Richard Thaler and Cass Sunstein’s book Nudge sparked a flurry of interest in media and political circles when it was published three years ago. The University of Chicago authors focus on ideas that are both paternalistic and libertarian. They argue for influencing people’s behaviour to make them healthier. That’s the paternalism. But they also require that the influence stop short of intrusion or compulsion. That’s the libertarianism.
They offer a plethora of examples. Reminders that the majority of people do not drink to excess can coax the heavy drinker into a more sober lifestyle. Putting fruit near the checkout counter in school canteens can prod students into eating more healthily. And changing the default options on donor cards can draw more people into volunteering their organs following death.
“Nudging”, as a recent edition of the British Medical Journal defines it, is “any aspect of the choice of architecture that alters people’s behavior in a predictable way without forbidding any options or significantly changing economic incentives”.
That means legislation is out, as is regulation or interventions that significantly alter economic incentives.
Thaler and Sunstein were smart enough to see how “nudging” had worked wonders for the retail industry. The food industry knows very well how to get us to eat more than we need. The drinks companies are experts in getting us to drink more, as we can see from the doubling of alcohol consumption in the UK over the last half century. Our roads favor cars over bicyclists or pedestrians, thanks to the motor industry.
The challenge, believe Thaler and Sunstein, is to use this knowledge to promote the common good: to reduce obesity; lower alcohol consumption; and to make the streets safer.
Now Theresa Marteau and her colleagues have provided evidence of the idea in action. Using yellow duck tape to divide a shopping trolley into sections for fruit and vegetables and the rest for other purchases leads to an increase in consumption of fruit and veg. Giving people feedback on their alcohol consumption via the internet has some impact on drinking habits.
The important thing is to remind ourselves that none of this is new. As the British Medical Journal’s editorial argues, the primary elements of nudging have been the bread and butter of public health professionals for over a century now.
Social marketing, motivational interviewing, public education and changes to physical, organizational or social environments have been used to prevent a range of impairments to human development.
But a more contentious issue is the role of legislation and compulsion.
Marteau and her colleagues observe that salt consumption in the UK has reduced, on average, by 0.9 grams with the threat of legislation. In Japan and Finland, where laws have been passed, the reduction is, on average, five grams.
Sometimes we welcome a little compulsion. People were loathe to wear car seat belts even when they acknowledged the safety argument. The requirement by law to “buckle up” was the excuse that many were waiting for.
References
Richard Thaler and Carl Sunnstein, Nudge: improving decisions about health, wealth and happiness, Yale University Press, 2008
Theresa Marteau, David Ogilvie and colleagues, ‘Judging nudging: can nudging improve population health?, British Medical Journal, 2011, 342:d228
Chris Bonell, Martin McKee and colleagues, ‘Editorial: One nudge forward, two steps back’, British Medical Journal, 2011, 342:d401
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