Head To Head

Is nudge an effective public health strategy to tackle obesity? No

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d2177 (Published 14 April 2011) Cite this as: BMJ 2011;342:d2177
  1. Geof Rayner, honorary research fellow,
  2. Tim Lang, professor of food policy
  1. 1Centre for Food Policy, City University, London EC1V 0HB, UK
  1. Correspondence to: G Rayner mail{at}rayner.uk.com

Adam Oliver (doi:10.1136/bmj.d2168) maintains that nudges may help people to make healthier choices, but Geof Rayner and Tim Lang worry that government proposals are little more than publicly endorsed marketing

Over the past decade a common picture on the aetiology of obesity has become largely agreed. After years of competing analyses, most people now accept that obesity is the result of a complex multifactoral interplay.1 2 It is not either food intake or physical activity but both. It is not just food oversupply or pricing or domestic culture or food marketing or poor consumer choice or genetic potential. In fact, it is all of these and more. At last, scientific advisers have accepted that they have an analysis to share with politicians and can begin the tortuous process of crafting frameworks for action.3

So why is the British government quietly breaking with this consensus and putting so much weight behind nudge thinking? Nudge is being presented as a new change mechanism from which public health gain will follow and as a means for avoiding the self defeating, heavy handedness of the state.

In fact, it is not that new. The notion that social norms set the framework within which behaviour occurs was articulated by 1930s social science and taken up by US advertising thinkers.4 What is new, in the form it is championed by Thaler and Sunstein’s book Nudge,5 is the incorporation of a more psychological view of behaviour into neoclassical economics, a world in which it was previously thought that rational consumers make informed choices that drive markets.

It is these free market origins, updated to explain why consumers make the wrong choices, that lie behind the UK coalition government’s enthusiasm for nudge. It dispenses with the complexity of real life contexts and acknowledges only the immediate proximal horizons of consumer choice. At a stroke, policy is reduced to a combination of cognitive and “light” environmental signals, such as location of foods within retail geography. Nudge, along with the responsibility deals, is presented as the alternative to regulation, or, in media jargon, the “nanny state.”

Commercial benefit

Richard Thaler, the Chicago economist and coauthor of Nudge, has argued that more regulation won’t solve the problems created by Wall Street; only better information will. “Don’t ban and mandate; just nudge.”6 What can it do for health? Nudge pitches government action at the soft end of policy interventions rather than the hard end where taxes, regulations, or bans feature.

Although the last government started the drift into this thinking via Change4Life as a social marketing approach, the coalition government has narrowed the strategy further. The government’s behavioural insights team, advised by Thaler, sets out numerous nudge inspired interventions, ranging from smoking cessation packs from Boots the Chemist to the London mayor’s bicycle hire scheme, sponsored by Barclays Bank.7 In 2011, a “Great Swapathon” was launched promising £50 vouchers for healthier choices but it emerged that shoppers needed to spend more than double that in order to redeem them.8 This resulted in sceptical questioning in the House of Lords behaviour change inquiry.9 The lesson here might be that nudge is a smokescreen for, at best, inaction and, at worst, publicly endorsed marketing. No wonder criticisms are voiced.10 11

We are not arguing that norms are unimportant. The understanding of the relation between norms and behaviour is complex, raising issues of habit formation, power, genetic vulnerability, individual and group behaviours, let alone the legacy of decades of marketing power and pricing messages. How can “nudge” reshape the agri-food business’s long commitment to lower the price of fat, soft drinks, or high calorie readymade foods or the ubiquitous “offer” of food at every newsagent, station platform, and petrol station?

The responsibility deals with industry that were formalised in the 2010 public health white paper12 add further concern to the use of nudging. Although Mr Lansley, the secretary of state for health, recently claimed the deals don’t “put industry in the driving seat,”13 the first of the three “pillars” in the deal is, “To enable, encourage and incentivise consumers to adopt a better diet and to increase their levels of physical activity as part of a positive decision to lead a healthier lifestyle.”14 Nevertheless, it seems that, at least in relation to the alcohol industry, questions of pricing or irresponsible marketing fall outside the permitted areas of discussion.15 Our final worry is that nudge becomes collusion between the state and corporations to hoodwink consumers. At least nannies are overt.

Notes

Cite this as: BMJ 2011;342:d2177

Footnotes

  • Competing interests: All authors have completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; TL and GR are members of the expert advisory group on healthy weight healthy lives; TL is a commissioner on the Sustainable Development Commission. GR is consultant to an EC funded study of public-private partnerships in obesity.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

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