'Can nudging improve population health?' asks BMJ

The British Medical Journal (BMJ) has published a free article assessing the nudge approach now popular with US and UK health policy makers. Judging nudging: can nudging improve population health? explores the concept of 'nudge' and whether it can make an impact on areas such as alcohol harm and obesity.

It explains nudging as 'an approach to behaviour change that focuses on altering environmental cues to prompt healthier behaviour', rather than relying on the provision of information such as through health campaigns. Citing the popularisation of the term 'nudge' in the book (and now blog) of the same title, it says:

"...nudging could include a wide variety of approaches to altering social or physical environments to make certain behaviours more likely. These might include providing information about what others are doing (“social norm feedback”) ... changing the defaults that surround the serving of food and drinks, or altering the layout of buildings to cue physical activity." 

The article sets out a table of nudge examples including making alcohol available in smaller glasses or raising awareness of lower alcohol consumption behaviours. The Health Secretary has emphasised an approach of "social responsibility, not state regulation" set out in the public health White Paper. Plans have been announced to make smaller glass sizes available, whilst the controversial Responsibility deals are expected to stay close 'social norm' approaches. The Change for Life campaign now includes a 'drink swap' element.

However the report warns of limitations to the evidence, potential for harmful nudges or 'perverse responses', and the role for regulatory measures. In conclusion, the article writes:

"Nudge and similar recent popular texts have stimulated policymakers to think about altering environments to change behaviour. These developments are to be welcomed. Evidence to support the effectiveness of nudging as a means to improve population health and reduce health inequalities is, however, weak. This reflects absence of evidence as well as evidence of little or no effect.

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."

An interesting collection of 'alcohol nudges' can be found on the nudge blog.

Comments

[RSA Training]

you should always drink moderately more especially if you are driving, to avoid any accidents. Bar attendants must also assist customers to drink within their appropriate limits. And in that way, they should be able to correctly identify customers to whom their service should be refused.

[efgd]

Why is it the Governments fault? Responsibility is paramount to life. It is better to hit the abuser in the pocket - not high prise alcohol, but cost of services to come out of abusers pocket - insurance and saving schemes for those who drink too much and have to have more heath-care than the norm.

[Hermann T. Meyer]

Nudging can only be a very little aspect in alcohol prevention, but still a useful one. As the British Government is not willing to act effectfully, such small items get attention like a straw.