Nudging us to better health

The first output from the government's new Behavioural Insight Team (BIT), already nicknamed the 'Nudge Unit' by the media, was published on the last day of 2010 - a discussion paper on applying psychological principles to improve public health (tinyurl.com/29s2rp2).

The paper notes how health and lifestyle issues, including loneliness, are the major contributor to half of all UK deaths. 'Strong-armed regulation is not the answer to rebalancing our diets, changing our desire to drink too much alcohol on a Friday night, or making our lives more active,' it says, arguing instead that people can be encouraged to live more healthily using cheaper and more effective 'Nudge-style' interventions, which emphasise prevention rather than cure.

This general philosophy, referred to as 'libertarian paternalism' by the authors of Nudge, was enshrined in the coalition government's agreement statement published last May: 'Our government will be a much smarter one, shunning the bureaucratic levers of the past and finding intelligent ways to encourage, support and enable people to make better choices for themselves.'

The bulk of the new discussion paper is made up of case studies of this new psychological approach as applied to smoking, organ donation, teenage pregnancy, alcohol, diet and weight, diabetes, food hygiene, physical activity and social care.
For example, in relation to organ donation, the BIT is working with the DVLA to include a compulsory question about registering as an organ donor on the form for applying for or renewing a driving licence. Previously this question could be skipped, but now people must answer, even if only to say that they don't want to decide now - an approach known as 'prompted choice'.

In relation to smoking, the team is working with the high-street chemist Boots to exploit the principle of loss aversion by having smokers sign a contract in which they agree to pay a fine if tests show they have smoked.

'It is clear to us from our work with the Department of Health, health professionals and businesses that there is a great deal of energy and enthusiasm for the new health agenda,' the paper concludes. 'If we can combine the insights from behavioural science with this enthusiasm and professional expertise, the benefits are likely to be very substantial indeed - fewer lives lost, better value for money and better health.'

Anyone with examples of how psychology is being, or could be, applied to health is invited to e-mail the Behavioural Insight Team on behaviouralinsights@dh.gsi.gov...insights@dh.gsi.gov.uk. David Halpern, director of the BIT and a psychology graduate, told us that economics and law are long-established disciplines in Whitehall and Westminster, but there is a growing recognition of the importance of psychology. 'Most policy challenges have a strong behavioural component - from health, to the green agenda, to economic growth and confidence. The creation of the Behavioural Insight Team within government is an acknowledgement of this importance,' he said. 'But it is a very small team, and we are very reliant on the wider academic and research community - we are always open to new evidence, ideas and support.'

A related development in December was the creation of a dedicated Behaviour and Health Research Unit at the University of Cambridge, tasked with informing government policy on assisting people to behave more healthily. The Unit is headed by Chartered Health Psychologist, Professor Theresa Marteau. The Behavioural Insight Team also played a key role in the Giving Green Paper published by the government just before Christmas. This is a public consultation on ways to encourage social action - volunteering, philanthropy and the provision of mutual social support.

--Christian Jarrett