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PUBLIC HEALTH


The nudging campaign that preceded the


smoking ban helped ensure the legislation was widely supported by the public


was exceeded, as nearly 90 per cent of mothers were able to identify the Change4Life logo a year after its launch. The overall success of the campaign in tackling obesity is still under debate, however, as obesity levels among young people have continued to rise. In a campaign progress report, public health minister Anne


Milton said: “In the past, we’ve generally tried to change attitudes as a precursor or accompaniment to changing behaviours. While this feels intuitively right, it’s troubling that, in health, people’s behaviours so often conflict with their stated attitudes. “By changing the choice architecture – for example, by


changing default options or changing perceptions of social norms – it may be possible to change what people do without necessarily changing their attitudes.” In 2011, the government announced its Public Health


Responsibility Deal (RD) – a public-private partnership that aims to “tap into the potential for businesses and other influential organisations” to improve public health by “helping us to create this environment”. Consisting of core commitments, supporting pledges and


collective and organisation-specific pledges, the initiative is another example of nudging in action. It has, however, come under criticism from public health advocates and others, who have suggested that it will be ineffective – and at worst perhaps even harmful.


Removing the smoke screen So while there are nudges that work, there are also cases where results achieved using the method are mixed. Might nudging’s greatest strength – especially when used in large-scale public health drives – lie in preparing the ground for change, by altering perceptions and attitudes? Perhaps, rather than guaranteeing behavioural change, nudging might work best as a means to introduce legislation, softening the blow of forced compliance?


The experience of the no- smoking campaign seems to back


this view. For years, a number of campaigning groups, charities and health professionals attempted to make more people quit smoking. The nudge was obvious: stop smoking and your life expectancy will rapidly rise. Despite the aggressive ways in which this message was broadcast – the ‘smoking kills’ warnings on tobacco packaging being one – in most countries it wasn’t until smoking was banned in public areas and heavy taxes were introduced that genuine progress was made. While the bans have been fiercely opposed by the tobacco


industry, they have been widely welcomed by the public: when the smoking ban was introduced in England in 2007, opinion polls showed strong support for it. It could be argued that the near-universal support experienced in both the UK and the US for the bans – countries that traditionally take a dim view of limiting the rights of individuals – are mainly thanks to a successful campaign of nudging. These campaigns helped people acknowledge the health threats of smoking to themselves, and identify the benefits associated with quitting, before measures were imposed. Whether the approach used with smoking can – or


should – be used in tackling obesity and inactivity by changing legislation remains to be seen. But it’s clear something needs to be done: ukactive says that, if everyone in England were sufficiently active, nearly 37,000 needless deaths a year could be prevented. “By 2020, the average Brit will be so sedentary that they will


use only 25 per cent more energy than if they spent the whole day sleeping,” says Fred Turok, chair of ukactive. “Over the last 50 years in the UK, physical activity levels have declined by 20 per cent. Even worse, they are projected to decline by a further 15 per cent by 2030.” While Turok stops short of wanting to change legislation, he wants funding streams to be altered to aid the nudging:


The overall success of Change4Life is under debate in spite of high brand recognition, as obesity levels among young people have continued to rise


46 Read Health Club Management online at healthclubmanagement.co.uk/digital


“Our best indication to date suggests that, on average, no more than 5 per cent of public health intervention budgets are targeted at reducing inactivity, compared with approximately 40 per cent on smoking cessation programmes and another 20 per cent on weight management programmes. If we’re to achieve our goal, this has to change.” ●


April 2014 © Cybertrek 2014


PHOTO: SHUTTERSTOCK.COM/MONKEY BUSINESS IMAGES


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