How to change people’s behaviour – nudge, nudge or the nanny state

It is the job of governments to change people’s behaviour when they see health or safety at risk but how they go about it is in dispute.  Some favour strong regulation but this is often derided as intervention from the “nanny state”.  The present government favours the “nudge” approach which aims to influence behaviour by altering the context or environment in which people choose.  

A Committee of the House of Lords has spent a year considering this and their report (Behaviour Change, http://www.publications.parliament.uk/pa/ld201012/ldselect/ldsctech/179/17902.htm) was issued last week.  They conclude that although much is understood about human behaviour from basic research there is little understanding about how to apply this knowledge to achieve change.  Nudges may not be enough to change behaviour; a range of interventions is likely to be needed, from nudges to legislation, but all approaches should be based upon evidence and the results evaluated carefully.  They comment that some current interventions on food labelling and alcohol pricing are not based on evidence.  The appointment of a Chief Social Scientist is recommended to support behavioural change policies.

For the most part the Report provides useful guidance to government in achieving change but their recommendation on food labelling seems likely to reignite a debate on this topic. The Report recommends clearly, in opposition to government policy, that food labelling should be based on the “traffic light” system.  This recommendation arises from a Case Study on obesity aimed at illustrating different potential approaches for behaviour intervention.

There is no dispute about the size of the problem of obesity; recent figures showed that in most parts of the UK, about a quarter of adults are obese and in some parts of the country the rate approaches that in the US, the most obese country in the world, where one in three adults is obese.  Obesity has very serious effects on human health.  Being obese increases the risk of suffering from cancer, heart disease, diabetes and arthritis.   Obesity decreases the quality of life for individuals, it increases health care costs and it has been shown that being obese decreases life expectancy. 

A government Foresight report in 2007 recognised the scale of the problem and concluded that we now live in an “obesogenic” environment.  We are confronted with an abundance of cheap, energy rich food and coupled with extensive use of motorised transport and a sedentary lifestyle this leads to obesity.  The report proposed that the problem should be tackled by population level interventions which should include promoting healthy eating, physical activity, changing the way towns operate to increase walking etc.

This lead to the “Healthy Weight, Healthy Lives” programme and its associated social marketing arm, Change 4 Life, aimed at promoting these goals.    After two years of the programme, obesity rates in children are beginning to level off but continuing to rise in other groups. This is a long term programme so we should not expect quick results but I am surprised that there is so little evidence of the programme in daily life, promoting good eating habits and promoting exercise. 

The House of Lords Report considers how these interventions are working.  The Report is generally supportive of weight management programmes but critical of government policy on advertising, marketing and labelling of food where policy is not evidence based.  It also questions whether voluntary agreements with business to tackle obesity, favoured by the present government,  will really work when commercial interests may be paramount. 

Let’s look in more detail at the recommendation in the Report for “traffic light” food labelling.  Food labelling is one way of making people aware of what they are eating and may be a means to alter behaviour.  Some major food retailers have adopted the “traffic light” system which provides a quick, clear indicator of levels of fat, sugar and salt in food.  Others have chosen instead to adopt the Guideline Daily Amount (GDA) system which in my view is more complex and provides less clarity.  This variability is very confusing for consumers so is there any evidence supporting either intervention?

An independent review in 2009 concluded that systems based on “traffic lights” provided more easily understandable information for consumers.   Consumers also acted on this information although it was not the only determinant of choice.  The Behaviour Change Report also cites anecdotal evidence in favour of “traffic light” labelling based on purchasing patterns in ASDA and Sainsbury’s.  “Traffic light” labelling has been endorsed by NICE and an integrated system combining “traffic lights”, GDA and text (high, medium, low), already used by ASDA, has been championed by the British Heart Foundation. This integrated system allows quick evaluation of food but also provides the extra numerical information.

Sadly, government policy is for a system based on GDA labelling alone and a similar policy has been agreed in the EU following intense pressure from some food companies.  Both policies run counter to the evidence base. 

Given the increasing support for the integrated “traffic light”/GDA/text system, surely the government should alter its policy and legislate for this single system of food labelling, backing this up with strong public education.  If it is serious about reducing obesity and the knock-on effect on health care costs this food labelling system provides the best chance for results.

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