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.

1. Regulating Lifestyle
the case of unhealthy diets,
alcohol and tobacco
Alberto Alemanno
HEC Paris

2. (short) premise

6. structure
< I > setting the scene
< II > the EU experience
< III > the behavioural turn
of (risk) regulation

7. <I>

8. Market liberalisation efforts provide economic
prosperity, and

9. world life expectancy

10. technological innovation

11. world food prices
The relative price of food in the United States
dropped by 15 percent from 1980 to 2000.

12. not

13. happiness

14. well-being

15. but

16. greater consumption.

17. Increases in the food
supply are the dominant
drivers of the weight gain
in population

18. Tobacco use

19. Harmful use of alcohol

20. Unhealthy diets

21. Lack of physical exercise

23. <lifestyle risk factors>
leading causes of
NCDs

24. NCDs, like heart attacks and
strokes, cancers, diabetes and
chronic respiratory disease account
for over 63% of deaths in the world
today
- 80% in low and middle-income countries -

25. Global burden of mortality, morbidity
and disability attributable to NCDs has
rapidly increased
also in developing countries
(‘double burden’)

27. UN General Assembly

28. 2011 UN General Assembly Political
Declaration on NCDs

30. ‘regulatory mix’
Evidence-based, cost-effective, population wide and
multisectorial intervention
through ‘the implementation of international
agreements and strategies, and education, legislative,
regulation and fiscal measures’
(great faith in the power of law)

31. addressees
Governments and ‘all relevant
stakeholders’, including individuals,
families and communities, NGOs, civil
society, academia, and – where
appropriate – the private sector

32. Regardless of the moral, philosophical and social
reservation you might have

33. an international
‘LIFESTYLE REGULATION
POLICY’
is emerging today

34. <II>

36. The EU is gradually stepping
in into the regulation of
‘lifestyle risks’

37. 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

38. Percentage of daily smokers (males) aged 15+ in the EU-27
Source: WHO-HFA, 2007
38

39. Male smoking

40. Female smoking

41. Risk factors in the EU

43. Male obesity
Global Prevalence of Adult Obesity International Obesity Taskforce, 2008

44. Female obesity
Global Prevalence of Adult Obesity International Obesity Taskforce, 2008

45. Risk factors in the EU
• EU Alcohol:
– 3rd largest risk factor
– 195.000 deaths per year
– Costs: 125 billion – 1.3 EU GDP

46. Alcohol consumption per capita
WHO Global Status Report on Alcohol 2011

47. As a result…
growing awareness of need to
tackle NCDs, but
What kind of action?

48. <EU Action>

49. Historically the EU has been regulating:
– Tobacco
– Alcohol
– Food
as goods that had to circulate freely

50. Now increasingly interested in reducing
their consumption

51. To what extent the EU
may develop a lifestyle
(health) policy?

52. Legal Basis - 168 TFEU
No legislative harmonisation on
public health grounds

53. Legal Basis- 114 TFEU
only on internal market ground

54. Yes

55. No

56. Yes

57. No

58. A way out…
While the EU approach to tobacco
products remains based on regulation,
self-regulation characterises the
EU emerging policy vis-à-vis obesity
prevention and alcohol

60. Alcohol & Health Forum
multi-stakeholder, partnership approach leading to
committments:
- by companies
- by governments and other stakeholders

61. Committments

62. food reformulation
SELF-REGULATION

63. EU Framework for National Salt Initiatives:
minimum of 16% over 4 years, against the individual
country baseline levels in 2008.

64. Committments
• Consumer information
• Voluntary labeling

65. marketing restrictions
SELF-REGULATION

66. Committments
• Marketing to children

67. 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

68. new initiatives

69. fat taxes
?

70. Ongoing revision of the tobacco
products directive

71. Plain Packaging

72. Australia PP

73. US new packs (22.09.2012)
U.S. District Judge Richard Leon ruled that the requirement ran afoul of the First Amendment's
free speech protections and blocked the requirement. The government appealed.

74. Plain packaging of food?

75. Plain packaging of alcohol?

76. Visual Display Ban

77. To sum up
• Coexistence of regulatory & self-regulatory schemes
• Coexistence of EU-wide & national initiatives

78. <III>

79. <a few more
ideas>

80. legitimacy
Generally dismissed as nannying
(paternalism)

81. effectiveness
To what extent lifestyle policy interventions
work?

82. design
How to realistically expect that regulation may
require people to, or not to eat, certain foods
and to do exercise

83. role of the industry
What should it be the role of the industry?

84. At a time in which international community
legitimised regulatory action vis-à-vis lifestyle
choices, some countries are experimenting new
forms of interventions

87. ‘Libertarian paternalism’

88. By changing the environment in which the
choice is made, a nudge-inspired policy steers
people - who are placed in this environment -
towards making positive decisions while
preserving individual choice.

89. examples

90. The classics

91. the location of food items in a
cafeteria

93. produce some unexpected impact

94. i.e.

96. you’re able to increase/decrease the
consumption of many items
by as much as 25%

99. Lesson learnt from classics
even small
apparently insignificant details
can have major impact
on people’s behaviour

100. The Brit Nudges

102. Diet & Weight

105. By filling in a questionnaire, people can get
access to a £50 vouchers giving money off
healthier food & activities
NHS with the industry

107. Diet & Weight (2)

109. Information at-a-glance: making it easier for consumers to see
what proportion of their daily nutritional needs are met.

112. What if no traffic light?

113. Diet & Weight (3)

114. Visual prompts
• Already widely used by supermarkets and
manufacturers
• Used now by ASDA and DoH to advertise
social norm messages:

115. Alcohol

116. Binge drinking

117. 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

118. Lack of physical activity

119. The Stockholm piano stairs
MUSICAL TUNES PLAYED WHEN PEOPLE CLIMB THE STAIRS NOT WHEN ESCALATOR

120. The features of Nudge

121. 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)

122. The appeal of Nudge

123. 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

124. The flaws of Nudge

125. • New paternalism
• Intrusiveness: a threat to liberty!
• Ineffective/lack of evidence
• Non transparent
• Ethical unacceptable
• Unintended side effects:
– Infantilization
– Hindrance to moral development
• Corruptibility

126. 1st assessment of Nudge-inspired policies

127. 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

128. should authorities ‘nudge’
people towards the ‘right’
choices?

129. should they rely on
findings of cognitive
science to nudge people
towards the ‘right’
choices?

130. How to turn behavioral
insights into
policymaking?

131. Thank you!
Comments welcome at
alemanno@hec.fr
More info at
www.albertoalemanno.eu