Judging nudging: Can nudging improve population health?
The BHRU launched onto the public health scene, achieving international interest with its first publication. Its paper ‘Judging nudging: Can nudging improve population health?’ questions whether the Government’s “nudge” approach to public health stands up to scientific scrutiny as a basis for improving population health.
Nudging involves altering environments to prompt healthier behaviour, without banning particular choices or using financial incentives. The concept of nudging people towards healthier behaviour has captured the imagination of the public, researchers, and policy makers. Its appeal lies in the seemingly simple, low cost solutions that can be applied to a wide array of problems, and there is some evidence that it can work.
For example, putting yellow duct tape across the width of supermarket trolleys with a sign requesting shoppers to place fruit and vegetables in front of the line doubled fruit and vegetable purchasing, and placing fruit by the cash register increased the amount of fruit bought by school children at lunchtime by 70%.
However, the BHRU authors argue that, “at present, the evidence to support the view that nudging alone can improve population health is weak.” They also point out that nudging has the potential to generate harms as well as benefits, particularly if an emphasis on nudging results in a neglect of other, potentially more effective interventions.
Nudging is often used very effectively by industry to prompt unhealthy behaviour, for example in the marketing of food and alcohol. The authors argue that effective nudging “may require legislation, either to implement healthy nudges … or to prevent unhealthy nudges from industry.”
Research is needed to determine the effectiveness and cost effectiveness of nudging and related ideas. Currently there is precious little good science on which to build practical examples which would work.
They conclude: “Without regulation to limit the potent effects of unhealthy nudges in existing environments shaped largely by 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.”
In an accompanying BMJ editorial, Chris Bonell and colleagues at the London School of Hygiene and Tropical Medicine also question whether it is clear what is meant by nudging and whether it really offers anything new, and warn that “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.”
Media interest
The BHRU’s first publication received high profile media attention featuring in The Telegraph and Guardian newspapers, and interviews with Professor Theresa Marteau on BBC Radio 4’s Today Programme, BBC Radio Cambridgeshire, BBC Three Counties Radio and with a science reporter from Washington DC.
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