Big Society's Little Nudges: The Changing Politics of Health Care in an Age of Austerity
| Date | 01 December 2010 |
| Author | Rhys Jones,Jessica Pykett,Mark Whitehead |
| Published date | 01 December 2010 |
| DOI | 10.1111/j.2041-9066.2010.00037.x |
| Subject Matter | Feature |
Libertarian Paternalism
This kind of governmental thinking
reflects ideas of ‘libertarian paternal-
ism’ or ‘nudging ’: this is a politics
defined by the promotion of welfare
(paternalism) at the same time as en-
suring freedom of choice (libertari-
anism). Government, Lansley stated,
should be concerned with, ‘nudging
individuals in the right direction.
Encouraging positive choices. Not
lecturing or nannying. But making
people feel empowered’. According
to nudging’s principal proponents,
Richard Thaler and Cass Sunstein, by
better designing the environments
within which individuals make de-
cisions, governments can encourage
individuals to make choices that are
in their own best interests. A good
example would be designing school
cafeterias to encourage young people
to choose healthier food by placing
fruit rather than sweets and choco-
late at eye level.
Despite Lansley’s claims about the
novelty of his approach, it is clear that
nudging and the broader issue of be-
haviour change had been part of La-
bour government strategy documents
and specific policies since before the
2005 general election. In 2004, the
UK Prime Minister’s Strategy Unit
published a paper on Personal Respon-
sibility and Changing Behaviour, derided
at the time as a harbinger of a new ‘fat
tax’. The use of nudging techniques
was also discussed in relation to the
promotion, among British citizens, of
greener behaviour, a more prudent
Big Society’s Little Nudges:
The Changing Politics of Health Care
in an Age of Austerity
In a speech to the UK Faculty of
Public Health Conference in July,
Andrew Lansley set out his vision
for how government should seek to
modify public behaviour on matters
of health. ‘Behaviour change is the
great challenge for public health’,
the Conservative Secretary of State
for Health said. According to Lansley,
the time has come to imagine more
effective mechanisms for changing
individuals’ behaviour. Rather than
‘preaching’ to its citizens – about the
most appropriate foods to eat, drinks
to consume and activities to engage
in – the Department of Health should
seek to empower them to make ap-
propriate decisions about their own
health. Key to this development is
an increased emphasis on the power
of social norms to influence citizens’
behaviour.
Lansley went on to criticise the
scaremongering tactics of previous
campaigns to reduce alcohol con-
sumption, since they have, allegedly,
reinforced a perception among the
public that everyone is consuming
vast quantities of alcohol. He called
for Department of Health campaigns
to focus on the moderate levels of
alcohol consumed by the majority of
individuals in the UK. The minister
did not underplay the significance of
this purportedly novel way of think-
ing about behaviour in the context of
public health. Instead he argued that
nothing less than a ‘paradigm shift’
was needed to bring about long-term
improvements in the health of the
nation.
The Conservative-led coalition has called for a new approach to public health in the UK. The
nanny state is out; ‘nudging’ citizens into making sensible lifestyle choices is in. Rhys Jones,
Jessica Pykett and Mark Whitehead examine what these changes mean for health policy.
attitude towards personal finance and
a greater commitment to maintaining
and improving their own health.
Moreover, the perceived value of
nudge policies extended well beyond
the confines of Millbank. David
Cameron met with Richard Thaler,
co-author of Nudge, in 2008. That
summer the Conservative leader also
suggested that Thaler and Sunstein’s
book should occupy a prominent po-
sition on Conservative MPs’ reading
lists. It is significant, too, that certain
Conservative-led local authorities
– the most notable example being
Barnet – began to experiment with
nudge policies within their own ar-
eas. Following the election of May
2010, the Conservatives have sought
to promote nudge policies within the
coalition government, even estab-
lishing a ‘behavioural insight team’,
commonly known as the ‘nudge
unit’, within Number 10.
Nudging Health Policy
Despite the similarities between the
Labour Party and the present coali-
tion’s desire to make use of nudging
techniques, it is evident that they in-
terpret nudging in contrasting ways.
For obvious financial and ideological
reasons, Conservatives place greater
emphasis on its libertarian principles
than their Labour predecessors ever
did. Evidence for this can be found in
the coalition’s attitude towards health
policy in general, and their charac-
terisation of Labour’s failings, which
Nudging
suggests that
governments
can use
environmental
design to
change the
health choices
individuals
make
85December 2010
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