Health Nudges Flashcards
Basis for health nudges
trend in obesity is such that if it isn’t reversed it’ll overtake smoking as the leading preventable cause of death
therefore one of the most significant causes of rising costs in health care
we are now consuming more calories than we used to
- Rationale theorists would argue that we choose to be obese and that perhaps the reason for this is that we consider the utility we get from eating vs the cost of being overweight and make a rational decision to eat more
overeating is related to
- present bias - enjoyment of a meal as immediate whereas consequence of weight gain is delayed
- sophisticated techniques to get us to eat more (smell of Cinnabons)
Popcorn study done through Cornell Uni
offered moviegoers free popcorn when they bought a ticket - either medium or large of stale but edible
- people who had the large ate 53% more
- when asked by the researchers of they thought the largest pot had induced them to eat more, vast majority convinced it had not - primed
- portion sizes vary according to container size so that people who use larger glasses and larger plates drink and eat more
Google’s Nudge cafe in NY
large plates and containers replaced with smaller ones got people to eat less
Sugary Drinks portion cap rule - NY
limit on soft drink size in NYC to prohibit the sale of many sweetened drinks more than 0.47 litres in volume
under plan, restaurants, theatres, stadiums etc banned from selling in more than 0.5 litres
- large drink manufacturers were very opposed
argued that the ban would disproportionately affect lower income people who tend to consume more sugary drinks and who have a harder time having to buy two smaller ones
- some argued ban took away their choices and imposed unnecessary restrictions on rights
- created what is known as reactance in psychology which can occur when people react to the ban by strengthening their resolve to disobey it, a form of “defiance”
- so bans often don’t work and can be difficult to implement and can create reactance and legal challenges
Relative value of choice
experiment at Cornell of students in the control group jeu were told they must take carrots with their meal
in experiment group 120 were given the choice (103/120 chose carrots) - 91% ate
of those forced to take carrots 83/120 actually ate them
shows if you give someone a choice it makes the choice more attractive
- if you force students to take vegetables it increases wastage and there’s no meaningful impact on consumption
- research also shows that when people are forced to change through elimination of choices or heavy incentives, long-term behaviour is unlikely to change
Changes in defaults
- if countries default option is to opt in then the majority opt in - Ariely and organ donation
experiment of changing default of sugar sachets to 7.5g to 4g (done with coffee in gyms in Catania)
- finding were the average intake of sugar was 5.83g during the control and 3.05g with the experimental
- if this was extrapolated to 2 cups of coffee per day this would result in a difference of 8100 calories per year
problem is that companies have no incentive to reduce what people to consume as it reduces profits
Changing paracetamol default
common method of suicide
- suicides are often impulsive and people tend to use drugs freely available at home
- people more likely to consume more than 25 tablets when they are in a loose pack rather than in a blister pack
- in 1998 law was changed in the UK so cannot be sold in large containers - max 16
- led to estimated 43% reduction in suicides and 61% reduction in registration for liver transplants due to paracetamol poisoning
evidence has been found that people don’t find an alternative route for suicides when faced with even small barriers but rather discontinue the attempt altogether
Does a change in the default always work?
study in a US school, students default changed from French fries to apple fries
students didn’t stick with the change in default
- shows you can have success in changing defaults if preferences are ambiguous, difficult or when people don’t care, but when they have a clear preference they will resort to that preference
Salience
making things more relevant - choice architecture
- by moving the salad bar so that it became more salient and more convenient salad sales increase and became part of the lunchtime routine for students
Traffic light system
experiment at large hospital cafe in US 2009-2012
items with more positives than negatives were green, equal were yellow and negatives were red
green items were more visible at eye level, salads next to the pizza counter
- consumption “results demonstrated that individuals exposed to food labelling and Environmental interventions will change their behaviour to make healthy choices over an extended period of time”
Food
research shows that disclosing calorie content of food has very limited effect
- no one really knows if 500 cals is a lot or not
- overloaded with information
- there’s more info in a NY times edition than the average person would be exposed to in an entire lifetime
therefore should label food with clear, consistent information with intuitive visuals like the traffic lights
Taking medicines/Prescriptions
up to a 1/3 of prescriptions made are never taken to the pharmacy and up to half of patients don’t take their pills
- In the US medication non-adherence causes 125,000 deaths and costs the health system up to $269bn
Wellth
company that has developed an app which says after a patient is discharged from hospital the company deposits $150 into their bank account which they patient can keep if they take their medication for 3 months
- get a reminder message every morning and need to send a selfie with proof
- if they miss $2 is taken out their account
- if they miss 2 days in a row they get a phone call
Weight loss programme
2 groups, one of which asked to put money into an account which would be returned to them with a supplement if they met their weight loss targets
- showed significant weight loss compared to other group
- fear of losing money creates strong incentive
- a lesson policy makers could emphasise the money that people would lose by not taking action, rather than the amount of money they could save
