Human behaviour in Health

Approaches to improving health outcomes
Health Economics Applications and Policy
EFN423
Health Economics Applications and Policy
EFN423
How to change Behaviour? Insights from Behavioural Economics
Many unhealthy behaviours do not result in negative outcomes in
every instance
• Each cigarette, drink, and bag of drugs is probabilistically related
to negative outcomes, not certain negative outcomes.
• Every unprotected sex, poor medicine compliance, delayed
cancer screenings are not going to kill with certainty
If a person is willing to accept the risk of negative outcomes for
greater reward, their “cost-benefit” ratio is acceptable.
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To effectively change behaviour, you need…
• Recognition that behaviour change is needed / desirable
• Motivation to make change
• Belief that change can occur and be maintained (perceived selfefficacy)
• Triggers/cues to initiate change
• Perceived benefits of that change
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Is health behaviour change hard to achieve…?
Yes.
For patients:
 Treatment non-adherence ranges from 30-60%
 Prophylactic treatment adherence only 30-35%
 Protective health behaviour 10-30%
For healthcare professionals (HCPs):
 Literature indicates HCPs do not follow clinical procedures they know
should be implemented: Physician performance ranges between 48-
72% of professional standard (Peterson et al., 1980)
 Nurses deviate from infection control rules (Raven & Harley, 1982)
 Dentists fail to adequately shield patients during x-rays (Green &
Neistat, 1983), 20% error rate in care procedures in old people’s
homes (Kayne & Cheung, 1973). etc…
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So what do we do to change health behaviour?
Behavioural Economics can offer some valuable insights.
There has been an enormous proliferation of interest in
behavioural economics in the last decade among policy
practitioners.
Both the UK and Australian Governments have developed
insights teams dedicated to finding new ways to ‘nudge’
citizens to be healthier, greener and more civic-minded.
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But…on average we would like people to make the ‘right’ health
decisions – from a societal point of view.
The Behavioural Economics approach to this problem is – NUDGE
Nudge – what is it?
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NUDGE: Principals and Procedures
PROCEDURES
 evidence-based
 testing of interventions in
reallife
context
 randomised control trials
PRINCIPLES
Philosophy of libertarian
paternalism
• Simplification and
framing of information
• Changes to the
physical environment
• Changes to the default
option
• Use of (descriptive)
social norms
NUDGE could be appropriate for healthy behaviour
Nudges are
appropriate when:
• choices have
delayed effects,
• when they are
complex or
infrequent and
thus learning is
not possible,
• when feedback
is not available,
and
• when the
relation
between
YES ?
Perceived complexity LOW
Perceived complexity HIGH
LOW
involve
ment
decision
HIGH
involve
ment
decision
YES YES
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NUDGE in a nutshell
“… any aspect of the choice architecture* that alters people’s behaviour in a
predictable way without forbidding any options or significantly changing their
economic incentives…. Putting the fruit at eye level counts as a nudge. Banning
junk food does not”.
Thaler, RH & Sunstein CR (2008) Nudge: Improving decisions about health, wealth, and happiness, New Haven, CT., Yale
University Press.
*aspect of the social/physical environment that makes a particular option more attractive, preferred
or even the default choice
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Some individual NUDGES are quite effective
95-99% of customers stay with the “green electricity default”
Duplex printing default ~ 30%
Smaller plates -> 20% less food waste
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NUDGE (alone) may not change health behaviour
Because making it part of policy and
practice will take a long time and
require some heavy legislation.
One of the most effective nudges
(other than defaults) is 50% drop in
Pringles crisps consumption after
adding 10% red Pringles.
It is people and stricter policies that will resist the obesogenic
environment. Nudge can help by offering policy makers and
citizens better tools.