Nudging people towards a healthier life
The 2017 global burden of disease report for India confirmed that non-communicable diseases (NCDs) like heart disease, cancer, lung disease and diabetes, have overtaken infectious diseases as our major killers. NCDs cause two-thirds of deaths in India. They are also economically harmful: NCDs are expected to result in a global output loss of $47 trillion between 2011 and 2031.
NCDs are often referred to as “lifestyle diseases” since certain preventable behaviours—especially tobacco and alcohol use, an unhealthy diet and physical inactivity—increase their risk or cause them. According to the World Health Organization (WHO), 80% of all heart disease, stroke and type 2 diabetes and 40% of cancers are preventable.
But, referring to NCDs as “lifestyle diseases” is misleading. It implies that people can make simple choices to change their behaviour when the reality is far more complex. A considerable body of work in behavioural science has shown that people are poor at calibrating their risks and are not always aware of how their decisions have been influenced. As a consequence, their choices can be at odds with what would be considered “rational” behaviour.
By recognizing these influences, policy makers can harness them into a force for good. Informed by this evidence, at Vital Strategies, a global health organization that works with governments to strengthen public health systems, we offer key strategies for designing effective policies to promote healthy choices that prevent and control NCDs.
1.Make healthy choices the default
People are prone to making choices that require the least effort. They have a latent tendency to accept the status quo. This principle has been applied effectively to promote healthy diets.
The government can promote healthy food choices by making fresh and nutritious foods easily accessible. There are several examples of how this can be done. They can subsidize healthy retail options, or incentivize mobile vegetable and fruit vendors in a wide array of neighbourhoods.
It can also promote a healthy diet by limiting the portion size and salt in restaurants, limiting sodium content in packaged foods, and banning the use of unhealthy trans-fats in processed foods and outlets selling them.
The government can also influence healthy choices by placing unhealthy products out of reach. For example, ban on the sale of tobacco or alcohol near schools protect against the marketing tactics of these products to the impressionable youth. Removal of unhealthy products from points of sale where people tend to make impulse purchases protects people from making hasty, poor choices.
2. Provide information that is simple, clear and actionable
Our ability to make rational, health-promoting decisions is often compromised by the daily need to wade through volumes of complex information when we have to arrive at quick decisions. To ease decision-making, we use mental short-cuts, such as assuming that if certain products are ubiquitous, they must be safe. And if coupled with aggressive marketing—like in the case of tobacco, alcohol, processed foods—this impression is even more trenchant.
To help counter these misleading prompts, it is critical that public authorities provide citizens with clear, simple and accurate information to guide their decisions. Public education campaigns, such as the government’s recent campaign on the harms of tobacco and second-hand smoke, are cost-effective ways of creating social behavioural change—especially when combined with the implementation and enforcement of relevant regulations. Warning labels on unhealthy products serve a similar purpose as they provide quick reminders at the point of purchase about the product’s harmful effects.
3. Use environmental signals to steer people towards healthy behaviour
The environment—both physical and social—provides behavioural triggers, and can be used to shape healthy behaviours. City planners use spatial design—which focuses on how and why people flow between places—to promote physical activity, reduce injuries and reduce pollution. For example, by making stairs more noticeable or reducing the number of escalators in shopping malls, they may promote physical activity.
Laws can serve a similar function of signalling acceptable social norms. Ban on smoking in public places—like those Bengaluru has adopted under its SmokeFree City Initiative—is an example of regulation that signals what is permissible and acceptable.
NCDs can be ignored at one’s own peril. We know that an ounce of prevention is worth a pound in cure, but we also know that people do not have perfect agency on their behaviour—they are often victims of their environments and their own bounded rationality.
Policies at the city, state and national levels can help make the necessary corrections to make healthy options the default and create the necessary preconditions for healthy behaviour. It is in our social and economic interest to do so.
Nandita Murukutla is vice-president, global policy and research, Vital Strategies.