular store often enough, they would give their phone numbers and addresses so that they could have the condoms delivered to their homes rather than run the risk of being identified in public as a regular customer of a condom retailer.”
Neil agrees that condom retailers like Gunshop are successful because they work at a choice architecture level; they are nearby, convenient and have made the narrative around condom use more socially accepted, and thus, more normalised.
“If discussion about condom use and safe sex is able to be raised in everyday conversation, then it will mean the topic will have become less of a taboo,” he says. “And then if you happen to be at that moment of truth in the bedroom with your partner, you’ll be able to make the right decision for you and them.”
Sending the Wrong Message
But this hasn’t always been the strategy for bringing about behavioural change at a public level, particularly in Vietnam. Neil points out that traditional strategies wrongly sent “quite rational messages” to a public that has since been proven for the most part to be irrational in its decision-making processes.
“In terms of sexual health, the message used to be ‘use a condom because otherwise you’ll get a horrible disease, you’ll get AIDS, you’ll die,’ so there was, and still is, a very kind of rational parent-to-child style of communication,” says Neil.
Neil also points to anti-smoking campaigns as a good example of this.
“We still have 20 to 30 percent of the adult population globally who smoke,” he explains. “Do they know that it will give them cancer? Of course they know, so what it means is that there are limits to how compelling a rational message is from a behavioural perspective.”
Indeed the figures stack up. According to WHO estimations, there are more than one billion smokers in the world with tobacco killing more than seven million people a year.
“If you want to communicate something, you have to be clear on its strategic intent,” adds Neil, who says that billboards at large traffic junctions are effective if it’s clear what’s trying to be achieved, “but if you’re trying to build emotionally competent associations in people’s minds or trying to trigger a behaviour like trying to prevent the spread of HIV through condom use [or the use of drugs], then I’d say it’s much more inappropriate because you want to say that in a bar or bia om.”
As for Steve, he is more circumspect about life in Vietnam.
“Not having health insurance played on my mind, but I tried my best to ignore it and hoped for the best,” he says.
Would he recommend others get insurance if they were living in Vietnam?
“No question about it. They’d be dumb not to.”
Photos by Mike Palumbo