Concluding that more conventional tools, such as legislation and taxation, appear to be having little impact upon the notable reluctance of the public to adopt behaviours to better serve their own interests or those of the wider community, the head of the Civil Service, Sir Gus O’Donnell, has announced the establishment in the Cabinet Office of the Behavioural Insights Team.
The aim of the team is to help the Government to develop and apply lessons from behavioural science and economics to public policy making, so that those policies better reflect how individuals really behave, not how they are assumed to behave. The team is thus intended to support the Government’s commitment to reducing the regulatory burden on business and society and to achieve its goals as cost effectively as possible, replacing bureaucratic levers with motivators and prompts to support people to make better choices.
The team has now produced a discussion paper Applying behavioural insight to health drawing upon case studies from smoking cessation, organ donation, teenage pregnancy, alcohol intake, weight management, diabetes, food hygiene, physical activity and social care, endeavouring to demonstrate how “nudge” – prompting people towards the behaviour which they would adopt if acting as rational human beings choosing to optimise their situation or that of society – can better serve the health and wellbeing of society as a whole.
In the UK today, behavioural and lifestyle factors are thought to be a major contributor to around half of all deaths. Yet the NHS currently spends over £2.5 billion per year in treating smoking related illness, as compared with £150 million on encouraging people to stop smoking; £2.7 billion on treating the results of excessive alcohol addiction, but only £8.7 million on promoting a sensible approach to drinking.
Clearly, coercion and strong-armed regulation are not the answers to improving our diets, changing the desire of the young to go out drinking on a Friday night or turning the committed couch potato into a more physically active individual. It undoubtedly makes more sense to focus on preventing ill health, in so far as that is possible, rather than to spend vast sums on treating the consequences of self-inflicted illness, and this approach is embedded in the Health and Social Care Bill.
Whether “nudge” is about realising the better qualities of mankind or, as the cynical would have it, manipulating individuals to conform to a Government diktat, probably depends on your world view and your socio-political outlook. Whether it will prove to be more successful in achieving better public health outcomes than compulsion and coercion, only time will tell but surely – with the UK in only second place to the United States in terms of its obesity epidemic and the accompanying ills of diabetes, cardiac complications and renal failure – no one would dispute that it has to be worth a try?