Public Health’s Paul Lambert knows a thing or two about temptation. In this blog he tells us a bit more…
Last week I popped over to the supermarket to pick up a few nibbles for my lunch. I had good intentions of choosing something nutritious, healthy and tasty and to be honest although I did, I also picked up three maple and pecan pastries.
Why? Did I just fancy eating a pastry at that exact moment? Possibly – but a not so subtle influence on my decision was a clear sign highlighting the offer of three pastries for £1. So rather than 45p for one I could have three for £1. How could I resist? What the supermarket had subtly done and has been doing for decades is ‘nudge’ me into making an additional purchase or three (to be precise).
Supermarkets and a whole plethora of industries employ various tactics to influence our decision making or ‘nudge’ us towards certain choices. Next time you go to the supermarket take a look at the range of offers and discounts, the chances are there’ll be an abundance of them. The concerning issue for me is that more often than not these nudges push us towards unhealthy choices rather than healthy ones.
It’s not just our food choices that are influenced. Health is one of many areas which can see nudge making a positive difference when budgets are tight. Everyday decisions can be influenced just by the way they are presented or designed. This is called choice architecture and is basically how the design or presentation of choices impact on our decision making.
What choice architecture does is appeal to the system in our brain that responds quickly and efficiently – the Automatic System (AS). The AS in part of our decision making process that makes those spilt second decisions, instinctive gut reactions, those decisions we make that we haven’t given a second thought. Although the AS is very fast and handles thousands of thoughts each day, it’s biased, irrational and doesn’t consider the consequences of choices and can be exploited for good or bad. The contrast to the AS is the reflective system (RS) which is the logical part of our brain. You could think of AS being Homer Simpson and the RS is Mr Spock: logical, plans and considers options before acting. Unfortunately the RS processes things much slower and therefore is no good when time is of the essence and decisions need to be made quickly. I know I was definitely not using the reflective system when I picked up those three maple and pecan pastries.
So when we’re rushing about in our work or home lives we use the automatic system more than the reflective one and therefore how the environment is presented can help or hinder our decision making process. For example, if you have a meeting on the first or second floor the chances are the lift is clearly visible with good signage, while stairs are typically not the obvious choice (unless your meeting is in the office I am based). This means the lift is the easy decision and because it is easy it becomes the default choice and thus the majority of people take it. If the majority of people take the lift, that’s the social norm which further perpetuates use of the lift.
‘So what?’ you might ask. Well if we really want to improve health, change lifestyle factors and get people to move more, eat healthier, have health screening or attend their appointments, then we need to make the choice to do so the easy choice; the social norm; the default. Giving us all information is fine but it doesn’t necessarily lead to the large population behaviour changes we aim for. It isn’t that people don’t want to be healthy but life can get in the way – taking the kids to school, watching the footy and eating a pie, going to the pub, being tied to the computer at work, going on holiday, and a hundred and one other things.
Our busy lives mean we usually will take the easy choice, often despite the knowledge doing something another way, such as taking the stairs instead of the lift, or eating fruit not crisps, could be beneficial for us. We more often than not choose the path with least resistance. For example, it’s important to have a pension and despite this knowledge, up until a few years ago a large number of workers did not have one because you had to opt into a pension scheme and many people never got round to it. That all changed in October 2012 when workers would be automatically enrolled into their employers pension scheme unless they opted out. If you are automatically enrolled into something inertia will discourage you from opting out and the evidence supports this. According to research from the Institute for Fiscal Studies, the automatic enrolment pension scheme is proving to be a huge success with a substantial rise in pension membership.
There are many ways in which a nudge can be used to manipulate our behaviour for good and bad, but ideally the ones we know are a nudge can work best. For example, presenting salad or vegetables instead of chips at the start of buffet has shown to increase healthier food choices. Or that annoying beep sound in a car to remind you to put on your seatbelt.
Changes to language, wording, layout and presentation of information have been shown to have marked effects on our behaviour. A study which investigated self-reported car mileage for insurance documents found that signing at the beginning of the form decreased dishonest self-reports in comparison to signing at the end. Personalised letters or texts have also been shown to increase response rates in marketing campaigns and improve attendance rates at apppointments.
This year marks the seventh anniversary of so-called Nudge Unit and sees the publication of the book ‘Inside the Nudge Unit – how small things can make big differences’. I highly recommend reading it for inspirational ideas to be applied to both public health work and hopefully get the health improvements we are aiming for, as well as more widely to improve the quality of people’s lives. It’s still debateable whether nudge can delivery large scale sustainable behaviour change, but the core framework of the book, namely make the things you want to change Easy, Attractive, Social and Timely EAST – are still applicable today. If we consider these simple principles in our interventions, services, campaigns or policies, it will hopefully lead to – among other things – better engagement, better services and better health.
Now back to that last maple and pecan pastry.