Humans, not Robots

Posted: 13th December 2010

On the 30th November the UK Government published a new white paper for public health in England. There is something new and refreshing about this white paper that I haven't seen in other government documents and strategies before; it puts a new emphasis on Behavioural Economics, a field which blends the borders of psychology and economics to anticipate how humans will really respond to given circumstances and choices and to the behaviours that follow. It highlights the fact that people don't always act in their own best interests, often make poor, irrational decisions, are biased, jump to conclusions, are influenced by other people and don't always think in a long-term way. The psychological triats behind this are known as 'Cognitive Biases' for which there is an ever inreasing (and often highly entertaining) raft of evidence and studies.

There is a lot of reference to "nudging" when describing this approach, after this brilliant book:

Nudge: Improving decisions about health, wealth, and happiness Richard H. Thaler and Cass R. Sunstein (2008)

which describes how it is possible to exert influence on decision making through clever framing and design of choices, essentially working with human cognitive biases, rather than against them. Since the white paper was published I have read many articles and blogs both for and against the approach but in the main I see this is a hugely positive step forward.

There was a time when public health was all about disease control and prevention and public protection, but as we've become more advanced in terms of medical intervention and research which has allowed us to live longer, and as we've become more affluent, the greatest threats to human health are now as a result of the lifestyle choices.

Govermment policies have to find the right place between total libertarian ("We'll butt out and let you get on with your lives with no interference from us") and authoritarian ("We're going to stop you from doing this by banning it").

Take obesity for example; if the government does nothing and allows us to just carry on as we are then we are storing up huge amounts of misery and suffering for the future. Humans are biologically programmed to eat calorie-dense food and to preserve energy expenditure. This helped our ancestors to survive in famine, but in today's society where food is easy to find the instinct works against us. Left to our own we will continue to become more and more obese and when our health fails as a result not only will the toll on the NHS become too great but the human misery will be unimaginable.

Then there's the flip-side; imagine if the government passed a law making it illegal not to participate in 3 hours of physical activity each week and banning high calorie foods from restaurants and supermarkets. The exercise police will be round to take you away if you don't met your legal requirement. Ok, that's silly, but the point I'm making is that the government can't do nothing and equally can't do everything. What it can do is to try and make the healthier options as attractive and easy to choose as possible and perhaps make it more difficult for us to make unhealthy choices.

This is what government policy has been doing for years. The difference this time, and this is what excites me about the new white paper, is that they are trying to work out how best appeal to the real human in us all. Most health service interventions I have come across so far have been designed with a rational person in mind. A robot. Robots like numbers, risk factors and can be influenced into lifestyle change on a logical argument. Robots have a running balance of active minutes in their heads, they see glasses of wine as a number of units and can tell you how many out of 100 smokers will die young. Healthy lifestyle change in robots is permanent too, because they don't have habits to fall back on.

Healthy lifestyle services aren't cheap and can run into the £100s if not £1000s per individual or family. Yet they are massively undersubscribed and few run at capacity. Service designers scratch their heads and puzzle over why the latest leaflets and posters have failed to generate more participants. Most healthy living marketing talks about risk of future-ill health, active minutes, alcohol units, steps, grams of salt, pieces of fruit and so on. If they shifted their approach to attract humans rather than robots, I think they'd enjoy better take-up.

We have designed a world for ourselves which allows for our humanness. We have alarm clocks and fuel gauges and diaries. Until now, healthy living services have relied too hard on internal factors, such as motivation, for success and by expecting us to behave in rational ways. By designing new health services for 'brilliantly flawed' human humans, with behavioural economics at their core we at least stand a better chance of better outcomes, more cost effective services, more sustainable behaviour change and a happier and healthier population.


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