Nudges and Public Health – getting the context right

In all the publicity recently over the challenges faced by the Government’s Big Society Agenda and its relaunch with a speech by the Prime Minister yesterday; another report questioning some aspects of the Government’s behaviour change agenda was perhaps a little overlooked.

The Guardian recently reported that the Government Nudge agenda, mixing Libertarian Paternalism with Behavioural Economics, was also being queried in a report in the British Medical Journal. This is important  to take note of as the use of various types of approach to behaviour change will in future be a key issue in the Government’s Public Health agenda. The article said:

“Meanwhile doctors warn today in the British Medical Journal that the government’s strategy of “nudging” people to adopt healthier lifestyles will not solve major public health problems such as obesity, smoking and alcohol misuse. They say the use of nudges to affect human behaviour is based on “weak” evidence and could ultimately prove harmful if it means ministers ignore other tactics.

“Andrew Lansley, the health secretary, has courted controversy by deciding to rely on nudges as a new way of tackling public health problems arising from people making unhealthy choices. They are defined as anything that does not include coercing people or exerting financial pressure on them to behave in certain ways. Examples include displaying healthy food more prominently in canteens and supermarkets rather than sweets, and people having to opt out of organ donation schemes.

“Public health experts, led by Professor Theresa Marteau from Cambridge University, say “nudging has captured the imagination of the public, researchers and policy makers as a way of changing human behaviour”.

“But, they say: “At present the evidence to support the view that nudging alone can improve population health is weak. Indirect harm might arise if an emphasis on nudging resulted in neglect of population level interventions that were potentially more effective”.

“In a separate editorial in today’s BMJ public health specialists from the London School of Hygiene and Tropical Medicine warn that nudging may lead to “muddled public health and wasted resources” and is based on the “explicitly self-contradictory concept” of “libertarian paternalism”.

The BMJ has raised an important series of issues, which we are well aware of. Indeed over the last six months a number of us at TCC have written other postings here making a range of points about the use of Nudges. These are worth flagging up:

• I have written about whether Nudges themselves should be studied in the context of people holding different values.
• TCC Chairman, Jonathan Upton has pointed out that Nudges themselves are impacted by Social Norms, drawing on the work of “Herd” author Mark Earls.
• TCC Non Executive Director Jeff French and myself have also written here and here as to whether Nudges should more appropriately be seen in the context of a wider mix of behavioural interventions.

In conclusion it is worth strongly reiterating the point I make in one of those postings:

The most important lesson from this research is to gather the deep information to ensure one uses the right mix of tools to deliver an effective intervention through a clear understanding of the context that existing behaviour operates within. So before deploying Nudge, Think, Steer and all the other one word behaviour change solutions that are on offer, the fundamental prior action is also one word – “Insight”!

Charlie Mansell is the Research and Development Officer at The Campaign Company. If you want to see what your own primary values set is, why not take the simple Values Questionnaire here.