One nudge forward, two steps back
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d401 (Published 25 January 2011) Cite this as: BMJ 2011;342:d401
All rapid responses
I am saddened to see the Nudge initiative get the push in this BMJ
editorial. As with your previous rapid responder, I would agree that
throwing the baby out with the bathwater is a fairly knee jerk reaction
and a little bit old fashioned.
The context in which the UK public health system operates has changed
since those heady days of water pumps and sewage systems. The traditional
models of health promotion are a good starting point but aren't
necessarily going to cut it anymore. Innovation in public health can be
stifled by always emphasizing the need for a thousand dusty tomes as
justification for every breath you take.
As a next generation public health consultant, I say let the nudge
initiative breathe. Public health initiatives that we now revere were
often ridiculed in their time. Give Nudge some credence and acknowledge
that the organisations who currently use this and other sophisticated ways
to persuade the public are laughing all the way to the corporate banks,
cashing in on the health of our population. Meanwhile, us well meaning and
worthy types tut and sigh and shake our heads at the idiocy of introducing
something new into our established ways of working...
Competing interests: No competing interests
It is a bit hard on the two American authors of "Nudge: improving
decisions about health, wealth and happiness" for trying to come up with
helpful alternatives to the deadly inaction promoted by powerful interests
in Congress (and Parliament?)(1). Unlike the overview provided by
Martineu et al (2), the editorial is decidedly frosty. In particular, the
claim that nudging has a weak theoretical basis, was made from the stand
point of popular socio-cognitive models used in public health. In fact
"nudging" has been around in consumer behaviour for a long time in the
form of cue utilisation models. (e.g.3,4,5). Cue manipulation during
decision-making may play small but significant roles in the attainment of
public health goals, such as changes in food berhaviours (4,5).
Neo liberals, neo conservatives and their ilk often want to avoid
state regulation and intervention and so are likely to champion approaches
such as nudging as they perceive them to be individually mediated and
relatively inexpensive in financial and political terms. However,
nudging itself is politically neutral; it can be used by individuals, as
in the control of their food consumption, or by the state through
regulation of choices, e.g. opt out clauses for organ donation.
It is important not to throw the baby out with the bathwater. Nudging
combined with regulation and co-regulation could be a valuable factor in
the promotion of the public's health.
email: tonyw@deakin.edu.au
References
1 Thaler RH and Sunstein C. Nudge: improving decisions about health,
wealth and happiness. Yale University Press, 2008.
2 Martineau TM, Ogilvie D, Roland m, Suhrcke M, Ke lly MP. Judging
nudging: can nudging improve population health? BMJ 2011;342:d228.
3 Ehrenberg ASC. The pattern of consumer purchases. Applied Statistics,
1959; 8(1):26-41.
4 Hamlin RP. Cue based decision making: A new framework for understanding
the uninvolved food consumer. Appetite, 2010; 55:89-98.
5 Wansink B. From mindless eating to mindlessly eating better. Physiology
and Behavior; 2010; 100: 454-63.
Competing interests: No competing interests
Nudges need Financial Help and Radical Changes in People's Culture.
What a pity for us; this year as the last one, Colombia doesn't
appear in the Hinari country's list and for that we cannot read freely,
each Saturday, all topics or matter treated in the last wonderful bmj
issue. Please, give us the possibility to read your admirable papers in the old way. Make each issue free after six months or a year of its
edition. Many thanks for giving us now, the possibility to read freely the
editorial and research sections. Our educational institutions like us, are
very poor and don't have money in order to pay subscriptions.
Please allow us to give our personal impressions about the editorial
entitled One Nudge Forward, Two Steps Back. We looked repeatedly at this
paper thinking all the time from our country's side, about the similar
situation in Colombia. We were surprised by the authors' grandiloquent
style and with the selected editorial theme. Their thoughts and writing
are fluent and bold.
In order to change people's behavior it's necessary to take decisions
according to the real social, economic and political situation in a
country, which are not the same around the world. In Colombia
there are radical disparities between theory and practice. The people cannot make true decisions related to their health in order to live
according to the natural requirements. Life has its essential needs and we
must accomplish them. People can understand what to do in order to
satisfy their needs and to make better their health, but they cannot do
that because of their bad daily wage. People live commercially oppressed
by other ones accommodative, evil-intentioned persons, who believe having
the true. Here in Colombia there are a lot of people who earn less than a
dollar for a hard working day, from morning till night. Because of no
money, a lot of people must sleep on the ground of magnificent cities,
adorned with innumerable monuments; several families sleep at home hearing
the crying of their hungry children. Because of injustice several people
are excluded from the society and have a hopeless poverty... Governmental
structural interventions to ameliorate the people's health are directed
to favor economical interests of a little group of financial business men,
who throughout the modern media, internet, TV, broadcasting, promote
changes from good to bad in morals, manners, actions or lifestyles. All
resources for health, at the end, go to the richest men's hands. There are
a lot of unsolved questions related with the reality of human sufferings.
The state must put its support into the people's happiness. It's time to
change to the truth. The state's activity must be focused on approaches,
which really ameliorate the true life of the Colombian people. State must
compromise until globalization of the workers wage, improving their
social, organizational and ecological conditions. The health resources
must be directed to primary prevention and not to the dishonest and
corrupt financial societies, who work, in a chain manner, with
governmental workers.
It's also urgent and necessary to make radical amendments in education. In
Colombia there is not an initial or primary education, there is only a
basic one, which doesn't help in forming a true citizen, who can live
accordingly with the natural laws. After nine years of basic compulsory
education the students don't have the essential competences for living in
community, don't recognize the social norms of conviviality, and as a
logical consequence, don't apply them in practice. The true initial
education must form persons for a better living place and for doing honest
and progressive work.
Competing interests: No competing interests