Behavioural science in public health policy

Abstract

Governments have a natural interest in making sure that people look after themselves. The burden on society of a population which makes poor choices in their physical, financial, social and personal lives is ultimately borne by the state, to varying degrees. Nowhere is this more true than in health, and in the UK we feel this particularly acutely because we have a state-funded universal health care system which commits to bearing the cost of treating all of its citizens. If we can prevent people getting ill, the benefits for the NHS, as well as to society as a whole, are potentially immense. The estimated cost to the NHS of alcohol misuse is £2.7 billion per annum, smoking £2.7 billion, obesity £4.2 billion and inactivity £1–1.8 billion. The wider cost to society is estimated at £20 billion per annum for alcohol misuse, £5.2 billion for smoking, £15.8 billion for obesity and £8.3 billion for inactivity, in England alone ( DoH 2009 ). The current climate of financial austerity only makes the need to reduce the impact of these lifestyle conditions more urgent and pressing. The publication of the Public Health White Paper signals the intention of the Coalition Government to pursue ‘nudge’ principles of behavioural science to improve the health of the population. But what really is the science behind ‘nudge’, and why should clinicians and hospital managers be interested in it?