England & Wales Health and social care

So, does nudging make a difference?



What would change my eating-too-much-chocolate behaviour – moving the confectionary display in Smiths? taxation? Banning chocolate might just work, but I would just have to resort to smuggling.

How can the government, then, change not just me but the whole population’s behaviour to make us all healthier and happier? Government ministers have supported the theories in Nudge by Richard Thaler and Cass Sunstein which advocated a range of non-regulatory interventions that can influence behaviour by altering the context or environment in which people choose, and seek to influence behaviour in ways which people often do not notice.

Nudge theory is reflected in, for example, the government’s policies towards healthy eating, with a emphasis on voluntary action by the food industry and less on legislative or fiscal intervention.

It clearly underpinned much of the thinking in the public health white paper Healthy Lives, Healthy People. The Prime Minister set up a behavioural insight team in October 2010 which was charged with introducing nudge to the big society or, as it says in the coalition agreement “finding intelligent ways to encourage people to make better choices for themselves”.

The House of Lords Science and Technology Sub-Committee, chaired by Baroness Neuberger, has been inquiring into this complex area and published today their report, Behaviour Change, after a year-long investigation.

The committee’s key message is that soft intervention – nudges – on their own are very unlikely to change the behaviour of the population and that government needs to use a whole array of interventions, including taxation, legislation and regulation. Key recommendations are:

  • The Government must invest in gathering more evidence about what measures work to influence population behaviour change
  • They should appoint an independent Chief Social Scientist to provide them with robust and independent scientific advice
  • The Government should take steps to implement a traffic light system of nutritional labelling on all food packaging
  • Current voluntary agreements with businesses in relation to public health have major failings. They are not a proportionate response to the scale of the problem of obesity and do not reflect the evidence about what will work to reduce obesity. If effective agreements cannot be reached, or if they show minimal benefit, the Government should pursue regulation.

Of course, as the report says, behaviour change interventions are nothing new. And there have been big successes – reducing smoking being perhaps the most obvious, where there has been the package of interventions, culminating in the ban on smoking in public spaces.

The King’s Fund, back in 2007-08 in its report Kicking Bad Habits talked about the concept of ‘nudging’; government and agencies cannot make people change their behaviour, but they can ‘nudge’ them to do the healthy thing, but rather than stand-alone interventions, combining techniques works best. Their report, like the new one, identified the lack of comprehensive evaluation that meant it is difficult to identify which combination of interventions is most effective.

All of this is going to be increasingly important for councils as they take over public health responsibilities. Understanding what works will be critical. Councils are not, however, starting from ground zero. There are excellent examples of councils, working with their health partners, using incentives to increase physical activity and healthy eating, like Barking and Dagenham’s smart card for young people.

Councils will be at the forefront of commissioning services to improve the health and wellbeing of their local communities, and they will want to shift the focus from acute services to prevention. Integrated commissioning plans for health and wellbeing can make behaviour change interventions a responsibility of everyone, including the new commissioning consortia and the wider council, not just public health professionals.

Sometimes a council may want to use regulation as well, such as banning fast food outlets from outside schools. The causes of unhealthy behaviour are clearly complex – there are many factors involved – nudging people to do the right thing will be one tool that can be used, but  as the report underlines, it must be one tool among many.

And back to my chocolate addiction? Well shame (and praise) seems to work – a weekly weigh in at the slimming club is the ideal nudge intervention.

Janet Sillett is the briefings manager at LGiU.

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