Intended for healthcare professionals

Rapid response to:


Judging nudging: can nudging improve population health?

BMJ 2011; 342 doi: (Published 25 January 2011) Cite this as: BMJ 2011;342:d228

Rapid Response:

Promoting Public Health

I have read with interest the articles promoting public health,
contrasting the anticipated and proven benefits of prescriptive measures,
namely legislation, and non-prescriptive, namely environmental &
presentational modification

Certainly, in the areas of tobacco & alcohol there is good
evidence that legislation to reduce availability & usage are effective
in reducing certain Non Communicable Diseases (NCD)

Legislation to beneficially modify diet and increase physical
activity does not yet exist

Certainly, people are influenced, beneficially or detrimentally, by
"advertising" and "display"

Certainly, increasing awareness of public health problems &
hazards does make the medical profession and public more receptive to life
-style modification1,2

If the above be so, then the lesson to be learned is that problems
with multi-factorial aetiology require multi-factorial measures to resolve

Does "nudging" have a place amongst those measures? Probably, yes, as
an additional approach to other, more widely employed measures

Now is the time to employ all available measures if we are to reduce
the incidence of NCDs

A project, employing all of the above measures, in conjunction with
diagnosis & treatment of heart disease, cardiac risk-assessment and
prophylactic statins when appropriate, will shortly be commencing in the
city of Ufa, situated in Bashkortostan, Russia

Numerous associated research projects will be undertaken, including
assessment of optimal ways of influencing Russian men, women &
children to adopt life-style modification

Details can be found at

1. Framingham Heart Study 2008; Social Networks exert key influences
on decision to quit smoking

2. North Karelia project Diabetes Voice 2008; vol 53 special issue

Competing interests: Executive Director International Cardiac Healthcare & RiskFactor Modification

31 January 2011
Harald M Lipman
Executive Director
Medical Advisor Raisa Gorbachev Foundation