Regulating Lifestylethe case of unhealthy diets,    alcohol and tobacco       Alberto Alemanno           HEC Paris
(short) premise
structure< I > setting the scene< II > the EU experience< III > the behavioural turn of (risk) regulation
<I>
Market liberalisation efforts provide economic                prosperity, and
world life expectancy
technological innovation
world food pricesThe relative price of food in the United Statesdropped by 15 percent from 1980 to 2000.
not
happiness
well-being
but
greater consumption.
Increases in the foodsupply are the dominantdrivers of the weight gain      in population
Tobacco use
Harmful use of alcohol
Unhealthy diets
Lack of physical exercise
<lifestyle risk factors>    leading causes of       NCDs
NCDs, like heart attacks and   strokes, cancers, diabetes andchronic respiratory disease accountfor over 63% of deaths in ...
Global burden of mortality, morbidityand disability attributable to NCDs has           rapidly increased        also in de...
UN General Assembly
2011 UN General Assembly Political      Declaration on NCDs
‘regulatory mix’Evidence-based, cost-effective, population wide and           multisectorial intervention   through ‘the i...
addressees      Governments and ‘all relevant stakeholders’, including individuals,families and communities, NGOs, civil  ...
Regardless of the moral, philosophical and social          reservation you might have
an international‘LIFESTYLE REGULATION         POLICY’    is emerging today
<II>
The EU is gradually stepping  in into the regulation of       ‘lifestyle risks’
Risk factors in the EU• EU Tobacco:  – Largest risk factor  – 650.000 deaths per year (out of 6 million www)  – Tobacco pr...
Percentage of daily smokers (males) aged 15+ in the EU-27                                      Source: WHO-HFA, 2007      ...
Male smoking
Female smoking
Risk factors in the EU
Male obesityGlobal Prevalence of Adult Obesity International Obesity Taskforce, 2008
Female obesityGlobal Prevalence of Adult Obesity International Obesity Taskforce, 2008
Risk factors in the EU• EU Alcohol:  – 3rd largest risk factor  – 195.000 deaths per year  – Costs: 125 billion – 1.3 EU GDP
Alcohol consumption per capita                WHO Global Status Report on Alcohol 2011
As a result…growing awareness of need totackle NCDs, but  What kind of action?
<EU Action>
Historically the EU has been regulating:  – Tobacco  – Alcohol  – Food as goods that had to circulate freely
Now increasingly interested in reducing          their consumption
To what extent the EUmay develop a lifestyle   (health) policy?
Legal Basis - 168 TFEUNo legislative harmonisation on    public health grounds
Legal Basis- 114 TFEUonly on internal market ground
Yes
No
Yes
No
A way out…  While the EU approach to tobaccoproducts remains based on regulation,self-regulation      characterises the EU...
Alcohol & Health Forummulti-stakeholder, partnership approach leading tocommittments:   - by companies   - by governments ...
Committments
food reformulation   SELF-REGULATION
EU Framework for National Salt Initiatives:minimum of 16% over 4 years, against the individualcountry baseline levels in 2...
Committments• Consumer information• Voluntary labeling
marketing restrictions     SELF-REGULATION
Committments• Marketing to children
Contested• Fear of regulation  self-regulation• Some, not all companies• Weak enforcement record• Coverage of committment...
new initiatives
fat taxes            ?
Ongoing revision of the tobacco      products directive
Plain Packaging
Australia PP
US new packs (22.09.2012)U.S. District Judge Richard Leon ruled that the requirement ran afoul of the First Amendmentsfree...
Plain packaging of food?
Plain packaging of alcohol?
Visual Display Ban
To sum up• Coexistence of regulatory & self-regulatory schemes• Coexistence of EU-wide & national initiatives
<III>
<a few more  ideas>
legitimacyGenerally dismissed as nannying         (paternalism)
effectivenessTo what extent lifestyle policy interventions                   work?
designHow to realistically expect that regulation mayrequire people to, or not to eat, certain foods              and to d...
role of the industryWhat should it be the role of the industry?
At a time in which international community legitimised regulatory action vis-à-vis lifestylechoices, some countries are ex...
‘Libertarian paternalism’
By changing the environment in which thechoice is made, a nudge-inspired policy steerspeople - who are placed in this envi...
examples
The classics
the location of food items in acafeteria
produce some unexpected impact
i.e.
you’re able to increase/decrease the     consumption of many items        by as much as 25%
Lesson learnt from classicseven smallapparently insignificant detailscan have major impacton people’s behaviour
The Brit Nudges
Diet & Weight
By filling in a questionnaire, people can getaccess to a £50 vouchers giving money offhealthier food & activitiesNHS with ...
Diet & Weight (2)
Information at-a-glance: making it easier for consumers to see   what proportion of their daily nutritional needs are met.
What if no traffic light?
Diet & Weight (3)
Visual prompts• Already widely used by supermarkets and  manufacturers• Used now by ASDA and DoH to advertise  social norm...
Alcohol
Binge drinking
Binge drinking• Need to correct the false perception of how  much students’ peers drink, how?• By making it less salient:C...
Lack of physical activity
The Stockholm piano stairsMUSICAL TUNES PLAYED WHEN PEOPLE CLIMB THE STAIRS NOT WHEN ESCALATOR
The features of Nudge
Nudging• Its intervention does not restrict choice• It must be in the interest of the nudgee• It involves a change in ‘cho...
The appeal of Nudge
Paternalism                          Nudge• Reduce the options set by         • Changes the environment in  legislating ag...
The flaws of Nudge
•   New paternalism•   Intrusiveness: a threat to liberty!•   Ineffective/lack of evidence•   Non transparent•   Ethical u...
1st assessment of Nudge-inspired policies
3 main conclusions• Mixed results:  – Nudges are less effective when used in isolation:    call for their integration with...
should authorities ‘nudge’ people towards the ‘right’         choices?
should they rely on  findings of cognitivescience to nudge people   towards the ‘right’        choices?
How to turn behavioral     insights into    policymaking?
Thank you! Comments welcome at   alemanno@hec.fr     More info atwww.albertoalemanno.eu
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco
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Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco

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Should governments regulate lifestyle by developing a lifestyle policy, affecting tobacco, alcohol and diets? Should they be allowed to change individual behavior to attain legitimate public health goals, such as higher life expectancy and improved public health?
The European Union has recently recognized the growing impact of NCDs, including cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, on the EU's economy and the well-being of its citizens and has consequently started to develop policies intended to tackle the four main factors to which they are linked. Nevertheless, if common themes emerge between the different EU policies intended to promote healthier lifestyles, no attempt has yet been made to systematize them.

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Regulating Lifestyle - The Emergence of a New European Policy on Alcohol, Diets and Tobacco

  1. 1. Regulating Lifestylethe case of unhealthy diets, alcohol and tobacco Alberto Alemanno HEC Paris
  2. 2. (short) premise
  3. 3. structure< I > setting the scene< II > the EU experience< III > the behavioural turn of (risk) regulation
  4. 4. <I>
  5. 5. Market liberalisation efforts provide economic prosperity, and
  6. 6. world life expectancy
  7. 7. technological innovation
  8. 8. world food pricesThe relative price of food in the United Statesdropped by 15 percent from 1980 to 2000.
  9. 9. not
  10. 10. happiness
  11. 11. well-being
  12. 12. but
  13. 13. greater consumption.
  14. 14. Increases in the foodsupply are the dominantdrivers of the weight gain in population
  15. 15. Tobacco use
  16. 16. Harmful use of alcohol
  17. 17. Unhealthy diets
  18. 18. Lack of physical exercise
  19. 19. <lifestyle risk factors> leading causes of NCDs
  20. 20. NCDs, like heart attacks and strokes, cancers, diabetes andchronic respiratory disease accountfor over 63% of deaths in the world today- 80% in low and middle-income countries -
  21. 21. Global burden of mortality, morbidityand disability attributable to NCDs has rapidly increased also in developing countries (‘double burden’)
  22. 22. UN General Assembly
  23. 23. 2011 UN General Assembly Political Declaration on NCDs
  24. 24. ‘regulatory mix’Evidence-based, cost-effective, population wide and multisectorial intervention through ‘the implementation of internationalagreements and strategies, and education, legislative, regulation and fiscal measures’ (great faith in the power of law)
  25. 25. addressees Governments and ‘all relevant stakeholders’, including individuals,families and communities, NGOs, civil society, academia, and – where appropriate – the private sector
  26. 26. Regardless of the moral, philosophical and social reservation you might have
  27. 27. an international‘LIFESTYLE REGULATION POLICY’ is emerging today
  28. 28. <II>
  29. 29. The EU is gradually stepping in into the regulation of ‘lifestyle risks’
  30. 30. Risk factors in the EU• EU Tobacco: – Largest risk factor – 650.000 deaths per year (out of 6 million www) – Tobacco prevalence around 29% – Costs: 125 billion – 1.3 EU GDP
  31. 31. Percentage of daily smokers (males) aged 15+ in the EU-27 Source: WHO-HFA, 2007 38
  32. 32. Male smoking
  33. 33. Female smoking
  34. 34. Risk factors in the EU
  35. 35. Male obesityGlobal Prevalence of Adult Obesity International Obesity Taskforce, 2008
  36. 36. Female obesityGlobal Prevalence of Adult Obesity International Obesity Taskforce, 2008
  37. 37. Risk factors in the EU• EU Alcohol: – 3rd largest risk factor – 195.000 deaths per year – Costs: 125 billion – 1.3 EU GDP
  38. 38. Alcohol consumption per capita WHO Global Status Report on Alcohol 2011
  39. 39. As a result…growing awareness of need totackle NCDs, but What kind of action?
  40. 40. <EU Action>
  41. 41. Historically the EU has been regulating: – Tobacco – Alcohol – Food as goods that had to circulate freely
  42. 42. Now increasingly interested in reducing their consumption
  43. 43. To what extent the EUmay develop a lifestyle (health) policy?
  44. 44. Legal Basis - 168 TFEUNo legislative harmonisation on public health grounds
  45. 45. Legal Basis- 114 TFEUonly on internal market ground
  46. 46. Yes
  47. 47. No
  48. 48. Yes
  49. 49. No
  50. 50. A way out… While the EU approach to tobaccoproducts remains based on regulation,self-regulation characterises the EU emerging policy vis-à-vis obesity prevention and alcohol
  51. 51. Alcohol & Health Forummulti-stakeholder, partnership approach leading tocommittments: - by companies - by governments and other stakeholders
  52. 52. Committments
  53. 53. food reformulation SELF-REGULATION
  54. 54. EU Framework for National Salt Initiatives:minimum of 16% over 4 years, against the individualcountry baseline levels in 2008.
  55. 55. Committments• Consumer information• Voluntary labeling
  56. 56. marketing restrictions SELF-REGULATION
  57. 57. Committments• Marketing to children
  58. 58. Contested• Fear of regulation  self-regulation• Some, not all companies• Weak enforcement record• Coverage of committments (TV not internet: adgames/mobiles): loopholes• Credibility of committment by industry – inherent conflict? – Article 5.3 FCTC
  59. 59. new initiatives
  60. 60. fat taxes ?
  61. 61. Ongoing revision of the tobacco products directive
  62. 62. Plain Packaging
  63. 63. Australia PP
  64. 64. US new packs (22.09.2012)U.S. District Judge Richard Leon ruled that the requirement ran afoul of the First Amendmentsfree speech protections and blocked the requirement. The government appealed.
  65. 65. Plain packaging of food?
  66. 66. Plain packaging of alcohol?
  67. 67. Visual Display Ban
  68. 68. To sum up• Coexistence of regulatory & self-regulatory schemes• Coexistence of EU-wide & national initiatives
  69. 69. <III>
  70. 70. <a few more ideas>
  71. 71. legitimacyGenerally dismissed as nannying (paternalism)
  72. 72. effectivenessTo what extent lifestyle policy interventions work?
  73. 73. designHow to realistically expect that regulation mayrequire people to, or not to eat, certain foods and to do exercise
  74. 74. role of the industryWhat should it be the role of the industry?
  75. 75. At a time in which international community legitimised regulatory action vis-à-vis lifestylechoices, some countries are experimenting new forms of interventions
  76. 76. ‘Libertarian paternalism’
  77. 77. By changing the environment in which thechoice is made, a nudge-inspired policy steerspeople - who are placed in this environment - towards making positive decisions while preserving individual choice.
  78. 78. examples
  79. 79. The classics
  80. 80. the location of food items in acafeteria
  81. 81. produce some unexpected impact
  82. 82. i.e.
  83. 83. you’re able to increase/decrease the consumption of many items by as much as 25%
  84. 84. Lesson learnt from classicseven smallapparently insignificant detailscan have major impacton people’s behaviour
  85. 85. The Brit Nudges
  86. 86. Diet & Weight
  87. 87. By filling in a questionnaire, people can getaccess to a £50 vouchers giving money offhealthier food & activitiesNHS with the industry
  88. 88. Diet & Weight (2)
  89. 89. Information at-a-glance: making it easier for consumers to see what proportion of their daily nutritional needs are met.
  90. 90. What if no traffic light?
  91. 91. Diet & Weight (3)
  92. 92. Visual prompts• Already widely used by supermarkets and manufacturers• Used now by ASDA and DoH to advertise social norm messages:
  93. 93. Alcohol
  94. 94. Binge drinking
  95. 95. Binge drinking• Need to correct the false perception of how much students’ peers drink, how?• By making it less salient:Communication campaign of accurate drinking levels to all university students in Wales
  96. 96. Lack of physical activity
  97. 97. The Stockholm piano stairsMUSICAL TUNES PLAYED WHEN PEOPLE CLIMB THE STAIRS NOT WHEN ESCALATOR
  98. 98. The features of Nudge
  99. 99. Nudging• Its intervention does not restrict choice• It must be in the interest of the nudgee• It involves a change in ‘choice architecture’• It implies strategic use of some patterns of human irrationality• The action it triggers does not stem from a fully autonomous choice (especially about the context)
  100. 100. The appeal of Nudge
  101. 101. Paternalism Nudge• Reduce the options set by • Changes the environment in legislating against risky which the choice is made to behaviour make risky behaviour less likely • Rests on the assumption that• Rests on the assumption that people conditioned by people behave rationally environment• Top-down: requires bureaucratic • Bottom-up: less funding oversight• Exaggerates the prevalence of • Play down the reality and depicts risky behaviour abstention as the social norm• Evidence-based (real) • Evidence-based (laboratory- setting)• Adversial to the industry • Cooperative with the industry
  102. 102. The flaws of Nudge
  103. 103. • New paternalism• Intrusiveness: a threat to liberty!• Ineffective/lack of evidence• Non transparent• Ethical unacceptable• Unintended side effects: – Infantilization – Hindrance to moral development• Corruptibility
  104. 104. 1st assessment of Nudge-inspired policies
  105. 105. 3 main conclusions• Mixed results: – Nudges are less effective when used in isolation: call for their integration with traditional forms – Being controversial need to be evidence-based – Overall less effective than behavioural marketing
  106. 106. should authorities ‘nudge’ people towards the ‘right’ choices?
  107. 107. should they rely on findings of cognitivescience to nudge people towards the ‘right’ choices?
  108. 108. How to turn behavioral insights into policymaking?
  109. 109. Thank you! Comments welcome at alemanno@hec.fr More info atwww.albertoalemanno.eu

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