I gave it a nudge but it won’t budge

New research suggests the superficial appeal of governing by light touch founders in the health arena where so many ‘unhealthy nudges’ are already in place, writes Emily Badger in Miller-McCune Magazine.

Legal scholar Cass Sunstein and behavioral economist Richard Thaler unleashed an incredibly seductive idea in 2008 with their popular book Nudge. Many of society’s biggest problems, they suggested, from poor public health to environmental degradation to lousy retirement planning, could be solved without expensive interventions or intrusive regulation.

All policymakers have to do is alter the environments in which people make decisions, gently nudging them toward the choices that would improve their lives — away from the potato chips, say, or toward that corporate 401(k) match.

“To count as a nudge, the intervention must be easy and cheap to avoid,” the authors wrote. “Nudges are not mandates. Putting the fruit at eye level counts as a nudge. Banning junk food does not.”

As an added bonus, Sunstein and Thaler figured the concept — recognized by some as “libertarian paternalism” — ought to appeal to liberal and conservative politicians alike.

Beyond the influence of their book, Sunstein and Thaler have taken these ideas straight to government. Sunstein now heads the White House Office of Information and Regulatory Affairs (under a liberal president), and Thaler is advising conservative British Prime Minister David Cameron’s cabinet through a group known cheekily as the “nudge unit.”

“It’s pretty popular over here,” said Theresa Marteau, director of the Behavior and Health Research Unit at the University of Cambridge Institute of Public Health. “These ideas are forming really the framework for how government wants to improve population health.”

And this gives her pause.

“The U.S. and the U.K. spend a lot of money on research — not enough in my view — trying to develop interventions, develop the evidence base for us to know what is more or less effective,” she said. “Then here comes a new book with the promise of changing behavior through the relatively simple means of altering environments, or the context in which behavior occurs, without using bans, without using pricing.”

Marteau and several of her colleagues question whether the elegant solution is really as effective as Nudge suggests (and as British and American politicians would like it to be), particularly when it comes to the vast and complex challenges of public health.

“As researchers, we’re paid to be skeptical, to say, ‘OK, well that’s interesting. Let’s now see where the evidence is,’” Marteau said. “Will this not only change behavior, but will it result in sustained change and sustained change that is large enough to be able to achieve the scale of change that’s needed to have an impact on population health?”

Her conclusion after an initial review of the research: “There was remarkably little evidence to support the ideas behind nudging in the context of changing health-related behavior.”

The full article is available from Miller-McCune.