Some relevant areas Post-16 participation Energy efficiency Parenting Transport choicesEducation/skills Adult literacy Environment Reduce, reuse, recycle Life skills (cooking etc) Consumption choices Volunteering Fly-tipping Drugs, alcohol, tobacco Anti-social behaviour Teenage pregnancy Crime preventionHealth Obesity Community Terrorism Keeping appointments Social mobility Organ donation Litter / graffiti Active job seeking Pension provision Service culture Self-careProsperity Entrepreneurship Care / ageing Mental health Personal aspiration Active ageing Diversity End-of-life choices
Behaviour change is big money Projected UK health care spending (% GDP public & private, annotations at 2002-3 prices)% GDP 14 US spent About £220 bn 14.6% GDP in over 15 years 2002 (OECD) 12 ke ta £30bn up ow Sl 10 Fully engaged 8 £154bn £96bn 2007-8 6 4 19 78 19 83 19 88 19 93 20 98 20 03 20 13 20 18 20 08 3 -2 - - - - - - - - - 17 77 82 87 92 97 02 07 12 22 19 Source: Wanless, 2002 Securing Our Future Health: Taking A Long-Term View
1. The 4-E approach to behaviour change Taxes & fiscal measures Remove barriers to act Regulation & fines Set defaults / opt-out vs opt-in League tables Form clubs / communities Targets / perf management Provide information Prizes / rewards / bonuses Enable Choose intervention timing Preferential treatment Personalise Status recognition Provide space / facilities Subsidies / discounts Build confidence Feedback Ease/cost of access Encourage Catalyse Engage Community/network action Evidence base Deliberative fora Walk the talk & lead Segmentation / focusConsistency across policies Exemplify Secure commitment Sustained approach Personal contacts Credibility / confidence Role models / super-usersBenchmarking / evaluation Paid/unpaid media campaigns Learning & improvement Pester power / Peer pressurePolitical consensus building Workplace norms
4-E approach to behaviour change Taxes & fiscal measures Remove barriers to act Regulation & fines Set defaults / opt-out vs opt-in League tables Form clubs / communities Targets / perf management Provide information Prizes / rewards / bonuses Enable Choose intervention timing Preferential treatment Personalise Status recognition Provide space / facilities Subsidies / discounts Build confidence Feedback Ease/cost of access Encourage Catalyse Engage Community/network action Evidence base Deliberative fora Walk the talk & lead Segmentation / focusConsistency across policies Exemplify Secure commitment Sustained approach Personal contacts Credibility / confidence Role models / super-usersBenchmarking / evaluation Paid/unpaid media campaigns Learning & improvement Pester power / Peer pressurePolitical consensus building Workplace norms
Some examples using the 4-E framework• Smoking• Drink driving• Recycling
Smoking prevalence All > age 16 (Britain)504540353025201510 5 0 1975 1980 1985 1990 1995 2000 2005 2010
Smoking and behaviour change High excise taxes Ban marketing practices NHS stop smoking treatment Address smuggling Smoke-free policies Enable Quit-lines (nb. Personal incentives) Pharmaceutical deregulation Encourage Catalyse Engage Smoke-free policies Social marketing campaignsClear messages from NHS Exemplify More graphic warnings Consistent package Major news media assault Clear goals Constant revisiting evidence Commercial arguments “Denormalisation”
But others forces are at work... ...as the force of theA cigarette for the beginner psychological symbolism is a symbolic act. I am no subsides, the longer my mother’s child, pharmacological effects I’m tough, I am an take over to sustain the adventurer, I’m not habit square... Dunn W. Vice President for Research and Development, Philip Norris. Why one smokes. 1968 Minnesota Trial Exhibit 3681.
Smoking: from the dark side Advertising Orchestrating smuggling Role models Lights Adult product definition Enable Filters Duty Free Wide availability Fighting smoke-free places Encourage Catalyse Engage Aspirational sell to poorProduct placement in films Exemplify Coupons and catalogues Sponsorship Coaching arguments Normalisation Distracting PR Bogus science
Drink driving Breathalyser Soft drinks normalisation More severe penalties Taxi services & Police enforcement Enable other innovations Driver training as part of penalty Encourage Catalyse Engage Strong sustained 30 year campaign Exemplify media campaignVilification of politicians No nod and wink Clever segmentation
Blood money Donors per thousand population5040 38.1302010 7.1 2.3 0 Developed Transition Developing World Health Organisation: Blood Transfusion Safety Unit 2007 data.
Paying for blood creates poor incentives Percentage of voluntary unpaid blood donations, 2007
Contracts for exercise Participation in walking programme100 81 80 60 40 31 20 0 Contract No contract Williams BR, Bezner J, Chesbro SB, Leavitt R. The effect of a behavioral contract on adherence to a walking program in postmenopausal African American women. Top Geriatr Rehab.2005;21(4):332- 342.
Contracts to create reciprocitySolidarity with others Peer pressure Enable Encourage Catalyse Engage Exemplify Contract & reciprocity
Teachers Expectations affect Student Outcome Proportion pupils achieving 30 point grade increase302520 21 “The soft bigotry of low expectations”1510 5 5 0 Randomly selected but labelled Control group "High achievers" Rosenthal, Robert & Jacobson, Lenore. Pygmalion in the classroom (1992). Expanded edition. New York: Irvington Quote: attributed to George W Bush
The Pygmalion Effect EnableEncourage Catalyse Engage Exemplify Expectation setting and belief
MINDSPACEMessenger: We are influenced by who communicates informationIncentives: Our responses are shaped by biases and shortcutsNorms: We tend to do what those around us are already doingDefaults: We ‘go with the flow’ of pre-set options
MINDSPACESalience: Our attention is drawn to what is novel and seemsrelevant to usPriming: Our acts are often influenced by sub-conscious cuesAffect: Emotional associations can powerfully shape our actionsCommitment: We seek to be consistent with our public promises,and reciprocate actsEgo: We act in ways that make us feel better about ourselves
The Science of Persuasion6 weapons of influence•Reciprocation: You did something for me and now I owe you•Consistency: One thing I do or think leads to another•Social proof: 9 out of 10 cats prefer...•Liking: I will buy Tupperware from you because I like you•Authority: More doctors smoke Lucky Strike•Scarcity: Get it now, or I’ll be sorry when it’s goneRobert Cialdini, The science of persuasion, Scientific American, 284, 76-81.
Some “biases” in real behaviour• Loss aversion• Recency Its illogical• Peak experience Captain...• Herding• Heuristics• Omission• Habit• Confirmation• Hyperbolic discounting
List of cognitive human “biases”Behaviour & Decision- Probability & belief SocialmakingBandwagon effect Ambiguity effect Actor-observer biasBase rate fallacy Anchoring effect Egocentric biasBias blind spot Attentional bias Forer effectChoice-supportive bias Authority bias False consensus effectConfirmation bias Availability heuristic Fundamental attribution errorCongruence bias Availability cascade Halo effectContrast effect Belief bias Herd instinctDéformation professionnelle Clustering illusion Illusion of asymmetric insightDenomination effect Capability bias Illusion of transparencyDistinction bias Conjunction fallacy Illusory superiorityEndowment effect Disposition effect Ingroup biasExperimenters Gamblers fallacy Just-world phenomenonExtraordinarity bias Hawthorne effect Notational biasFocusing effect Hindsight bias Outgroup homogeneity biasFraming Illusory correlation Projection biasHyperbolic discounting Ludic fallacy Self-serving biasIllusion of control Neglect of prior base rates effect Self-fulfilling prophecyImpact bias Observer-expectancy effect System justificationInformation bias Optimism bias Trait ascription biasInterloper effect Ostrich effect Ultimate attribution errorIrrational escalation Overconfidence effectJust-world phenomenon Positive outcome biasLoss aversion PareidoliaMere exposure effect Primacy effectMoney illusion Recency effectMoral credential effect Disregard of regression toward the mean.Need for Closure Selection biasNegativity bias StereotypingNeglect of probability Subadditivity effectNormalcy bias Subjective validationNot Invented Here Telescoping effectOmission bias Texas sharpshooter fallacyOutcome bias Well travelled road effectPlanning fallacy Consistency biasPost-purchase rationalization CryptomnesiaPseudocertainty effect Egocentric biasReactanceRestraint bias False memory Hindsight bias For more informationSelective perceptionSemmelweis reflex Reminiscence bump Rosy retrospection Wikipedia search:Status quo biasVon Restorff effect Self-serving bias Suggestibility “List of cognitive biases”Wishful thinkingZero-risk bias
Use segmentationWilling to act 1: Positive greens I think it’s important that I do as much as I can to limit my 2: Waste watchers impact on the environment. ‘Waste not, want not’ that’s 18% important, you should live life thinking about what you are 3: Concerned consumers doing and using. 12% I think I do more than a lot of people. Still, going away is important, I’d find that hard to give up..well I wouldn’t, so 7: Honestly disengaged carbon off-setting would make Maybe there’ll be an me feel better. 14% environmental disaster, maybe not. Makes no difference to me, I’m just living life the way I 5: Cautious participants want to. 18% I do a couple of things to help the environment. I’d really like to do more, well as long as I saw others were. 14% 4: Sideline supporters 6: Stalled starters I think climate change is a big I don’t know much about problem for us. I know I don’t climate change. I can’t afford think much about how much a car so I use public water or electricity I use, and I transport.. I’d like a car forget to turn things off..I’d like to though. 10% do a bit more. 14% Able to act
4. Be careful with the relationship between citizen and state
4: Establish the case for intervention “The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant”.But… Children? Addiction? Influence of background?Mental illness? Collective costs? Regret...?
From soft paternalism to regulationPublic (external) impacts Passive smoking - workers Passive smoking - public Hooking kids Unregulated addiction Health impacts Private impacts