Applying behavioural insights to challenges in health policy

Abstract

Many of the more significant challenges we face in healthcare - such as reducing smoking, encouraging exercise and improving clinician adherence to evidence-based guidelines - will only be resolved if we are more successful at changing behaviours. The traditional tools used when thinking about influencing behaviour include legislation, regulation and information provision. Recently, interest has been shown in policies that ‘nudge’ people in particular directions; drawing on major advances in our understanding that behaviour is strongly influenced (in largely automatic ways) by the context and situation within which it is placed. Insights from across the behavioural sciences and particularly behavioural economics provide us with a powerful set of new and refined policy tools to use when trying to influence health-related behaviours. My thesis - ‘Applying behavioural insights to challenges in health policy’ - considers the theoretical basis for why ‘nudges’ might work and presents the Mindspace framework (that I co- developed with colleagues) that supports policy makers and practitioners looking to apply behavioural insights. Mindspace sets out what are considered to be the most robust effects on behaviour that operate largely, though not exclusively on automatic neurobiological and psychological systems. I explore the evidence for each of the Mindspace effects and demonstrate how they can be applied to specific areas of challenge including in enhancing the safety of medication prescribing, improving hand-hygiene compliance and reducing the trajectory of health spending in developed health systems. I do so through a mixture of qualitative and quantitative approaches, at all times grounding the work in the practicalities of my experience as a clinician. I explore the ethical and political considerations in determining whether it is appropriate to target automatic processes of judgment and make suggestions as to the direction of travel of ‘nudging’ in health policy going forward, particularly in relation to new information and communication technologies.