Tough lessons in ethnic outreach

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Multicultural consumers are at higher risk for cardiovascular and other diseases that drugmakers are targeting, but few pharma marketing dollars are aimed at this segment. While Pfizer is the U.S.' fourth-largest advertiser, according to Advertising Age data, it falls to No. 40 among Hispanic advertisers, according to the Association of Hispanic Advertising Agencies.

Hispanics spent $14.1 billion on prescription drugs in 2003 but pharmaceutical companies devoted only 0.9% of their '03 ad budgets to Spanish-language TV and print media, compared with 7.3% for telecommunications companies and 4.5% for carmakers, according to data from TNS Media Intelligence/CMR compiled by AHAA.

Hispanic spending on prescription drugs is growing 13.2% annually, faster than non-Hispanic growth of 11.3%, according to Global Insight data cited by NBC Universal-owned Telemundo in a study commissioned to persuade pharma marketers to create budgets for the Hispanic market.

To Pfizer's credit, AHAA ranks it first among pharmaceutical companies targeting Hispanics, spending 2.5% of its ad budget on the Latino market.

Pfizer has run Spanish-language ads for Lipitor and Viagra, but the company's most innovative program is an unbranded educational effort called "Sana la Rana" in Miami, Los Angeles and Houston. The name comes from an old Spanish rhyme used to soothe sick or hurt children.

cuts across nationalities

The full rhyme "Sana, sana, colita de rana. Si no sanas hoy, sanaras manana" defies exact translation but reassures children that if they don't feel better now, they will tomorrow. The rhyme cuts across nationalities and is meaningful to almost anyone who grew up speaking Spanish. The program's logo, a friendly green frog in a white medical jacket, comes from the "colita de rana" phrase that means "frog's tail."

" `Sana la Rana' is ingrained in the culture," says a Pfizer executive. "There's a warm feeling for the rhyme, and it connotes health."

The emphasis of "Sana la Rana" is on cholesterol, but visitors to the Web site and callers to an 800-number can also get information and brochures in Spanish on diabetes, hypertension, erectile dysfunction, depression and arthritis. The only branding is "A health program by Pfizer."

"We found the idea of cholesterol needed to be explained, and why it is important to be treated," says Janice Cruz Rowe, Pfizer's team leader-multicultural marketing, who works on unbranded efforts.

A TV spot by Omnicom Group's Dieste Harmel & Partners, Dallas, Pfizer's Hispanic agency of record for "Sana la Rana" and Lipitor, uses the analogy of a clogged sink to explain high cholesterol and encourages viewers to visit their doctor and for more information. Lipitor isn't mentioned.

The first Spanish-language ads for Lipitor began running this year. Print ads and a spot by Dieste, airing in Chicago and Los Angeles, contrast people with different lifestyles to make the point that you can't tell who has high cholesterol.

In the commercial, a voice-over explains that high cholesterol can affect those who exercise, as a young woman runs up the stairs at work, and those that do not, as a portly man takes the elevator. The commercial recommends Lipitor as the most-prescribed medication for high cholesterol. A Lipitor competitor, Merck & Co.'s Zocor, also markets to Hispanics.

Pfizer's Viagra also has gotten Hispanic ad support, via HispanAmerica, New York, though that advertising isn't currently running.

To build trust at the grassroots level, Pfizer works with organizations like the National Council of La Raza and trains local women called promotoras de salud (health promoters) to talk about health issues like high cholesterol. They have credibility with the unacculturated Latina gatekeeper who looks after the health of her entire family and is Pfizer's main target.

"One of the things that run through many disease states is the issue of denial," Ms. Cruz Rowe says. "Multicultural patients sometimes wait till symptoms occur, and they often access acute care in the emergency room."


Pfizer has addressed the dearth of materials and health information in Spanish with a companion program called "Vidasana" ("Healthy Life"). Bilingual flip-charts, for instance, help doctors who don't speak Spanish to explain cardiovascular disease to Spanish-dominant patients. A quick cultural competence update describes Hispanic attitudes about health and healthcare in a note to doctors on the flip-chart. For example, Hispanics respectful of a physician's authority may be too deferential to ask questions, and believe the doctor would raise an issue if it were important. Also, many Hispanics have a fatalistic attitude about life and health.

"Anglos think they can control nature," says Jaime Gonzalez Mir, general manager of Dieste's New York office. "Hispanics think the book has been written."

To direct multicultural efforts, Pfizer has a few people at its New York headquarters like Ms. Cruz Rowe and Hispanic expert Alejandro Marichal, but it hands down responsibility for specific brands' efforts to the individual brand teams.

"Multicultural lives across the company, which is a good thing," says the Pfizer executive who spoke about "Sana la Rana." "It's not off to one side, but within each brand and department."

Looking at other ethnic groups, Ms. Cruz Rowe says African-Americans may turn to their church "so we work to educate ministers."

Pfizer has some educational programs targeting African-Americans and has made a few local efforts in California with Asian-Americans, but almost all the company's multicultural work focuses on Hispanics.

Pfizer executives are cagey about plans to extend the "Sana la Rana" program to more cities or start Spanish-language advertising for more brands.

"It's too early to tell," says the Pfizer executive.

Hispanic media hope their own efforts to woo pharmaceutical marketers will pay off. Telemundo's survey of 600 Hispanics and 600 non-Hispanics found that 61% of Hispanic respondents said they feel more comfortable about prescription drugs advertised on TV, compared with 25% of non-Hispanics. And 79% of Hispanics surveyed said they would like to see more pharmaceutical ads on Spanish-language TV.

awareness problem

Fewer Hispanics are familiar with prescription drugs or use them. In the Telemundo survey, 57% of Hispanics had heard of Lipitor, compared with 94% of non-Hispanics. And just 35% of Hispanics had heard of Zocor, compared with 90% of non-Hispanics.

Asked what prescription brands they use, 13% of Hispanic respondents and 33% of non-Hispanics cited Lipitor. For Zocor, the figures were 2% of Hispanics and 13% of non-Hispanics.

"Next year there's a good chance there will be new [pharmaceutical] advertisers in the marketplace," says Michael O'Shea, Telemundo's VP-business development and presenter of the pharmaceutical study.

"They've reached saturation level in the general market," he says. "Some brands have more than $100 million in marketing behind them. They're looking for sources of new business."

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