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‘Nudging’ Healthy Lifestyles: The UK Experiments with the Behavioural Alternative to Regulation and the Market

Published online by Cambridge University Press:  20 January 2017

Adam Burgess
Adam Burgess*
Affiliation:
University of Kent
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Abstract

This article critically reflects upon the introduction of behavioural, ‘nudging’ approaches into UK policy making, the latest in a series of regulatory innovations. Initiatives have focused particularly upon correcting lifestyle risk behaviours, marking a significant continuity with previous ‘nannying’ policy. On the other hand, nudging represents a departure, even inversion of previous approaches that involved the overstating of risk, being based partly upon establishing a norm that bad behaviours are less, rather than more common than supposed. Despite substantive similarities, its attraction lies in the reaction against the former approach but must also be understood in the context of the economic crisis and a diminished sense of liberty and autonomy that makes intimate managerial intervention seem unproblematic. Problems are, in fact, substantial, as nudging is caught between the utility of unconscious disguised direction and the need to allow some transparency, thereby choice. Further, it assumes clear, fixed ‘better outcomes’ but encourages no development of capacity to manage problems, contradicting a wider policy intent to build a more responsible and active citizenry. More practically, nudging faces considerable barriers to becoming a successfully implemented programme, in the context of severe, Conservativeled austerity with which it is now associated.

Type
Symposium on Nudge
Information
European Journal of Risk Regulation , Volume 3 , Issue 1 , March 2012 , pp. 3 - 16
Copyright
Copyright © Cambridge University Press 2012

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References

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18 Their initial projects are on: smoking, organ donation, teenage pregnancy, alcohol, diet and weight, diabetes, food hygiene, physical exercise, and social care. See “Applying Behavioural Insight to Health”, (London: Cabinet Office Behavioural Insights Team, 2010), available on the Internet at <http://www.cabinetoffice.gov.uk/resource-library/applying-behavioural-insight-health> (last accessed on 11 January 2012).

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22 Sunstein situates ‘Nudge’ in this context in this interview, available on the Internet at <http://www.youtube.com/watch?v=DD-fUJs5t_k> (last accessed 11 January 2012).

23 Lord Alderdice quizzed civil servants applying behavioural solutions, making the useful distinction between ‘informed design’ which describes most behavioural ideas, and actually ‘evidence based policy’. See House of Lords Select Committee on Science and Technology Inquiry on Behaviour Change, Evidence Session 2 (2 November 2010), available on the Internet at <http://www.parliament.uk/documents/lords-committees/science-technology/behaviourchange/ucSTI021110ev1.pdf> (last accessed on 20 December 2010).

24 Men aim at the ‘fly’, reducing spillage.

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28 The notion of ‘nannying’ derives from the phrase the ‘nanny state’; that is an overly interventionist style of government that dictates to its citizens like a grandmother (‘nanny’).

29 Reaction to this description prompted a direct response from the authors; Cass R. Sunstein & Richard H. Thaler, “Libertarian Paternalism Is Not an Oxymoron”, 70 U. Chi. L. Rev. (2003), at p. 1159, and expanded on in Nudge (pp. 4–6). This has been the subject of much further debate, such as in Amir and Lobel, Stumble, Predict, Nudge, supra note 6.

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34 Heavy drinking in public is an endemic not epidemic phenomenon in the UK; a long established cultural trend. At the same time it is still subject to considerable fluctuation because of shifts in social behaviour, such as the decline in young people's drinking in the later 2000s. See Burgess, Adam, “The Politics of Health Risk Promotion. ‘Passive Drinking’: A ‘Good Lie’ Too Far?” 11(6) Health Risk and Society (2009), pp. 527 et sqq. p. 536CrossRefGoogle Scholar.

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38 For example, the Safeguarding Vulnerable Persons Act – which subjected all adults coming into contact with children on any regular basis to regulation – was so badly drafted that it required 250 amendments by the end of its parliamentary progress. The Act was a response to the publicity generated by the murder of two schoolgirls by a school caretaker, Ian Huntley, and the subsequent public inquiry.

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44 Lansley's speech (A New Approach to Public Health, supra note 31) makes clear that he shares a similar agenda to his predecessors – from targeting obesity to amplifying the threat of flu epidemic.

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57 For a useful philosophical critique, see Whyte and Selinger, Competence and Trust in Choice Architecture, supra note 54.

58 Bovens also makes this point, The Ethics of Nudge, supra note 55, p. 12.

59 Recent analysis now tends to suggest that they are at least as effective, probably more so than traditional fat and calorie controlling diets. See for example, Dansinger, Michael L., Gleason, Joi Augustin, Griffith, John L. et al., “Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial”, 293(1) Journal of the American Medical Association (2005), pp. 43–53 CrossRefGoogle Scholar. Increasing recognition that weight loss may be better achieved through limiting carbohydrates also illustrates the often counter-intuitive nature of biological processes, as becoming less fat is not necessarily best done by eating less fat.

60 Bovens discusses this issue interestingly, suggesting that nudge needs to preserve at least ‘in principle’ rather than ‘actual’ token interference transparency; that we could, at least theoretically, be able ‘to identify the intention of the choice architecture and she could blow the whistle if she judges that the government is overstepping its mandate.’, The Ethics of Nudge, supra note 55, p. 13.

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78 The impulse behind Coalition policy remains a debateable question. But in my view, critics tend to act as if financial restrictions simply do not exist – yet they are plainly real. Further, an example like the transformation of higher education suggests that the ideological determination to shift the focus of power is predominant. The changes in higher education are likely to cost the state more in the long term, as a large proportion of the new student loans will not be paid back. Meanwhile, the immediate consequence is to take resources from university teaching budgets and, at least theoretically, place greater power in the hands of the individual student ‘consumer’.

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83 Maintaining ‘good health’ in the past was not generally regarded as an end in itself – as tends to be the case today – but simply as the bodily prerequisite for moral, intellectual and practical achievement. Those unreasonably concerned were known as ‘hypochondriacs’, a term which also indicates the necessary connection with unending concern about even the most minor possible threats to health.

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88 See Burgess, The Politics of Health Risk Promotion, supra note 34, p. 537.

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