Influencing Healthy Lifestyles: Nudging or Shoving? The Ethical Debate Department of Health Symposium
Should policy-makers try to influence people’s behaviour when it comes to lifestyle choices? Does nudging represent an efficient yet proportionate tool of governance or might it be seen as a step towards a nanny state? These and other questions will be debated at a half-day symposium on Monday 11th May, 9.30a.m. to 1p.m. in the Bedford Hall Suite, Dublin Castle.
The well documented connection between lifestyle choices, disease and healthcare costs has led to policy-makers seeking more creative ways to influence behaviour and steer populations towards making healthier lifestyle choices. Nudging, (applying behavioural science to encourage populations towards better health) is one such measure.
Advocates of the use of nudging say that the private sector has been nudging people (in the form of marketing) for years and that governments should use similar techniques to level the playing field and to encourage people to adopt healthier lifestyles. They also claim that nudging does not restrict personal choice but merely guides people towards the most beneficial options. However, while nudging does not involve compulsion it is a powerful tool of persuasion, possibly even manipulation, and consequently raises a number of ethical issues relating to individual freedom, dignity, solidarity and personal responsibility.
“Nudging focuses on personal choice and personal responsibility, yet factors such as poverty and unhealthy early childhood conditions are also important for determining susceptibility to most diseases. It is important that public health strategies are sensitive to social inequalities and avoid stigmatising marginalised groups”, said Dr Siobhán O’Sullivan, Chief Bioethics Officer at the Department of Health.
Dr Tony Holohan, Chief Medical Officer said that: “While innovative policy-making is to be encouraged, it is essential that it is done in a thoughtful, responsible and ethical manner. This symposium offers us an ideal opportunity to do just that.”
Note for Editors:
- Six of the ten biggest contributors to the global disease burden are related to individual lifestyle habits, including tobacco use, alcohol consumption, high cholesterol, high blood pressure, unsafe sex and obesity.
- Social and economic inequalities lead to inequality in health. In fact, almost half of people living in consistent poverty in Ireland report having some form of chronic illness.
- One of the Department of Health’s key priorities is to safeguard and improve the health and wellbeing of the population with a main focus being on prevention and keeping people healthier for longer. This involves using a mix of regulation (including recent legislation restricting access to sunbeds, introducing minimum unit pricing for alcohol, making calorie counts mandatory on restaurant menus and standardising cigarette packaging) and more traditional public health interventions such as education and information campaigns.
- In 2008 Richard Thaler and Cass Sunstein published a book entitled Nudge: Improving Decisions About Health, Wealth, and Happiness. In it they use the term nudge to describe “any aspect of the choice architecture that alters people’s behaviour in a predictable way without forbidding any options.”
- Their concept draws on the disciplines of behavioural economics and social psychology to explain why people behave in ways that appear to be against their interests. The authors argue that this discrepancy between interests and actions is, in part, attributable to an automatic and sub-conscious process that is largely conditioned by the environment in which choices are made. Thaler and Sunstein suggest that it is via this sub-conscious system that it is possible to ‘nudge’ people into making certain ‘beneficial’ choices.
- Nudging includes a wide variety of approaches to altering social or physical environments to make certain behaviours more likely. These might include providing information about what others are doing (“social norm feedback”) framed to make healthy behaviours more salient, changing the defaults that surround the serving of food and drinks, or altering the layout of buildings to cue physical activity.
- Examples of health-based nudges include: placing healthy food options in more prominent positions in buffets and cafeterias to encourage people to select them over less healthy options, making salad rather than chips the default option in restaurants, the “five a day” slogan to encourage more people to eat fruit and vegetables, prompting people to join the Organ Donor Register using “reciprocity” messages (‘if you needed an organ, would you take one?’) and offering lower health insurance premiums for people who lead healthier lifestyles.
- Bioethics serves as an important tool for making decisions about the direction and governance of science and medicine. It plays another valuable role in that it anticipates future questions of concern, encourages awareness about them and stimulates debate within all sections of society.
- The Bioethics Unit provides bioethical advice and input into policy and legislative developments across a number of different units within the Department.
- Healthy Ireland is the national framework for action to improve the health and wellbeing of the people of Ireland. Its main focus is on prevention and keeping people healthier for longer. Healthy Ireland’s goals are to:
-Increase the proportion of people who are healthy at all stages of life
– Reduce health inequalities
– Protect the public from threats to health and wellbeing
– Create an environment where every individual and sector of society can play their part in achieving a healthy Ireland
- This event is one of a series of open policy seminars under the Civil Service Renewal Plan to promote a culture of innovation and openness by engaging with practitioners and experts in policy issues .