Experts doubt ‘nudging’ will improve public health
The government’s new approach to public health has been called into question by researchers.
Analysis by University of Cambridge experts criticised the lack of scientific evidence for the concept of ‘nudging’, which involves subtly changing environments to prompt healthier behaviour.
But Rick Muir of the Institute for Public Policy Research thinktank said nudging had a role to play as it struck an effective balance between nanny state interference and a more arms-length approach.
The government has enthusiastically embraced the idea of taking a less intrusive approach to improving the nation’s health.
By staying out of people’s everyday lives as much as possible they hope to avoid accusations of continuing the ‘nanny state’ Conservative politicians had accused the Labour government of presiding over.
“At present, the evidence to support the view that nudging alone can improve population health is weak,” Therese Marteau, director of the behaviour and health research unit, wrote in the article, published on the British Medical Journal’s website.
She said the moves had to be viewed within the context of more “unhealthy nudges” from the food and drinks industry.
“Nudging towards healthier behaviour may struggle to make much impression on the scale and distribution of behaviour change needed to improve population health to the level required to reduce the burden of chronic disease in the UK and beyond,” the article added.
Chris Bonell and colleagues at the London School of Hygiene and Tropical Medicine went further, wondering whether the concept offers anything new at all.
They wrote: “Little progress will be made if public health policy is made largely on the basis of ideology and ill-defined notions that fail to deal with the range of barriers to healthy living.”
The Department of Health said its nudging approach was part of its broader adoption of a ‘ladder of interventions’ which links the extent of intrusiveness with the urgency of the need to do so.
Access to public exercise facilities, cycle paths or safe playgrounds are listed as examples of giving people a ‘nudge’ in the right direction.
The BMJ article cited the use of yellow duct tape on supermarket trolleys and a sign asking shoppers to place fruit and vegetables in front of the line. Research has shown fruit and vegetable purchasing doubled as a result.
“We are pleased the BMJ recognises that the ‘nudge’ approach has had some positive effects and agree that alone it is not enough to improve the health of the nation,” a government spokesperson said.
“But a better understanding of behavioural science is an important part of our wide-ranging approach. For example, improving fruit and vegetable displays in the food stores of deprived areas has increased sales.”
The DoH is establishing a public health service, called Public Health England, which will supervise the transferral of responsibility for public health to local authorities.
“Local areas will be able to try out and evaluate innovative approaches to behaviour change,” the spokesperson added.
Dr Muir, associate director for public service reform at the IPPR, told politics.co.uk he wanted to see “proper public deliberation” about which measures were legitimate ‘nudges’.
“Clearly there is a balance to be struck,” he said.
“Individual liberty is a very important thing and something which is protected in this country by the Human Rights Act.. There are things the government can’t force on people.
“Beyond that… I think there is space for public authorities to get involved in behaviour change simply because there’s a public interest in it.”
The entire advertising industry’s focus on nudging consumers into new behaviour requires regulation, Dr Muir agreed, but he argued this should take place in addition to positive nudging rather than instead of it.
He added: “We all spend a lot of money on the NHS and so if we can spend that more effectively by encouraging people to change their behaviour then I think there’s a valid public interest in doing that. But at the same time you’re giving people the option.”
