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Healthy Nations: Behavioural Approaches in Public Health Policy

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Behavioural Policies for Health Promotion and Disease Prevention

Part of the book series: Palgrave Studies in Public Health Policy Research ((PSPHPR))

Abstract

This chapter explores the rise of behavioural approaches to public health policies in different nation-states, exploring these in the context of contrasting efforts to address the social and spatial determinants of health and well-being. It examines how moral and political arguments for health promotion have given way to ‘simpler’ health strategies, albeit those which are based on increasingly sophisticated evidence and data relating to human behaviour and decision-making. In highlighting place-based and geographically variable understandings of health inequalities, the chapter considers how behavioural public health policies, which are growing in global significance, recast notions of health citizenship and governance towards behavioural, universal and marketised ideals. Using case studies from Singapore, the UK and the USA, the chapter explores the wider ethics of the behavioural turn in terms of its unintended consequences, its long-term sustainability and its capacity to transform health inequalities in different geographical contexts.

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Notes

  1. 1.

    The exception here is Tobacco use and its role in causing cancer, which was identified in the 1950s and put on the global health agenda in 1964 (see Herrick 2014, 186; Porter 1999, 299).

  2. 2.

    https://www.eiu.com/public/topical_report.aspx?campaignid=DemocracyIndex2016

  3. 3.

    https://obamawhitehouse.archives.gov/the-press-office/2015/09/15/executive-order-using-behavioral-science-insights-better-serve-american

  4. 4.

    https://nudgecoach.com/nudgeapp/

  5. 5.

    Since 2017: https://oes.gsa.gov

References

  • Baum, F., & Fisher, M. (2014). Why behavioural health promotion endures despite its failure to reduce health inequities. Sociology of Health & Illness, 36(2), 213–225.

    Article  Google Scholar 

  • Berndt, C., & Boeckler, M. (2017). Economic, experiments, evidence: Poor behaviour and the development of market subjects. In V. Higgins & W. Larner (Eds.), Assembling neoliberalism. Expertise, practices, subjects (pp. 283–302). New York: Palgrave Macmillan.

    Chapter  Google Scholar 

  • Bhargava, S., Loewenstein, G., & Benartzi, S. (2017). The costs of poor health (plan choices) and prescriptions for reform. Behavioural Science & Policy, 3(1), 1–12.

    Article  Google Scholar 

  • Blumenthal-Barby, J. S., & Burroughs, H. (2012). Seeking better health care outcomes: The ethics of using the “nudge”. The American Journal of Bioethics, 12(2), 1–10.

    Article  Google Scholar 

  • Brown, R. C. H. (2013). Moral responsibility for (un)healthy behaviour. Journal of Medical Ethics., 39, 695–698.

    Article  Google Scholar 

  • Carter, B., Danford, A., Howcroft, D., Richardson, H., Smith, A., & Taylor, P. (2013). ‘Stressed out of my box’: Employee experience of lean working and occupational ill-health in clerical work in the UK public sector. Work, Employment and Society, 27(5), 747–767.

    Article  Google Scholar 

  • Carter, E. D. (2015). Making the Blue Zones: Neoliberalism and nudges in public health promotion. Social Science & Medicine, 133, 374–382.

    Article  Google Scholar 

  • Chen, J., Vargas-Bustaante, A., Mortensen, K., & Ortega, A. N. (2016). Racial and ethnic disparities in health care access and utilization under the Affordable Care Act. Medical Care, 54(2), 140–146.

    Article  Google Scholar 

  • Cohn, S., & Lynch, R. (2017). Falling into a routine: From habits to situated practices. Sociology of Health and Illness,39(8), 1–14. https://doi.org/10.1111/1467-9566.12597.

    Article  Google Scholar 

  • Commission on the Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: World Health Organization.

    Google Scholar 

  • Crawshaw, P. (2013). Public health policy and the behavioural turn: The case of social marketing. Critical Social Policy, 33(4), 616–637.

    Article  Google Scholar 

  • Department of Health. (2011). Changing behaviour, improving outcomes. A new social marketing strategy for public health. London: Department of Health.

    Google Scholar 

  • Duncan, C., Jones, K., & Moon, G. (1999). Smoking and deprivation: Are there neighbourhood effects? Social Science & Medicine, 48(4), 497–505.

    Article  Google Scholar 

  • Hallsworth, M., Snijders, V., Burd, H., Prestt, J., Judah, G., Huf, S., & Halpern, D. (Behavioural Insights Team). (2016). Applying behavioural insights. Simple ways to improve health outcomes. Doha: World Innovation Summit for Health.

    Google Scholar 

  • Halpern, D. (2015). Inside the nudge unit. How small changes can make a big difference. London: WH Allen.

    Google Scholar 

  • Halpern, D., Bates, C., Mulgan, G., Aldridge, S., Beales, G., & Heathfield, A. (2004). Personal responsibility and changing behaviour: The state of knowledge and its implications for public policy. London: Cabinet Office.

    Google Scholar 

  • Hausman, D. M., & Welch, B. (2010). Debate: To nudge or not to nudge. The Journal of Political Philosophy, 18(1), 123–136.

    Article  Google Scholar 

  • Herrick, H. (2014). (Global) health geography and the post-2015 development agenda. The Geographical Journal, 180(2), 185–190.

    Article  Google Scholar 

  • Hollands, G. J., Marteau, T. M., & Fletcher, P. C. (2016). Non-conscious processes in changing health-related behaviour: A conceptual analysis and framework. Health Psychology Review, 10(4), 381–394.

    Article  Google Scholar 

  • Jaspen, B. (2017, September 1). Billionaire Bloomberg spends millions to rescue Chicago-area soda Tax. Forbes. Available at: https://www.forbes.com/sites/brucejapsen/2017/09/01/billionaire-bloomberg-spends-millions-to-save-chicago-area-soda-tax/#265be4b31238. Accessed 05 Oct 2017.

  • Jochelson, K. (2006). Nanny or steward? The role of government in public health. Public Health, 120(12), 1149–1155.

    Article  Google Scholar 

  • Jones, R., Pykett, J., & Whitehead, M. (2010). Big society’s little nudges: The changing politics of health care in an age of austerity. Political Insight, 1(3), 85–87.

    Article  Google Scholar 

  • Jones, R., Pykett, J., & Whitehead, M. (2013). Changing behaviours. On the rise of the psychological state. Cheltenham: Edward Elgar.

    Book  Google Scholar 

  • Kelly, M., & Russo, F. (2018). Causal narratives in public health: The difference between mechanisms of aetiology and mechanisms of prevention in non-communicable diseases. Sociology of Health and Illness, 40(1), 1–18. https://doi.org/10.1111/1467-9566.12621.

    Article  Google Scholar 

  • Khullar, D. (2017, April 13). How behavioral economics can produce better health care. New York Times. Available at: https://www.nytimes.com/2017/04/13/upshot/answer-to-better-health-care-behavioral-economics.html. Accessed 28 Nov 2017.

  • Lansley, A. (2010). Secretary of State for Health’s speech to the UK Faculty of Public Health Conference – ‘A new approach to public health’. Available at http://webarchive.nationalarchives.gov.uk/+/http://www.dh.gov.uk/en/MediaCentre/Speeches/DH_117280. Accessed 28 Nov 2017.

  • Lourenço, J. S., Ciriolo, E., Almeida, R. S., & Troussard, X. (2016). Behavioural insights applied to policy: European report. EUR 27726 EN. https://doi.org/10.2760/903938.

  • Marteau, T., Ogilvie, D., Roland, M., Suhrcke, M., and Kelly, M. P. (2011, January 29). Judging nudging: Can nudging improve population health? BMJ, 342,263–365.

    Article  Google Scholar 

  • McDaid, D., & Merkur, S. (2014). To nudge, or not to nudge, that is the question. Eurohealth, 20(2), 3–5.

    Google Scholar 

  • National Health Service. (2014). Five year forward view. NHS England, at: https://www.england.nhs.uk/five-year-forward-view/. Accessed 14 Sept 2018.

  • OECD. (2017a). Behavioural insights and public policy. Lessons from around the world. Paris: OECD. Available at: http://www.oecd.org/gov/regulatory-policy/behavioural-insights-and-public-policy-9789264270480-en.htm. Accessed 28 Nov 2017.

  • OECD. (2017b, May). Behavioural insights in public policy: Key messages and summary from OECD international events. Paris: OECD. www.oecd.org/gov/regulatory-policy/OECD-events-behavioural-insights-summary-may-2017.pdf. Accessed 28 Nov 2017.

  • Oliver, A. (2015). Nudging, shoving, and budging: Behavioural economic-informed policy. Public Administration, 93(3), 700–714.

    Article  Google Scholar 

  • Ong, P. (2015). Speech by Mr Peter Ong, head of civil service Singapore at “Frontiers of behavioural economics: Choice and well-being in the Asia Pacific”. https://www.cscollege.gov.sg/About%20Us/newsroom/2015/Pages/Speech-by-Mr-Peter-Ong,-Head-of-Civil-Service-Singapore-at-Frontiers-of-Behavioural-Economics.aspx. Accessed 02 Nov 2017.

  • Porter, D. (1999). Health, civilization and the state. A history of public health from ancient to modern times. London: Routledge.

    Google Scholar 

  • Rayner, G., & Lang, T. (2011). Is nudge an effective public health strategy to tackle obesity? No. BMJ, 342, d2177.

    Article  Google Scholar 

  • Reisch, L. A., Sunstein, C. R., & Gwozdz, W. (2017). Beyond carrots and sticks: Europeans support health nudges. Food Policy, 69, 1–10.

    Article  Google Scholar 

  • Rosen, G. (2015 [1958]). A history of public health (Revised expanded ed.). Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Sparks, K., Cooper, C., Fried, Y., & Shirom, A. (1997). The effects of hours of work on health: A meta-analytic review. Journal of Occupational and Organizational Psychology, 70, 391–408.

    Article  Google Scholar 

  • Sunstein, C. (2011). Empirically informed regulation. University of Chicago Law Review, 78(4), 1349–1429.

    Google Scholar 

  • Tan, V., Utravathy, V., & Ling, C. (2017). Healthy living, everyday. In Ethos 17 (pp. 44–51). Singapore: Civil Service College.

    Google Scholar 

  • Tengland, P.-A. (2012). Behavior change or empowerment: On the ethics of health-promotion strategies. Public Health Ethics, 5(2), 140–153.

    Article  Google Scholar 

  • Thaler, R. (2015). Foreword. In D. Halpern (Ed.), Inside the nudge unit. London: W H Allen.

    Google Scholar 

  • Thaler, R., & Sunstein, C. R. (2008). Nudge. Improving decisions about health, wealth and happiness. London: Yale University Press.

    Google Scholar 

  • Theseira, W., & Qiyan, O. (2017). The hidden costs of behavioural interventions. In Ethos 17 (pp. 68–75). Singapore: Civil Service College.

    Google Scholar 

  • Thomas, B., Dorling, D., & Smith, G. D. (2010). Inequalities in premature mortality in Britain: Observational study from 1921 to 2007. BMJ, 341, c3639.

    Article  Google Scholar 

  • Thompson, L., Pearce, J., & Barnett, J. R. (2007). Moralising geographies: Stigma, smoking islands and responsible subjects. Area, 39(4), 508–517.

    Article  Google Scholar 

  • Verwei, M., & van den Hoven, M. (2012). Nudges in public health: Paternalism is paramount. The American Journal of Bioethics, 12(2), 16–17.

    Article  Google Scholar 

  • White House. (2015). https://www.whitehouse.gov/ostp/nstc#Committees

  • Whitehead, M., Howell, R., Jones, R., Lilley, R., & Pykett, J. (2014). Nudging all over the world: Assessing the global impact of the behavioural sciences on public policy. Available at: https://changingbehaviours.files.wordpress.com/2014/09/nudgedesignfinal.pdf. Accessed 28 Nov 2017.

  • Whitehead, M., Jones, R., Lilley, R., Pykett, J., & Howell, R. (2017). Neuroliberalism. Behavioural government in the twenty-first century. London: Routledge.

    Book  Google Scholar 

  • World Bank. (2015). Mind, society and behaviour: World development report. Washington, DC: World Bank Group.

    Google Scholar 

  • World Health Organisation. (1993a). Social marketing for health. Geneva: World Health Organisation.

    Google Scholar 

  • World Health Organisation. (1993b). Behavioural science learning modules. Geneva: World Health Organisation.

    Google Scholar 

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Authors and Affiliations

  1. University of Birmingham, Birmingham, UK

    Jessica Pykett

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  1. Jessica Pykett
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Correspondence to Jessica Pykett .

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  1. FernUniversität in Hagen, Hagen, Germany

    Benjamin Ewert

  2. FernUniversität in Hagen, Hagen, Germany

    Kathrin Loer

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Pykett, J. (2019). Healthy Nations: Behavioural Approaches in Public Health Policy. In: Ewert, B., Loer, K. (eds) Behavioural Policies for Health Promotion and Disease Prevention. Palgrave Studies in Public Health Policy Research. Palgrave Pivot, Cham. https://doi.org/10.1007/978-3-319-98316-5_4

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