Don't forget about Gen X when you're planning your next hospital marketing campaign.

What about the Xers? So much of the healthcare marketing we see now is geared towards the Boomers. Boomer this, Boomer that—Boomers even have their own health conditions named for them, like “Boomeritis.”  How old do the members of the Breakfast Club have to be before they become a target audience for your hospital service lines?

Here’s a tip if you are going to start messaging to Generation X, leave the Boomer-speak at the door, a whole other language is required. And those services you were hoping the Boomers would use? Guess what? Xers are already using them.

According to research conducted by Thomson Reuters Healthcare, Generation X is the “Educate Me” generation. While other generations seek engagement or connection, the Xer wants to be sure you know what you are talking about.  Here are some highlights from their study:

• An interest in being engaged and educated characterizes Generation X.

• Relatively healthy as compared to older generations, they are notably curious and actively seek information.

• They assume physicians and staff are knowledgeable and have a strong interest in amenities.

• Consumers in this generation are more likely to switch physicians and hospitals based on their most recent experience, rather than their overall past experience.

• This group has more in common with the Millennial adults than with the Boomers.

• When Generation X thinks about medical professionals, their definition is broad and includes nurse practitioners, physician assistants, insurance companies, and pharmacies.

Generation X comprised the highest volume of callers to hospital call centers. Although they initially seek information online, they follow-up with call centers to determine expertise and seek additional information. Consider your services. What are you offering that speak to this generation?

It can be scary to bust some new moves.

In all communications with consumers, whether it’s online, in print or over the airwaves, it’s easy to forget that we’re just talking to people. Usually that’s because there’s a laundry list of information that “needs” to go into each ad. In fact, in healthcare advertising there’s a well-known dance:

Step 1: Mention skilled doctors, latest technology and dedicated staff.

Step 2: Throw in a patient testimonial.

Step 3: Always tell people about your awards (even if they have no idea what you’re talking about).

Step 4: Grab a partner (preferably a celebrity).

That’s why so many hospital communications are eligible for the Hall of Same. And it’s a real shame because hospitals are so much more than this set list—and with some creativity and courage, communications could be very different.

It can be scary to bust some new moves. It feels safe to repeat the tried and tested sequences. Just keep in mind that this isn’t how you talk to people. You don’t go around having the same conversations you’ve had for the last ten years, listing the same points (well, at least we hope you don’t). That’s when people start to ignore you.

There might be one thing worse than repetition when you’re talking to people. And that’s telling people what to do. It’s easy to fall into that trap when you’re writing a healthcare ad (“Go get a mammogram now!” “Get tested for prostate cancer stat!). Let’s be honest, no one likes being told what to do, not in person and not in print. When a hospital cares about its patients and wants to be successful, it just needs to find its voice and starting talking, not telling.

A lot of voices sound the same out there. If you covered up the logo on a print ad or TV commercial, could you tell which hospital was being advertised? Probably not. That’s why it’s so important to think about who you are and what your voice is. Finding your individual voice and not being afraid to show some personality is key. Every communication is a hospital’s chance to let people know who they are beyond a list of services, patients and beds.

The hospitals and agencies that are brave enough to break the age-old dance routine are the ones that will be up on the dance floor for years to come.

This blog post previously appeared in Ragan's Health Care Communication News.

The agency world

After more than a decade as a marketer for major health systems, I crossed over to the dark side: the agency world. The world where you live and die by your client’s needs and deadlines. Where you stress over timesheets and sales reports. Where you become — gasp — a “salesperson.”

It was the right move. And I didn’t become a salesperson. Instead, I’ve developed productive relationships with people who’ve become partners, not just clients. I’ve been able to step back and look at the big picture for these partners, because I’m no longer bogged down in hospital politics and appeasing physicians who clearly know more about marketing than the rest of us. I can focus on doing things I always wanted to do, but never had time for.

Most important to the agency’s clients, my understanding of healthcare and complex hospitals and health systems gives me a unique perspective. And that perspective comes in handy internally, sharing ideas and brainstorming with a creative team that thrives on innovation.

Would I tell every healthcare marketer to jump to the dark side? No! As Una Newman says in the May issue of Healthcare Marketing Report, agencies are not for the faint of heart. But if you have thick skin and are willing to use your in-hospital experience to your clients’ advantage, they’re not a bad place to be.

Hospitals are using Social Media

Some hospitals are early adopters; others are still waiting on the sidelines. Some are high-tech, while others are high-touch. I’m not talking about whether or not a hospital has the latest robot or a brand personality, I’m talking about a social media presence.

At AB&C, our healthcare clients range all across the social media spectrum. Some have jumped in with both feet and have been posting and tweeting for more than a year. Others are just about ready to make the leap, while others still are trying to convince their senior leadership that they need a social media presence.

Research shows that 906 hospitals in the U.S. are active in social media, with Facebook and Twitter being the most popular vehicles. With these numbers growing and marketing budgets shrinking, it’s becoming more and more clear to healthcare marketers that social media is here to stay and can be an effective and cost-efficient part of any marketing plan.

Regardless of where you are on the social media spectrum, here are a couple of my favorite sites:

Children's Hospital Boston

Regions Hospital

California Pacific Medical Center

Working with an agency

How can a PR agency help you in your quest for the gold? How can they understand the constraints of hospital PR and the competitive, ego-rich environment you have to navigate every day?

1. Use an agency with proven experience in healthcare public relations and media relations. You need someone who has been there and done that.

2. Let your agency be on your team. The more they know, the better they can help you. That means inviting them to clinical team meetings and making sure they have access to all your collateral materials. You can be assured that they will always have your back at all times.

3. Choose an agency that has the right tools. If your account executive has never heard of ProfNet, HARO, Cision, Vocus, SHSMD or NACHRI, you need to start shopping around. The right PR tools will help ensure that you are visible in the marketplace.

A good PR agency works with you, has a strong grasp of your goals and is well versed in your communication strategy. They should be intimately familiar with your hospital’s culture and assets. Because, when the pressure’s on and you’re reaching for the gold, your PR agency can extend your reach.

Get noticed by the media

So whatever happened to Dr. McDreamy? The world’s news cameras are at your door and you can’t wait to show off the medical miracles happening in your hospital. Here’s where the level head comes in.

With the needs of the patients and family, the media, and the executives in mind, you need a well-oiled PR department in which everyone knows what to do. (And maybe even a PR agency. But more on that later.)

Interviews are scheduled, executives are informed and expectations are managed. At the end of the day, the media gets what they want — a compelling, informative story told through the eyes of real people. The C-suite gains exposure for the clinical team and hospital investments. You get a chance to enhance your media relations.

Here is where a steady stride will pay off. A hospital PR professional who produces a steady stream of newsworthy stories — and keeps the information coming — will be noticed by the media. If you focus on the media relationship and tell stories with people in mind, you’ll reach the pot of gold and maybe even land an interview on CNN.

Make your healthcare story gold

You’re a hospital public relations professional and you want to get on the evening news. And you will — because you have Dr. McDreamy saving lives in your OR and Elmo visiting patients in your cancer ward. And yet, at the end of every news-crew-coordinating day, your executives demand a completely different level of recognition.

The C-suite wants gold: the CNN interview with the highly sought-after surgeon they just hired. A 60 Minutes story about the new hunk of technology the board just agreed to pay for. Even if you’re a seasoned and connected PR professional, these are elusive goals. So what do you do?

Ask yourself what rates as news. Think like an editor, reporter and producer — or better yet, like a reader or viewer. Is this a story you would tune into? Never pitch a story that is not newsworthy — it will keep you from the gold.

Focus on who — not what — makes miracles happen. Acquiring the latest technology has to be about more than flexing muscles in a competitive environment. The new doohickey must be saving or improving people’s lives.

Be creative. In the sea of new media, find the most effective vehicle for the story. The award and accreditation story may be best told via trade media. The health clinic and expert panel may be best told in a social media outlet. The sensational patient story is best on the evening news, while the issue-related medical ethics story is best for a print outlet. Be aware of your venues and use them wisely.

With media calling on one line and your executives on the other, you need to go for the gold, but keep a level head and steady stride.

Making Hospital Commercials Memorable

What commercials stick out the most in your memory? Maybe it’s “Keep your hands off my Doritos!” Maybe it’s the Geico cavemen spots. What makes them memorable? That’s easy — they’re funny.

Now, when’s the last time you told a friend, “Oh, man, you should see this hospital commercial!” Exactly. Healthcare-related ads are typically very subdued: a panoramic view of a hospital floor, smiling doctors and nurses, high-tech equipment, etc. A soothing voice assures you that, as a patient, you’ll receive the best care possible. Ho-hum.

Is there another way to get that message across?

Fauquier Health in Virginia seemed to think so. While their message is typical —you are a priority, your care is personalized — their delivery is anything but. Instead of pleasant but forgettable images of their own facilities, Fauquier’s TV commercials depict just the opposite: a factory-like hospital treating patients on an assembly line. In one spot, anonymous patients roll by doctors in hard hats who shout instructions across the factory floor (“This one’s goin’ to x-ray!”). In another spot, pregnant women are treated like cattle. A nurse hands out cups to mothers without making eye contact, mechanically chanting, “Ice chips. Ice chips.” A doctor almost cruelly flashes a newborn at its mother then tosses the baby into a passing bassinet.

Not what you would expect from a hospital. But, no doubt, you can relate to being treated impersonally in a healthcare setting. So, while there’s no word yet on whether these spots have had an impact on Fauquier’s bottom line, they’re probably gonna stick in your mind.

Become involved (and strategic) with social media.

Fear is a terrible thing. Especially when it causes healthcare systems to back away from using a potentially powerful communications tool. When it comes to using social networking sites such as Facebook or Twitter, healthcare systems tend to fall into two categories. The first suffers from significant fear regarding negative feedback that may come from using such tools. This group also struggles with how much time it will take to make this a successful venture. The second group is “gung-ho” and jump into the pool before they check to make sure it’s been filled with water.  This group tends to throw every possible press release, article and “approved” message they can find onto their social media channels, only to realize  they’ve created a one-way conversation.

There is a better way.

You wouldn’t run a cardiology advertising campaign without putting together a strategy. You wouldn’t invest in a web banner advertising campaign without determining key messages. Why is social networking any different? Everyone knows how large Facebook has become. We know that Ashton Kutcher has millions of Twitter followers. We know that healthcare executives are hearing the buzz and don’t want to miss out.

Items to consider before you get started.
1. Define goals. Be specific and make them related to interactions, not followers
2. Establish channels. Certain sites will work better for different messages.
3. Define internal and external resources. Who can help provide good content for your channels?
4. Integrate existing materials. Chances are you are already doing community-based events. Why not promote them?
5. Prepare for the worst, even though you probably won’t need it. Commit to a customer service model for any negative comments that are made. Resolve to help make situations better, not to censor.
6. Dedicate time. Social networking is just like live networking. If you’re not in the room you can’t have a conversation. But that doesn’t mean it should fall on only one person’s shoulders.

So, before you get started, get strategic. Get creative in how you use and measure your successes. Most important—end the silence.

Creating a customized online risk assessment

So how do you get a cardiovascular campaign to stand out above the clutter when there are more than 50 hospitals flooding the market with similar messages? How do you engage consumers to come to your website and sign up for your marketing materials? How do you get people to realize that they’re at risk for heart disease and proactively seek out a cardiologist in your health system?

These are all questions we were asked by The Chester County Hospital (TCCH) marketing team and questions we asked ourselves as we developed marketing recommendations for their cardiovascular service line.  Our answer was to develop an online risk assessment that would determine an individual’s risk level for heart disease.

But this assessment needed to be different from the templated ones that could be bought from other companies. It needed to be customized and reflect the TCCH brand.  It needed to have evidence-based questions and it needed to promote and link to the system’s monthly screenings and community outreach programs. It also needed a personal component that offered a resource to individuals at high risk.

After several planning sessions and a month of programming, Heart Tracks emerged. This customized online heart risk assessment was built with the marketing and Cardiovascular teams at TCCH, and provides a custom report that links the individual’s risk factors to TCCH programs and services. Those who are at high risk can request a personal consult with the TCCH cardiac nurse navigator and if necessary, have an appointment immediately scheduled with a TCCH cardiologist.

Backed by a comprehensive advertising campaign, this initiative has been hugely successful with more than 1,500 people completing the assessment, 300 people signing up for TCCH marketing materials, 20 scheduled appointments with a TCCH cardiologist and an appearance on the cover of a leading health care marketing publication. All of this in less than three months!

Why online advertising is important for hospitals.

By: Kelly Hocutt and David Michaluk

Are you still reluctant to advertise your hospital on the web? Maybe you’re bound by tradition. Or maybe you think healthcare is too private for the web — and people seek information only from people they can trust. But research by OTX and Google shows that adding search and web advertising to your marketing mix is more than just helpful — it’s essential.

That’s right. Consumers are increasingly going online for hospital information. 41% go to the Internet before seeking advice from healthcare professionals or friends and relatives. When these information-seekers get to the Internet, 76% go to hospital websites, 62% to search engines and 56% to health websites. They’re using more than one destination — which means if you’re not using search engine ads and ad networks, you’re missing a sizable audience. If they don’t see you, you don’t exist.

And they’re not just window-shopping, either. After finding information, 59% of these consumers take action. This includes 46% who look for more information, 16% who clicked on an ad, 14% who forwarded a link or video and 10% who booked an appointment. These additional actions translate into greater awareness of your organization, good feelings, referrals and appointments. Do these goals sound familiar?

Just as important: Recall is higher for online search than for any other medium. Yep, more bang for your buck. 43% remember online ads while only 32% recall TV ads, 28% informational brochures, 18% newspaper ads and 18% billboard ads. Isn’t your aim in advertising to get your audience to remember you? You’re spending a lot of money advertising, so get more value for your money and welcome online advertising into your marketing mix. Plus, when people recall an online ad, 43% look online for more information, 38% ask a medical professional about a hospital, and 38% ask a friend or family member about a hospital.

So, should your hospital advertise online? The numbers say it all.

Sometimes you have to get mean.

If your communications department has been enlisted to shore up compliance with hand hygiene requirements (pre- and post-patient contact), take a lesson from Denver Health. As reported in the February 2009 issue of the Journal of Communication in Healthcare, Colorado’s primary “safety net” institution tried humor, incentives, prizes — but nothing worked until they got mean. They put a button on the home page of their intranet so employees could report offenders anonymously. Communication professionals are taught to rely on positive messaging to initiate change. But the Denver example shows that sometimes you have to slap a few hands to get them washed.

Medical Marketing Becomes an Origami Crane.

Authors: Kathleen Dunn and Peter Gordon

Part V. Now is it a crane?

It is if you can take each of your different edges and planes and decide that they meet at well-defined creases, and that the combination of folds results in a recognizable final offering and a structure to support it. This structure is evaluated by testing each of the message streams to ensure that they are believable (each target audience must be convinced that what you say about the offering is true — and that it has true value to their particular area of expertise) and supportable (all claims must be supported by legitimate data that are relevant to each prospect’s particular needs).

If your final figure withstands this multivariate scrutiny, then maybe you do have a crane. Or a bird that better suits your offering. It may not necessarily be symmetrical. In fact it may be a bit messier than you would like; life has a way of not conforming to the exact strictures of an artificial system. But don’t be bothered by the little wrinkles — it means you have tested this construct and found it robust. Now it’s time to see if it flies….

Medical Marketing Becomes an Origami Crane.

Authors: Kathleen Dunn and Peter Gordon

Part IV. Is it a crane yet?

Marketers need to keep in mind that each prospective audience comes to the party with its own set of contextual variables, as well as its own set of conceptions — and misconceptions. Obviously, you begin with a thorough analysis of the needs of each target audience. The critical questions and message streams that flow out of this analysis guide the communication with each.

Are you done? Do you have an origami figure? No, you only have several target-specific efforts or campaigns. Now comes the really hard part — the heavy folding. Just as when you’re creating an elaborate origami bird, you now have to rationalize the various facets of the offering into a cohesive branding structure.

Each message stream and the strategy that underlies it must be tested and evaluated from the perspective of each of the target audiences. Where are the touchpoints? How does this message impinge on the world of target A, on target B, on target C? Once you have taken all of your messages together and cranked them through each of the targets, you should have discovered where the commonalities are (this is the gold we seek, those key messages that serve as the foundation for the brand across all segments) and where the differences are (this is where you show your value, by creating expressions of the brand that serve different purposes, and different prospect needs, without contradicting each other).

In Part V, I think we’ll find the Crane.

Medical Marketing Becomes an Origami Crane.

Authors: Kathleen Dunn and Peter Gordon

Part III. Origami marketing - folding the messages

It is not critical to understand how all of these scientific disciplines function. However, it is necessary to know where the hinges are — those areas of convergence that connect you with the disciplines that will further the efforts of all.

The challenges may be biggest for pharmaceutical marketers. Accustomed to communicating with prescribing physicians and pharmacists, these marketing professionals must set their sights on a much wider audience, and probably a smaller patient population. They must craft new messages and be able to understand and communicate with other healthcare disciplines: radiology and molecular imaging, pathology and laboratory medicine, oncology, cardiology, even genetic counseling.

The challenge now is folding the messages into an integrated whole that is both creatively compelling and scientifically supported. It’s a lot like Air Traffic Control, in which managers are evaluating a host of vehicles in three dimensions, in every conceivable vector — often extremely close to one another. And of course everything must be done on time, regardless of the weather.

In Part IV we’ll talk about approaching the “Crane State.”

Medical Marketing Becomes an Origami Crane.

Authors: Kathleen Dunn and Peter Gordon.

Part II. From quantum leap to fold change.

Diagnostic and genomic tests are now being applied to pharmaceutical decisions. Today, the use of genomic data can optimize the ability to identify discrete subpopulations in clinical trials, leading to the development of highly targeted drug therapies, such as Her-2/Neu measurements to optimize the therapy decision-making for a breast cancer patient. In fact, 10% of pharmaceuticals now have pharmacogenomic data in their labeling.

What are the implications for marketers? There are no longer simple boundaries, but intersections where several disciplines are folding back on one another. Your marketing challenge is now a kind of origami puzzle, with different shapes meeting others at odd angles, with small or large junctions and hinges connecting them. What at first seems like oddly configured folds on a piece of paper eventually emerges a beautiful bird, like the classic origami crane.

Part III takes on Origami Marketing itself.

Medical Marketing Becomes an Origami Crane.

Authors: Kathleen Dunn and Peter Gordon.

Part 1. A head-on collision.

Over the last several years, marketing the Life Sciences has meant different things to different people, encompassing pharmaceuticals, diagnostics, molecular diagnostics, molecular imaging, medical devices, bioinformatics, genomics and proteomics, to name the major players.

Ironically, as the disciplines named above have become more defined, they have started occupying the same space. As developments in many of these fields begin to integrate, they also begin to collide. These disciplines are now affecting each other — and affecting each other’s developments.

Marketers of these products are now faced with having to think outside their own discipline — outside their own box. It means they have to start thinking inside someone else’s box (maybe a lot of them at once).

In Part II we’ll see where these collisions are happening.

The power of celebrity.

Celebrity is potent. We’ve seen the power of celebrity recently with the death of a certain music icon — how it takes over the news and, in his case, a city budget.

The power comes from celebrities’ ability to generate awareness — whether it’s fashion, diet or a cause, if they are affiliated with it, attention will be paid. Sometimes the attention comes about unintentionally, as with the awareness now surrounding prescription drug overdose.

This is the second public figure in two years to die from suspected prescription drug abuse. Too many pills from too many different people. Many contraindications. Is the problem that celebrities have too much access to whatever they want? Or is the problem that we have a healthcare system that enables someone to fill multiple prescriptions from different physicians? Will the deaths of Heath Ledger and Michael Jackson prompt real action on this issue or will it simply raise awareness?

Consider what can happen when a celebrity purposely supports a cause to generate awareness. After the country watched Katie Couric get a colonoscopy on The Today Show, a national study published in the Annals of Internal Medicine reported a monthly increase in colonoscopies from 15 to 18.1, with a hike in the percentages of women perceiving themselves at risk and being screened. Michael J. Fox not only educated the public about early Parkinson’s diagnoses, but then went on to raise close to 150 million dollars strictly for Parkinson’s research. The power of celebrity can launch foundations, research initiatives and important public discussion.

But what happens when the celebrity raises the awareness of an important cause with the wrong facts?

On the 1997 April cover of Ebony Magazine, Cookie Johnson claimed “God Cured Magic!” Those in the AIDS community knew what this meant — his treatment had been so successful that his viral load was deemed undetectable. Did the Ebony readers know this? Did they know enough about the disease to even comprehend this? Cookie’s celebrity could have helped spread valuable information — but instead, it fueled rumors and myths that the AIDS virus could be cured by prayer. The readers never learned that Magic had to take 900 pills a month and those pills came with their own brand of side effects that required their own clinical management. The readers never learned that an undetectable viral load goes right back up to highly detectable if all of these medications are not taken precisely according to protocol. All the readers learned was that God had cured Magic Johnson — imagine how disappointed they felt to later learn it was not true, or even possible.

The power of celebrity can be a phenomenal force. It can generate awareness, inspire action and create change. And apparently this is the case in life or death.

Are hospitals turning away patients?

Ten years ago a hospital system in New York City opened several public diabetes clinics to help people better manage their disease. From insulin injection assistance to nutrition education, diabetic consumers could gain the knowledge they needed to change their behaviors. Within seven years, these clinics closed. Did the public need the clinics? Of course. Were they underutilized? Not at all. The hospital was forced to close the clinics because the services did not increase patient volume for treatment procedures due to diabetic complications. The issue here was not the execution, but the intention.

The hospital administration wanted heads in the beds and when that wasn’t happening soon enough, the clinic was considered a fiscal failure. People who were benefitting from the onsite assistance to live healthier lives were left with limited resources. The American healthcare system has spent years rewarding those who fix problems when presented—be it in surgical procedures or pharmaceutical prescriptions—as opposed to those who help prevent the problems in the first place. Fortunately there is a new trend in hospital services that are paved with much healthier intentions.

The recent health issue of Time magazine focuses on preventative care in the hospital setting. The issue features hospitals such as the Cleveland Clinic that have adopted prevention-based models of care focusing on wellness, not sickness. Their intention is to keep the heads out of the beds.

Since the diabetes clinics had to close throughout Manhattan, one must wonder, what’s in it for hospitals that adopts such a model?

1. Hospitals can keep people from getting sicker- and sicker means they pay more in the long run.

If a health system were dedicated to providing assistance for behavior modification— such as nutrition classes, cooking classes, spinning classes, tobacco cessation meetings—and the physicians focused on helping patients find the motivation to use these services, there would be a phenomenal opportunity to prevent chronic disease.

Let’s take Joe Public. He’s 47 years old and 30 pounds overweight. When hospitals and health systems help Joe lose weight and maintain a healthy Body Mass Index, they may be helping Joe control other risk factors such as high blood pressure and cholesterol. However if they do not help Joe lose weight, then the risk factors associated with being overweight could lead to heart disease and diabetes.

By the time Joe presents with a TIA or cardiac event in the emergency department, he’s not just sick, he is sicker than he was back when he could have used help achieving a healthy weight.

Hospitals around the country are now beginning to connect the dots between prevention and ROI. The Cleveland Clinic learned directly from their own employees how prevention services benefit their bottom dollar. Employees are encouraged to take advantage of Clinic offerings such as the Lifestyle 180 program, designed to reverse the effects of chronic disease by focusing on nutrition, exercise, stress management and the Tobacco Treatment Center’s cessation services.

As a result of employee participation and lifestyle changes, the Clinic’s HR director anticipates that employee premiums will not increase in 2010. Since employees are leading healthier lives, the prevention efforts save the clinic “between $5,000 and $10,000 a year per patient on claims they would have otherwise filed for treatments such as dialysis, angioplasty or bypass.”

By providing these prevention services to consumers in their communities, hospitals can also avoid future expenses due to patients who need the dialysis or bypass but who have limited insurance coverage.

2. Hospitals can become a comprehensive health home.

Hospitals are businesses, and every business has a brand. What good is a brand if customers are not loyal to it? Healthcare consumers want to be loyal to a brand but they need to feel a hospital is worthy of that affinity.

By providing communities with a spectrum of services that focus on keeping consumers healthy, hospitals can build trust. Healthcare consumers who have been empowered by these services are far more likely to turn to the hospital when treatment is needed.

Joe Public, who lost weight through the Lifestyle 180 program and quit smoking with the Tobacco Treatment Center’s support, will likely choose the Cleveland Clinic for future care and treatment if necessary. Three factors ensure this—relationships have been formed between the Joe and the hospital, he has witnessed the effectiveness of previous services and, as a result, trust has been established between Joe and the institution. It is this trust that actualizes the hospital brand and builds loyalty and, eventually, a return on the hospital’s investment in prevention.

One has to wonder how loyal diabetic consumers in NYC feel toward the hospital that cut off its resources because they were actually learning to live healthier lives.