The UK Government recently announced its plans for “Public Health England”, with ‘nudging’ high on the agenda. What the government considers a ‘nudge’ is unclear, though it seems to mean giving people the opportunity to improve their own health. Here’s why I think this is a flawed policy.
As a recent BMJ article pointed out, there appear to be many more ‘nudges’ in the opposite direction. As long as private companies are allowed to push their delicious fatty foods and cigarettes with all the marketing that they desire, it seems that any government ‘nudge’ will be overshadowed. In the UK, the total value of tobacco sales alone was £11.3 billion, while the government suggests a figure of just £4 billion to be ring-fenced for the new public health service. True, Public Health England will be able to spend almost all of this money on ‘nudging’, but with Diageo (the world’s biggest spirit maker) alone pulling in revenue of £7.1 billion and profits of £1.6 billion in 2010/11, it’s hard to see how a measly £4 billion could counteract the industries’ marketing ‘nudges’.
This doesn’t even take in to account the utility individuals gain from scoffing that 3rd bag of Walkers, or guzzling that penultimate pint of cheap lager at last orders. Nor does it take in to account the fact that you really can’t be bothered using that new-cycle-path-shaped ‘nudge’ to get to work tomorrow, or the fact that you’ll have to sacrifice an hour of your valuable leisure time to take your kid to that new playground. Nor does it take in to account the fact that you don’t even have a bike, and you’re too drunk to even notice the ‘nudge’ on that second bottle that says “the average British drinker drinks one glass of wine a night”.
To be fair, I know very little about behavioural economics, and I have not read “Nudge” (though I will). However, my understanding of compensating and equivalent variations tells me that people are going to need some hard-cash-value incentives or disincentives to have them change their behaviour; either that or regulatory restrictions.
So, where does the ‘nudge’ stand in relation to health economics? Is it something that we should be harnessing? Will anybody be trying to evaluate the QALY loss or gain from particular ‘nudges’? Surely we should, otherwise we might be getting ‘nudged’ into accepting a policy that currently has almost no empirical support.