The public and public health – what to do?Ben Page, Chief Executive, Ipsos MORI LGA Annual Conference 26 Feb 2013
A noble goal...what would make you happiest?% 60 Double my 50 income Better Health 40 30 20 10 0 15-24 25-34 35-44 45-54 55-64 65-74 75+ Age Base: 2,015 interviewed face to face in home in GB aged 15 +, 20-25 Sept
The public claim to be in good healthQ How is your health in general? Would you say it was... 100 % 90 80 Very good/ good health 76 70 60 50 40 30 20 10 Very bad/ bad health 6 0 Data up to 2002 are unweighted. From 2003 onwards, data have been weighted for non-response Base: Adults aged 16+ in England (at least 4,500 per wave) Source: Health Survey for England
The facts say …..obesity levels Source: Health Survey for England
The facts say - booze consumed Source: Health Survey for England
They are aware of the big health issuesQ Thinking generally, what are the biggest health problems facing people today? What else? Cancer 34% Obesity/overeating 30% Alcohol abuse 16% Heart disease 16% Age-related illnesses 16% Smoking 13% Diabetes 10% Unhealthy lifestyle 9% Stress/pressure 9% Obesity in children 8% Dementia 8% Mental health 8% Poor diet 7% Drugs abuse 6% Lack of exercise 5% All mentions above 2% Base: 1,004 English adults aged 16+, Dec 2012 Source: Ipsos MORI/DH Perceptions of the NHS Tracker
And they say they recognise the importance of lifestyleQ Looking at this card, which factors, if any, do you think have the biggest impact on your chances ofliving a long and healthy life? Your lifestyle 79% Your genes 39% Your social circumstances 35% NHS 17% Whether you are male or female 7% Having a university degree 2% No answer 1% Dont know 1% Base: 1,994 British adults, Aug 2008 Source: Ipsos MORI
They claim price is key to helping them be healthierQ Which of the following would encourage you to lead a healthier lifestyle? Lower prices for using leisure centres 44% Lower prices for healthy food 40% Better sports and leisure facilities 24% Having more time 23% Being told to by my doctor for health reasons 17% Having more healthy food available in local shops 15% Better access to weight loss services 10% Better information about how to eat healthily 9%Better information about how to be more physically active 6% Having help with my caring responsibilities 4% Better access to stop smoking services 3% Advice and support to stop/cut down drinking alcohol 2% Nothing, I already lead a healthy lifestyle 19% Base: 4,824 adults, Sept - Dec 2011 Source: Ipsos MORI
Meanwhile there are calls for stronger intervention
Public support for anti-smoking measuresQ Now thinking about smoking: What, if anything, do you think government should do? Strongly support/tend to support Provide information 92% Incentivise people to stop smoking 73% Ban smoking in public places 74% Ban smoking altogether 45% Make tobacco companies invest against smoking 78% Base: 1,014 UK residents aged 16-64, November 2010 Source: Ipsos Global @dvisor
On healthy eating?Q Now thinking about what people choose to eat: What, if anything, do you think government should do? Strongly support/tend to support Provide information about healthy eating 86% Provide incentives, such as health food vouchers 72% Make unhealthy foods more expensive 37% Ban unhealthy foods 33% Make companies promote healthy choices 81%Base: 1,014 UK residents aged 16-64, November 2010 Source: Ipsos Global @dvisor
Less open to forceful intervention compared to neighboursQ Government should introduce laws to ban unhealthy foods Strongly support/tend to support China 89% South Korea 89% Saudi Arabia 88% India 87% Indonesia 87% Turkey 87% Russia 86% Mexico 71% Japan 70% Argentina 68% Italy 65% Spain 64% OUTRIGHT BAN Poland 63% Hungary 55% Brazil 53% Germany 43% South Africa 42% Canada 41% Belgium 39% France 35% Sweden 35% Australia 33% Great Britain 33% USA 21% Base: c.500 - 1,000 residents aged 16-64 (18-64 in the US and Canada) in each country, November 2010 Source: Ipsos Global @dvisor
Should the lifestyle we choose affect the carewe receive?
Whose responsibility is public health?Q I am going to read out two statements, one at either end of a scale. Please tell me where your view fitson this scale. Agree much more with A Agree much more with B A B It is the job of the NHS 5% It is the individual’s to keep people healthy 25% 27% 39% responsibility to keep 4% themselves healthy The NHS should be The NHS should give there to take care of less priority to people people regardless of 31% 21% 26% 14% 9% who do not take care why they are ill of their health Base: 1,646 British adults 15+, April 2010 Source: Ipsos MORI personal responsibility 2010
But some willingness to MAKE people take right decisionsQ If the NHS was to face lower levels of spending, which of these, if any, would you be most/ least willing toaccept? % Most % LeastRequiring patients to change lifestyle before they are allowed treatment (e.g. give up 53 7 smoking, change diet) Longer waiting lists 7 12 Charges for visiting your GP 6 35 Some types of treatment not available in 5 16 your area, depending on where you live Fees for hospital stays 3 19 None of these 17 7 Base: 1,041 British adults aged 16-64, Sept 2009 Source: Ipsos MORI personal responsibility 2010
So how will the move of public health into localgovt affect public perceptions?
NHS more loved and respected than local governmentQ Can you tell me which of the phrases on this card best describes the way you would speak about thatservice to other people? % Critical % Speak highly Net score -7 (-8 in 2011) Your local council 28 21 The police in my 19 32 +13 local area 16 54 +38 My local hospital Local NHS (GPs, hospitals, ambulance 12 63 +51 service, dentists and other parts of the NHS) Base: 828 adults aged 15+ in England , Dec 2009 Source: Ipsos MORI
Will local govt as the messenger affect public receptivity?
Low awareness of local government’s roleQ I am going to read out a list of services and, for each one, I would like you to tell me whether youthink it is the responsibility of your local London Borough Council or not… % Yes % No % Not sure/ Dont know The police service 49 42 8 Your local hospital 45 46 8 Rubbish collection 97 3 and recycling The Freedom Pass 60 29 11 Base: 1,001 adults aged 18+ in Greater London, April 2008 Source: Ipsos MORI
Behind the scenes: what happens next forpublic health in local govt?
Upheaval ahead though demands remain unchanged Ongoing purpose to Focus on transition protect local populations and Normalising to new environment inform commissioning A whole systems approach to business as usual
There will be new indicators to measure and track
And a new opportunity for collaborative data collection
Why it matters... “Doesn’t bother me, it’s shit here.” Blackburn resident Source: Ipsos MORI
How do human beings make choices/decisions ?Rationaldecision Gather pertinent Process pertinent Calculate optimal ‘Rational-making information information choice decision’process Decide Decide without Decide without all the fully based on data/using processing faulty cal- irrelevant the facts culations Short- data circuits of the ‘rational’ process ‘Irrational decision’
Successful change campaigns use a mixof informing, enabling, incentivising and enforcing Inform Enable Influence Incentivise Enforce Source: Websites, press search
But you can also learn from behavioural science People make choices without Inform going through a full ‘rational’ decision-making process’ Certain biases pre-dispose Enable people to short-cut the rational decision-making Influence process Incentivise Using these biases in a systematic way can make campaigns significantly more Enforce likely to succeed
Question What percentage of African countries are members of the United Nations?
Evidence – anchoring Numbers shown on Mean “roulette” estimate of wheel respondents 10 25% 65 45% Source: Kahneman and Tversky, 1974
Example bias – anchoring People’s estimates are swayed by data suggested to them beforehand, even when they know the data is irrelevant or false. Source: Daniel Kahneman, Daniel Tversky (1974); McKinsey synthesis
Case study – anchoring Source: 5 a Day campaigns in Argentina, Chile, Germany, Japan, Mexico, Spain, UK, US
Case study – anchoring! Source: 6 a Day campaign in Denmark
Example bias – Social norms People tend to follow their peer group – if they see many people doing something, they aim to do it too. Source: Bandura, Grusec and Menlove (1967); Milgram et al (1969); Cialdini; McKinsey synthesis
Example bias – reciprocity You are more likely to obtain a large commitment if you obtain a small one first. Source: Festinger, 1957; Cialdini (2006); McKinsey synthesis
Behavioural Norms we can use…. Short-circuits of rational Biases decision-making process Reciprocity Liking Status quo Decide without all the data/using Consistency Scarcity Endowment irrelevant data Availability/ Social norms Authority recency Decide without Choice fully processing Justifiability Anchoring overload all the facts Framing/ Hyperbolic Regret aversion contrast discounting Decide Certainty Probability Loss aversion based on faulty preference misassessment calculations Mental Breakpoints False memory accounting
Final case example – the AIDS awareness change in the UK • Number of diagnoses of gonorrhoea (000s) 70 60 50 40 30 20 10 0 1925 1935 1945 1955 1965 1975 1985 1995 2005 Source: Health Profile of England and Wales
Action across multiple fronts to reduce Sexual Infections BBC programming about AIDS Inform Distribution of free condoms Enable Influence “Tombstone” campaign Incentivise None Enforce Use of numerous biases including Authority, Liking, Hyperbolic Discounting, Probability Misassessment and Social norms
Social norm: James Bond and the decline in sexual diseases in the 1980s Average Bond girls per film by actor Lazenby 3 Connery Moore Brosnan 2 Dalton 1 0 1960 1970 1980 1990 2000 Source: Avert; BBC; www.universalexports.net
In conclusion...•Lots of public support•Lots of public interest – in principle•Lots of public confusion – needs great communications•Needs measurement – but be careful – need to understand people’s real motivations•Over to you....•Good luck