England & Wales Health and social care

Health White Paper: will nudging be enough?


The health White Paper wants to replace the nanny state with targeted interventions based on “nudge” theory. Some of the wilder media reaction to the release has said that amounts to little more than bribing the fat, the feckless, and the lazy to get fit. Janet Sillett, the LGiU’s health expert, has argued that it’s a bit more subtle than that. Her report, All’s Well that Ends Well, found that councils like Barking and Dagenham are already pioneering effective “nudge” schemes.

Barking and Dagenham’s scheme is based on a smart card, Street Base Connect, that aims to improve data collection, incentivise behaviour change and increase physical activity and healthy eating. The scheme is already working well. What’s more, it isn’t just the young people who are already eating healthily or doing lots of sport that are getting involved. Large numbers of children who aren’t in great shape are also participating. The scheme also ticks all the “Total Place” boxes: it’s a partnership scheme between schools, the voluntary sector, businesses, the NHS and the council.

Having said all that, nudging won’t be enough to get everyone off the fags and on to the broccoli. Lansley will surely also want to reflect on the success of legislation in some areas. The smoking ban, for instance, is widely agreed to have worked well. Some councils will also want to be able to legislate, for instance to stop fast food outlets opening near schools.

These issues will be discussed in more detail at an LGiU event on Monday: What next for councils and public health? The event will include contributions from the DH, the Association of Directors’ of Public Health, Local Government Improvement and Development and Kent Department of Public Health.