The campaign by Ketchum UK, Liming with Gran won Silver in Social Purpose Educational and Gold in Social Purpose Government at The Drum Awards. It aimed to break the silence around genetic health discussions within the UK’s Caribbean community, leveraging culturally resonant dominoes to foster family health conversations.
Genomics is now standard medicine in the NHS, using DNA to understand the role heredity plays in predisposing offspring to particular diseases and conditions. In fact, one in 17 people in the UK have, or are at risk of developing, a potentially serious life-threatening genetic condition. But knowledge is power. Many conditions can be prevented with early intervention and lifestyle changes – and if families have important health conversations between generations. Yet some marginalized UK minority groups, particularly those of Black and Caribbean heritage, distrust genetics research and clinical care, fearing it could be used to discriminate or perpetuate existing health inequalities. This is especially true among the UK’s Caribbean elders, who consider it taboo to have such open ancestral health discussions.
This code of silence is an intergenerational killer. Rates of poor health among Black Caribbean men and women are equivalent to those of White British people who are 10 years older, and 45% report longstanding health conditions. Malignant cancers and heart diseases contribute to nearly 65% of deaths in the Black Caribbean community. Hypertension is more prevalent in both Black-Caribbean men (31%) and women (34%) compared with Caucasians (19% and 13% respectively). Black Caribbean men are also at two-thirds’ greater risk of having a stroke than the general population. Diabetes is far more common by age 25 than in the general UK population. Sickle cell disease is now the fastest-growing genetic blood disorder in England, and it disproportionately affects Black people.
Genomics England and the University of Cambridge challenged us to find a new medium to break down the taboo of silence and get the Caribbean community talking about family health with one another. Nearly half of the UK’s 619,000 Black Caribbean population (1.10% of the UK), live in tight-knit boroughs scattered across the city of London. Our goal was to conceive a pilot to test among these neighborhoods which could be scaled with the right future partners and funding.
Reaching this audience directly and cost-efficiently wouldn’t be easy. We had to think outside the traditional earned media box and employ a hyper-local and direct outreach strategy where Caribbean families live and work – funded by a modest paid and earned media budget.
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We would use an omni-channel approach, ensuring repeated exposure through multiple culturally relevant touchpoints. A creative out-of-home campaign would reach boroughs with large Caribbean populations, ensuring visibility in everyday spaces. At the same time, we’d enlist trusted community influencers to drive credibility. Most of all,though, we would need a culturally familiar and emotionally resonant communication medium or trusted platform with the power to drive engagement and behavior change.
Insight/Idea: First, we studied Caribbean-island culture and their native patois dialect to understand this community’s social behaviors and family traditions… And discovered “liming.” Liming is the act of hanging out with family and friends and enjoying good conversation and laughter. In Western terms, “Let’s go lime” is the equivalent of saying, “Let’s chill or hangout.”
Then we considered what Caribbean families love to do that’s naturally conducive to liming… and discovered that one lasting family tradition that generations of Caribbeans love, even to this day, is a friendly game of dominoes. And who do Caribbean elders want to play dominoes and lime with the most? Something they love even more than the game - their grandkids!
Could a simple game of dominoes be the game-changing medium we were seeking to bring young and old Caribbeans together and make sharing stories on family ancestry and health feel safe and natural?
To test our hypothesis, we reimagined the game and designed a bespoke handcrafted set full of beautiful and colorful pieces inspired by island history, heritage, and the Caribbean aesthetic. This new set was also the first of its kind: Our pieces uniquely featured scientifically derived questions to prompt liming specifically about family ancestral history and health.
A UK Caribbean designer created six different color ways, taking inspiration from UK Caribbean homes in the 1950s – earthy reds, oranges, and greens from the land and blues from the ocean. We used the iconic Empire Windrush font in celebration of the Caribbean immigrants who came to the UK in the late 1940s/early 1950s. Professors at the University of Cambridge designed questions to prompt liming and family storytelling as players enjoyed a game together.
Central to launching our dominoes game was a short film, shot by an award-winning director. We needed the perfect protagonists to help us demonstrate how to play our game version to London’s tight-knit Caribbean community. So, our search began to find a third-generation young Caribbean with a charismatic and storied grandparent who had been among the first to arrive in the UK from the islands in the ‘40s.
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Through casting calls, we finally found the ideal pair: Tré, 29, and his grandmother Jean, 84, who came to England from Jamaica in the Windrush generation, and had recently lost her husband to a genetic condition that might have been preventable with more candid health conversations between generations. Our film features Tré and Jean playing the game and warmly having an open and honest conversation about family ancestry and health.
We premiered the film to the Caribbean community during Black History Month at the Genesis Cinema in London. An outdoor digital campaign in islanders’ native patois dialect brought the film via QR code to London transit stations, shopping centers, and bus shelters in Caribbean neighborhoods – including The London Underground, reaching riders of a dedicated new Windrush line. And now, sets are in barber shops, community centers, cafes, and churches, giving family members the chance to play the game together.
‘Liming with Gran’ had a big ambition: Show that by understanding and creatively leveraging familiar and embedded cultural behaviors and traditions, we could unlock promising new methods to prompt critical family health conversations between generations which one day can lead to better health outcomes.
The £85k pilot program reached 48% of London’s 300,000 Black-Caribbeans.
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The National Health Service (NHS) has adopted the dominoes as an official health conversational tool and using it in research with prostate cancer and diabetes patients.
The UK’s health system is celebrating the pilot’s success:
‘Liming with Gran’ proved that a more human, culturally grounded approach can open doors. And in public health, opening the door is where all change begins.
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