Analysis

Judging nudging: can nudging improve population health?

BMJ 2011; 342 doi: 10.1136/bmj.d228 (Published 25 January 2011)
Cite this as: BMJ 2011;342:d228

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  1. Theresa M Marteau, director1,
  2. David Ogilvie, clinical investigator scientist2,
  3. Martin Roland, professor of health services research1,
  4. Marc Suhrcke, professor of public health economics3,
  5. Michael P Kelly, director4
  1. 1Behaviour and Health Research Unit, University of Cambridge Institute of Public Health, Cambridge CB2 0SR, UK
  2. 2MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research, Institute of Public Health, Cambridge
  3. 3School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
  4. 4Public Health Excellence Centre, National Institute for Health and Clinical Excellence, London, UK
  1. Correspondence to: T M Marteau theresa.marteau{at}medschl.cam.ac.uk
  • Accepted 9 January 2011

Nudging has captured the imagination of the public, researchers, and policy makers as a way of changing human behaviour, with both the UK and US governments embracing it. Theresa Marteau and colleagues ask whether the concept stands up to scientific scrutiny

If people didn’t smoke, drank less, ate healthier diets and were more active, the huge burden of chronic diseases such as cancer, heart disease, and type 2 diabetes would be much reduced.1 The prospect of being able to nudge populations into changing their behaviour has generated great interest among policymakers worldwide, including the UK government.2 We explore what nudging is and assess the prospect of nudging our way to a healthier population.

Understanding behaviour change

Most people value their health yet persist in behaving in ways that undermine it. This can reflect a deliberate act by individuals who happen at different moments in time to value other things in life more highly than their health. It can also reflect a non-deliberate act. This gap between values and behaviour can be understood by using a dual process model in which human behaviour is shaped by two systems.3 The first is a reflective, goal oriented system driven by our values and intentions. It requires cognitive capacity or thinking space, which is limited. Many traditional approaches to health promotion depend on engaging this system. Often based on providing information, they are designed to alter beliefs and attitudes, motivate people with the prospect of future benefits, or help them develop self regulatory skills. At best, these approaches have been modestly effective in changing behaviour.4

The second is an automatic, affective system that requires little or no cognitive engagement, being driven by immediate feelings and triggered by our environments. Despite wishing to lose weight, for example, we still buy the chocolate bar displayed …

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