Nudging for better health

The increase in chronic diseases and co-morbidities is one of the most eminent challenges to our health systems. Risk factors such as high blood pressure, the excessive consumption of alcohol and tobacco, lack of exercise and obesity are to a large extent related to lifestyle and are therefore susceptible to change.

Difficult behavioural change

However, as we all know, behavioural change is extremely difficult. Based on the findings from many health promotion and prevention campaigns as well as on our own experience, a wide gulf exists between people’s knowledge about what would contribute to their health and their actual behaviour. We continue smoking, can’t resist those delicious cakes and forget about taking our medicines regularly.

Behavioural economists have shown that we don’t always act in our own best interests, but that we are influenced by many biases, constraints on cognition and social norms. Also, lifestyle factors are often deeply embedded in the fabric of our everyday lives. At the same time, insights and tools derived from behavioural economics can be used to “nudge” people to do the right thing. But whereas insights from behavioural economics have already been widely applied to encourage provision for one’s old age, energy saving or the use of public transport, policy makers are only beginning to explore them with a view to improving health outcomes.

Overvalue the present and discount the future

We are all familiar with the tendency to overvalue the present and discount the future. The benefit of the cigarette in the present seems high, while the cost in the future, i.e. lower life expectancy or lung cancer, seems low. We also know that people are heavily influenced by what they think others are up to. Knowing what makes people tick can be used to design effective health programmes, e.g. for smoking cessation. If smokers commit themselves to quitting smoking in a way that they stand to lose something, e.g. money they had deposited in a savings account, if they fail to achieve their objective, they are more likely to be successful. The desire for loss aversion and commitment devices are powerful forces in behaviour change.

Pro-social motivations

Other behavioural tools tap into our pro-social motivations, i.e. our desire for approval on the one hand and our desire to help others on the other. Both can be used to improve health care. For example, health care professionals often “forget” about washing their hands every time they see a patient. Reminding them that hand hygiene protects patients from disease has proven more effective at inducing them to wash than reminders that hygiene protects the practitioners themselves.

I don’t suggest that behaviour change techniques are the panacea for our health problems. However, I do believe that it is worth examining how they could be applied to encourage healthier behaviours and support people in managing their chronic conditions.

Author: Edith Maier has a background in social anthropology and information science and has been specialising in digital health solutions. Recent research projects explore how to design and implement health technology to support changes in health behaviour and increase acceptance of relevant products and services.

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