Intended for healthcare professionals


Changing behaviour through state intervention

BMJ 2008; 337 doi: (Published 15 December 2008) Cite this as: BMJ 2008;337:a2543
  1. Theresa M Marteau, professor of health psychology1,
  2. Adam Oliver, RCUK academic fellow in health economics and policy2,
  3. Richard E Ashcroft, professor of bioethics3
  1. 1Department of Psychology, King’s College London, Guy’s Campus, London SE1 9RT
  2. 2LSE Health, London School of Economics and Political Science, London WC2A 2AE
  3. 3School of Law, Queen Mary, University of London, London E1 4NS
  1. theresa.marteau{at}

    When does an acceptable nudge become an unacceptable shove?

    The question of when governments should intervene to change our behaviour sits at the heart of political philosophy and bioethics.1 In their recent book, Nudge: improving decisions about health, wealth, and happiness, Richard Thaler and Cass Sunstein argue that public and private organisations can and should intervene more often than they currently do to alter people’s behaviour.2 Their thesis is based on the observation that people often behave in ways that are not in their best long term interests. The remedy, they argue, is to present options in such a way as to increase the likelihood that people will choose what they would, on reflection, most prefer. This approach has attracted much interest and support from politicians including Barack Obama and David Cameron.

    Thaler and Sunstein call their general approach “libertarian paternalism”—paternalistic in that governments, for example, play an active role in framing options, but libertarian in the sense that people ultimately remain free to choose. Examples of such approaches in the health context include placing fresh fruit …

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