A Dose of Change: Big pharma takes small but steady steps to address the marketing challenges of targeting Hispanics

December 01, 2005
By Derek Reveron

When one of Cecilia Alvarez's children took ill in her native Mexico City, she consulted a doctor by phone and bought antibiotics herself without prescriptions. Shortly after Alvarez moved to Miami eight years ago, another child became sick. Not able to connect with her doctor directly, she waited hours in an emergency room before receiving a prescription for an antibiotic. "It was a culture shock and a waste of time and money for something I could have gotten myself in Mexico," says Alvarez, the co-author of a study on Latinos and health care published this year by Kalorama Information, an imprint of MarketResearch.com.

Alvarez is one of millions of Latinos now living in the United States who retain cultural views about what a drug is — and how to buy and use it — that differ from those of mainstream consumers.

Medical drug laws and enforcement are less strict in Latin America, where consumers do not need prescriptions to buy certain medications that require a doctor's order in the U.S. As a result, self-medication is more common among U.S. Latinos than in the general population, according to Hispanic market researchers and health care providers. Other cultural differences exist as well. Latinos tend to be more deferential to doctors and hesitate to ask questions. They are less likely to take medicine as a preventive measure and more likely to lack health insurance (see sidebar).

Such differences create advertising and marketing roadblocks for the pharmaceutical industry, which is taking small steps to tap the Hispanic market after practically ignoring it for decades. Some pharmaceutical companies are trying to overcome the cultural differences by educating the Hispanic market about diseases and drugs. But the industry still has much to learn, marketing experts say. "The general-market advertising approach is, 'Here's the drug. Ask your doctor about it.' That doesn't work with U.S. Hispanics," says Michael Saray, president of Michael Saray Hispanic Consulting in New York. "They are more likely to view ads as educational and credible, so educate them."

The pharmaceutical industry spends relatively minuscule amounts of money on the Hispanic market, despite its health-care buying power. According to a 2003 study by Kalorama Information, Hispanics spend $70 billion a year on all health care. Nevertheless, in the same year the industry spent only 0.9 percent of its advertising dollars on Hispanic media, according to the latest data compiled by the Association of Hispanic Advertising Agencies (AHAA).

During the first six months of 2005, pharmaceutical firms invested $2.6 million in Hispanic media, compared to $3.2 million during the same period the year before, according to Nielsen Monitor-Plus, a unit of Marketing y Medios parent VNU.

Pfizer Inc. is the top-ranked pharmaceutical advertiser among Hispanics while reserving 2.5 percent of its ad budget for that market, according to AHAA. By comparison, the telecommunications industry spends 7.3 percent of its ad budget on Hispanic media. Pfizer is one of the nation's biggest spenders on general-market ads, but ranks 39th in Hispanic advertising outlays, according to AHAA (see chart).

Industry observers point to several reasons for the lag in the pharmaceutical industry. There has been an overall lack of research on the Hispanic market and its view of what the pharmaceutical industry calls direct-to-consumer (DTC) prescription drug advertising. Drug makers constantly change brand managers, and that contributes to a lack of focus on the Hispanic market, says Rupa Ranganathan, senior vice president and ethnic strategist at Strategic Research Institute (SRI) in New York. "It's not clear at many companies who is responsible for marketing to Hispanics," she adds. "Companies need to define for themselves, internally, exactly what marketing to Hispanics is and who is responsible for it, says Ranganathan, who helps SRI organize an annual conference called "Market Development & Outreach Multicultural Pharmaceutical."

Several pharmaceutical companies declined to discuss their marketing efforts, citing a policy of not doing so.

But pharmaceutical companies are gradually targeting Hispanic consumers, and this year the sector saw a burst of activity. In August AstraZeneca hired The Bravo Group as its lead Hispanic agency.

"They are ramping up their spending on the market and making a major commitment," says Gary Bassell, Bravo chairman and CEO, though he declined to be specific. Bravo also has worked with Wyeth for several years, producing television and print advertisements for over-the-counter medications including Advil, Alavert allergy medication, Robitussin cough syrup and Dimetapp cold medication for children.

In March, Los Angeles-based cruz/kravetz: IDEAS launched a separate unit called The Neighborhood LLC, which focuses on Hispanic marketing and education for the pharmaceutical and health care industries. So far, The Neighborhood has completed health education projects for Aventis Pharmaceuticals, Bayer Immunology and Abbott Laboratories. "We expect to get a new batch of clients next year," says CEO Carl Kravetz.

Insiders predict more pharmaceutical companies will expand their Hispanic marketing efforts for two principal reasons: Competition among drug makers is increasing and Hispanics represent one of the few remaining sources of domestic market growth, and the nation's 43 million Hispanics have a higher incidence of health problems such as diabetes, high blood pressure, heart disease, asthma and AIDS, according to Kalorama Information.

Hispanics purchased $14.1 billion worth of prescription drugs in 2003, according to AHAA. Hispanic spending on prescription drugs is growing 13.2 percent a year, compared to 11.3 percent a year for non-Hispanics, according to a 2004 study, "The Hispanic Market and Pharmaceutical Drugs," commissioned by Telemundo to convince drug makers to advertise to Hispanics.

EDUCATION COMES FIRST

Since DTC ads aim to convince viewers to ask their doctors about prescription drugs, it's a difficult pitch for people who do not visit physicians.

"There is an issue of how to get Hispanics to turn to medical professionals for advice and education as their first source as opposed to their second or last source," says Bravo's Bassell. Second- and third-generation Hispanics who have higher incomes and acculturation levels tend to seek more help from doctors, Alvarez says. But the cultural values tend to remain even as the use of Spanish declines. "That's why putting a [prescription drug] ad out there that doesn't speak to me as a Hispanic won't work," she adds.

Experts advise pharmaceutical companies to abandon Spanish-language remakes of general-market DTC ads that basically introduce drugs, explain their benefits and risks and how they can improve health.

"It has been 'Brand, brand, brand: Do not pass go, go directly to physician.' That message doesn't work with certain segments like Hispanics," says Mark Bard, president of Manhattan Research, a New York health-care marketing information and services firm. To reach Hispanics, he says, pharmaceutical companies must first educate them about a disease, the importance of treating it and how a drug can improve their lives.

Pharmaceutical companies that take the lead have one clear advantage: When it comes to prescription drugs, the Hispanic market is practically a clean advertising slate upon which pharmaceutical marketers can imprint their message. "Hispanic consumers are much less jaded because they have so few DTC ads targeted at them. The general market can't watch a program without seeing a prescription ad," says Michael O'Shea, Telemundo vice president of business development, who helped commission the study.

Among the study's major findings: 61 percent of Hispanics feel more comfortable about prescription drugs advertised on television, compared with 25 percent for non-Hispanics. Seventy-nine percent of respondents said they want to see more pharmaceutical ads on TV. Fifty-seven percent of Hispanics had heard of Pfizer's cholesterol-lowering drug Lipitor, compared to 94 percent of non-Hispanics.

UNBRANDED EFFORTS

One of the perks of the market that pharmaceutical companies should keep in mind is brand loyalty. Once Hispanics try a prescription drug brand they are more likely to stick to it. But the trick is getting Hispanics to try a brand. To do that, pharmaceutical companies should start with unbranded educational campaigns that do not push the names of prescription drugs, marketing experts advise. The campaigns should connect with Hispanics culturally while educating them.

Pfizer, despite its relatively small Hispanic advertising budget, is leading the way in this area, marketers say.

Pfizer's "Promotoras de Salud" program with the National Council of La Raza trains women in local communities to discuss health matters with friends and family members. Pfizer's "Vidasana" program provides bilingual educational materials for doctors who don't speak Spanish.

In 2001, Pfizer and Ketchum Multicultural Marketing unveiled the "Sana la Rana" educational campaign in New York. The program, which later added Houston, Los Angeles and Miami, stems from a rhyme that Latinos of nearly all nationalities recite to ill children: "Sana, sana, colita de rana. Si no sanas hoy, sanarás mañana."

The campaign's logo depicts a frog in a white doctor's coat because "colita de rana" is a frog's tail. Sana means healthy, or to heal. Sanalarana.com says: "Sana sana colita de rana. Visita a tu doctor por una vida sana." The Web site provides the schedules of local health screenings and takes requests for Spanish-language brochures on several diseases via e-mail or an 800 number. " 'Sana la Rana' is a fantastic program because it took into account health and culture," says Hispanic market consultant Saray.

Dallas-based Dieste Harmel & Partners, Pfizer's Hispanic agency for "Sana la Rana" and Lipitor, created an unbranded Spanish-language TV ad for the drug. The ad likens high cholesterol to a stopped-up sink and suggested that viewers seek more information from their doctors and sanalarana.com. A branded Lipitor Spanish-language TV ad that ran in Los Angeles and Chicago drove home the message that it is difficult to tell who has high cholesterol. In July, Pfizer introduced the Spanish-language Web site colesterol.com, to promote Lipitor.

Dieste partnered with up to 50 churches in Los Angeles and Miami this past summer and fall to conduct an unbranded Lipitor campaign. The churches hosted cholesterol screenings where consumers received information about heart health. Visitors could sign up to later receive information about Lipitor by e-mail or postal mail. Churches publicized the screenings in their Sunday bulletins and through teams of members that handed out flyers in neighborhoods. "Our goal was to get sufferers and potential sufferers of high cholesterol closer to visiting a doctor and not rely on home remedies," says José Pablo Rodriguez, Dieste's account director of Lipitor and "Sana la Rana."

STILL NOT PREPARED

Cruz/Kravetz's The Neighborhood organized an unbranded diabetes educational campaign sponsored by Aventis that directly addressed cultural differences. The campaign, conducted during the second quarter of this year, included educational forums at community centers in 12 markets. Local teaching hospitals and community organizations co-sponsored the forums and invited people to attend. Direct mail also was used.

Since health care choices tend to be family decisions among Latinos, invitations to the forums encouraged people to bring their families. During the presentations, a Spanish-speaking doctor and diabetes educator told attendees that self-medication delays treatment, says Kravetz.

Unfortunately, such campaigns are still rare. Some pharmaceutical companies still ignore the Hispanic market, says O'Shea. After Telemundo completed its study, O'Shea asked every major pharmaceutical company for a meeting to discuss the results. Nine companies accepted, two declined. "They said we weren't prepared for multicultural marketing or didn't have it in place," he says. "That's a problem."