We would like to challenge some of the points raised in Dr Fitzpatrick's sceptical take on the ‘latest cult’ of ‘nudging’ the behaviour of the British public.1 In particular, we were surprised at his claim that behaviour contributes only marginally to most health problems. This is not the typical experience of many doctors in the NHS, who spend significant portions of their day dealing with the consequences of behaviours such as smoking, alcohol misuse, and poor diet. Neither is it reflected in morbidity and mortality figures that show the increasing impact of such behaviours on measures of health.2
We as doctors – whether we like it or not – are in the business of influencing behaviour. This may be in encouraging some behaviours (vaccination, cancer screening) and discouraging others (smoking, excess alcohol). While we may have developed a nuanced approach to influencing the behaviour of individuals that we have known for some time, it can be more challenging for policy makers seeking to influence the health behaviour of whole populations.
Unfortunately, despite five decades of research on how to influence behaviour, we are still faced with a short supply of effective interventions that can be used to tackle these problems.3 Insights from behavioural economics and the wider behavioural sciences now provide us with a powerful set of new and refined policy tools to use. Rather than being ‘pop psychology’ such insights are built on many years of robust and cross disciplinary work – more fully explored in the MINDSPACE report.4
We need to recognise that we face an increasing burden of disease related to the decisions we make. Introducing policies that better align behaviour with underlying intentions – while ultimately respecting an individuals autonomy5 – is, in our view, something worthy of fuller consideration.
Notes
Competing interests
DK is a co-author of the MINDSPACE report.
- © British Journal of General Practice, January 2011
