One nudge forward, two steps back

In the linked article (doi:10.1136/bmj.d228), Marteau and colleagues offer a timely note of caution about “nudging”—an approach to behaviour change described in Nudge: Improving Decisions about Health, Wealth and Happiness, a book by the US academics Richard Thaler and Cass Sunstein—which is the coalition government’s preferred strategy for promoting public health.1

Based on an explicitly self contradictory concept termed “libertarian paternalism,”2 nudging recognises that our everyday decisions are often not conscious and rational. Much of our behaviour is automatic or follows perceived norms, and it relies on poor information about consequences or overinterpretation of misleading information. Consequently, nudging is based on the principle that it is legitimate to influence people’s behaviour to make their lives healthier (paternalism), but that such influence should be unobtrusive and not entail compulsion (libertarian). Nudges might involve subconscious cues (such as painting targets in urinals to improve accuracy) or correcting misapprehensions about social norms (like telling us that most people do not drink excessively). They can alter the profile of different choices (such as the prominence of healthy food in canteens) or change which options are the default (such as having to opt out of rather than into organ …