Nudging Health


Book edited by I. Glenn Cohen, Holly Fernandez Lynch, and Christopher T. Robertson: “Behavioral nudges are everywhere: calorie counts on menus, automated text reminders to encourage medication adherence, a reminder bell when a driver’s seatbelt isn’t fastened. Designed to help people make better health choices, these reminders have become so commonplace that they often go unnoticed. In Nudging Health, forty-five experts in behavioral science and health policy from across academia, government, and private industry come together to explore whether and how these tools are effective in improving health outcomes.

Behavioral science has swept the fields of economics and law through the study of nudges, cognitive biases, and decisional heuristics—but it has only recently begun to impact the conversation on health care.Nudging Health wrestles with some of the thorny philosophical issues, legal limits, and conceptual questions raised by behavioral science as applied to health law and policy. The volume frames the fundamental issues surrounding health nudges by addressing ethical questions. Does cost-sharing for health expenditures cause patients to make poor decisions? Is it right to make it difficult for people to opt out of having their organs harvested for donation when they die? Are behavioral nudges paternalistic? The contributors examine specific applications of behavioral science, including efforts to address health care costs, improve vaccination rates, and encourage better decision-making by physicians. They wrestle with questions regarding the doctor-patient relationship and defaults in healthcare while engaging with larger, timely questions of healthcare reform.

Nudging Health is the first multi-voiced assessment of behavioral economics and health law to span such a wide array of issues—from the Affordable Care Act to prescription drugs….(More)”

One Crucial Thing Can Help End Violence Against Girls


Eleanor Goldberg at The Huffington Post: “…There are statistics that demonstrate how many girls are in school, for example. But there’s a glaring lack of information on how many of them have dropped out ― and why ― concluded a new study, “Counting the Invisible Girls,” published this month by Plan International.

Why Data On Women And Girls Is Crucial

Without accurate information about the struggles girls face, such as abuse, child marriage, and dropout rates, governments and nonprofit groups can’t develop programs that cater to the specific needs of underserved girls. As a result, struggling girls across the globe, have little chance of escaping the problems that prevent them from pursuing an education and becoming economically independent.

“If data used for policy-making is incomplete, we have a real challenge. Current data is not telling the full story,” Emily Courey Pryor, senior director of Data2X, said at the Social Good Summit in New York City last month. Data2X is a U.N.-led group that works with data collectors and policymakers to identify gender data issues and to help bring about solutions.

Plan International released its report to coincide with a number of major recent events….

How Data Helps Improve The Lives Of Women And Girls 

While data isn’t a panacea, it has proven in a number of instances to help marginalized groups.

Until last year, it was legal in Guatemala for a girl to marry at age 14 ― despite the numerous health risks associated with the practice. Young brides are more vulnerable to sexual abuse and more likely to face fatal complications related to pregnancy and childbirth than those who marry later.

To urge lawmakers to raise the minimum age of marriage, Plan International partnered with advocates and civil society groups to launch its “Because I am a Girl” initiative. It analyzed traditional Mayan laws and gathered evidence about the prevalence of child marriage and its impact on children’s lives. The group presented the information before Guatemala’s Congress and in August of last year, the minimum age for marriage was raised to 18.

A number of groups are heeding the call to continue to amass better data.

In May, the Bill and Melinda Gates Foundation pledged $80 million over the next three years to gather robust and reliable data.

In September, the U.N. women announced “Making Every Woman and Girl Count,”a public-private partnership that’s working to tackle the data issue. The program was unveiled at the U.N. General Assembly, and is working with the Gates Foundation, Data2X and a number of world leaders…(More)”

Open Innovation: Practices to Engage Citizens and Effectively Implement Federal Initiatives


United States Government Accountability Office: “Open innovation involves using various tools and approaches to harness the ideas, expertise, and resources of those outside an organization to address an issue or achieve specific goals. GAO found that federal agencies have frequently used five open innovation strategies to collaborate with citizens and external stakeholders, and encourage their participation in agency initiatives.

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GAO identified seven practices that agencies can use to effectively implement initiatives that involve the use of these strategies:

  • Select the strategy appropriate for the purpose of engaging the public and the agency’s capabilities.
  • Clearly define specific goals and performance measures for the initiative.
  • Identify and engage external stakeholders and potential partners.
  • Develop plans for implementing the initiative and recruiting participants.
  • Engage participants and partners while implementing the initiative.
  • Collect and assess relevant data and report results.
  • Sustain communities of interested partners and participants.

Aspects of these practices are illustrated by the 15 open innovation initiatives GAO reviewed at six selected agencies: the Departments of Energy, Health and Human Services, Housing and Urban Development, and Transportation (DOT); the Environmental Protection Agency; and the National Aeronautics and Space Administration (NASA).

For example:

• With the Asteroid Data Hunter challenge, NASA used a challenge and citizen science effort, beginning in 2014, to improve the accuracy of its asteroid detection program and develop an application for citizen scientists.

• Since 2009, DOT’s Federal Highway Administration has used an ideation initiative called Every Day Counts to identify innovations to improve highway project delivery. Teams of federal, state, local, and industry experts then implement the ideas chosen through this process….(More)”

A decentralized web would give power back to the people online


 at TechCrunch: “…The original purpose of the web and internet, if you recall, was to build a common neural network which everyone can participate in equally for the betterment of humanity.Fortunately, there is an emerging movement to bring the web back to this vision and it even involves some of the key figures from the birth of the web. It’s called the Decentralised Web or Web 3.0, and it describes an emerging trend to build services on the internet which do not depend on any single “central” organisation to function.

So what happened to the initial dream of the web? Much of the altruism faded during the first dot-com bubble, as people realised that an easy way to create value on top of this neutral fabric was to build centralised services which gather, trap and monetise information.

Search Engines (e.g. Google), Social Networks (e.g. Facebook), Chat Apps (e.g. WhatsApp )have grown huge by providing centralised services on the internet. For example, Facebook’s future vision of the internet is to provide access only to the subset of centralised services endorses (Internet.org and Free Basics).

Meanwhile, it disables fundamental internet freedoms such as the ability to link to content via a URL (forcing you to share content only within Facebook) or the ability for search engines to index its contents (other than the Facebook search function).

The Decentralised Web envisions a future world where services such as communication,currency, publishing, social networking, search, archiving etc are provided not by centralised services owned by single organisations, but by technologies which are powered by the people: their own community. Their users.

The core idea of decentralisation is that the operation of a service is not blindly trusted toany single omnipotent company. Instead, responsibility for the service is shared: perhaps by running across multiple federated servers, or perhaps running across client side apps in an entirely “distributed” peer-to-peer model.

Even though the community may be “byzantine” and not have any reason to trust or depend on each other, the rules that describe the decentralised service’s behaviour are designed to force participants to act fairly in order to participate at all, relying heavily on cryptographic techniques such as Merkle trees and digital signatures to allow participants to hold each other accountable.

There are three fundamental areas that the Decentralised Web necessarily champions:privacy, data portability and security.

  • Privacy: Decentralisation forces an increased focus on data privacy. Data is distributed across the network and end-to-end encryption technologies are critical for ensuring that only authorized users can read and write. Access to the data itself is entirely controlled algorithmically by the network as opposed to more centralized networks where typically the owner of that network has full access to data, facilitating  customer profiling and ad targeting.
  • Data Portability: In a decentralized environment, users own their data and choose with whom they share this data. Moreover they retain control of it when they leave a given service provider (assuming the service even has the concept of service providers). This is important. If I want to move from General Motors to BMW today, why should I not be able to take my driving records with me? The same applies to chat platform history or health records.
  • Security: Finally, we live in a world of increased security threats. In a centralized environment, the bigger the silo, the bigger the honeypot is to attract bad actors.Decentralized environments are safer by their general nature against being hacked,infiltrated, acquired, bankrupted or otherwise compromised as they have been built to exist under public scrutiny from the outset….(More)”

For Better Citizenship, Scratch and Win


Tina Rosenberg in the New York Times: “China, with its largely cash economy, has a huge problem with tax evasion. Not just grand tax evasion, but the everyday “no receipt, please” kind, even though there have been harsh penalties: Before 2011, some forms of tax evasion were even punishable by death.

The country needed a different approach. So what did it do to get people to pay sales tax?
A. Hired a force of inspectors to raid restaurants and stores to catch people skipping the receipt, accompanied by big fines and prison terms.
B. Started an “It’s a citizen’s duty to denounce” exhortation campaign.
C. Installed cameras to photograph every transaction.
D. Turned receipts into scratch-off lottery games.

One of these things is not like the other, and that’s the answer: D. Instead of punishing under-the-table transactions, China wisely decided to encouragelegal transactions by starting a receipt lottery. Many places have done this — Brazil, Chile, Malta, Portugal, Slovakia and Taiwan, among others. In Taiwan, for example, every month the tax authorities post lottery numbers; match a few numbers for a small prize, or all of them to win more than $300,000.

China took it further. Customers need not store their receipts and wait until the end of the month to see if they’ve won money. Gratification is instant: Each receipt, known as a fapiao, is a scratch-off lottery ticket. People still game the system, but much less. The fapiao system has greatly raised collections of sales tax, business income tax and total tax. And it’s cheap to administer: one study found that new tax revenue totaled 30 times (PDF) the cost of the lottery prizes.

When a receipt is a lottery ticket, people ask for a receipt. They hope to get money, but just as important, they like to play games. Those axioms apply around the globe.

“We have groups that say: we can give out an incentive to our customers worth $15,” said Aron Ezra, chief executive of OfferCraft, an American company that designs games for businesses. “They could do that and have everyone get an incentive for $15. But they’d get better results for the same average price by having variability — some get $10, some get $100.” The lottery makes it exciting.

The huge popularity of lotteries shows this. Another example is the Save to Win program, which credit unions are using in seven states. Microscopic interest rates weren’t enough to get low-income customers to save. So instead, for every $25 they put into a savings account, depositors get one lottery entry. They can win a grand prize — in some states, $10,000 — or $100 prizes every month.

What else could lotteries do?

Los Angeles and Philadelphia have been the sites of experiments to increase dismal voter turnout in local elections by choosing a voter at random to win a large cash prize. In May 2015, the Southwest Voter Registration Education Project in Los Angeles offered $25,000 to a random voter in one district during a school board election, in a project named Voteria.

Health-related lotteries aren’t new. In 1957, Glasgow held a mass X-ray campaign to diagnose tuberculosis. Health officials aimed to X-ray 250,000 people and in the end got three times that many. One reason for the enthusiasm: a weekly prize draw. A lovely vintage newsreel reported on the campaign.

More than 50 years later, researchers set up a lottery among young adults in Lesotho, designed to promote safe sex practices. Every four months the subjects were tested for two sexually transmitted diseases, syphilis and trichonomiasis. A negative test got them entered into a lottery to win either $50 (equivalent to a week’s average salary) or $100. The idea was to see if incentives to reduce the spread of syphilis would also protect against HIV.

The results were significant — a 21.4 percent reduction in the rate of new H.I.V. infections, and a 3.4 percent lower prevalence rate of HIV in the treatment group after two years. And the effect was lasting — the gains persisted a year after the experiment ended. The lottery worked in large part because it was most attractive to those most at risk: many people who take sexual risks also enjoy taking monetary risks, and might be eager to play a lottery.

The authors wrote in a blog post: “To the best of our knowledge, this is the first H.I.V. prevention intervention focusing on sexual behavior changes (as opposed to medical interventions) to have been demonstrated to lead to a significant reduction in H.I.V. incidence, the ultimate objective of any H.I.V. prevention intervention.”…(More)”

Seeing Cities Through Big Data


Book edited by Thakuriah, Piyushimita (Vonu), Tilahun, Nebiyou, and Zellner, Moira: “… introduces the latest thinking on the use of Big Data in the context of urban systems, including  research and insights on human behavior, urban dynamics, resource use, sustainability and spatial disparities, where it promises improved planning, management and governance in the urban sectors (e.g., transportation, energy, smart cities, crime, housing, urban and regional economies, public health, public engagement, urban governance and political systems), as well as Big Data’s utility in decision-making, and development of indicators to monitor economic and social activity, and for urban sustainability, transparency, livability, social inclusion, place-making, accessibility and resilience…(More)”

Data Revolutionaries: Routine Administrative Data Can Be Sexy Too


Sebastian Bauhoff at Center for Global Development: “Routine operational data on government programs lack sexiness, and are generally not trendy withData Revolutionaries. But unlike censuses and household surveys, routine administrative data are readily available at low cost, cover key populations and service providers, and are generally at the right level of disaggregation for decision-making on payment and service delivery. Despite their potential utility, these data remain an under-appreciated asset for generating evidence and informing policy—a particularly egregious omission given that developing countries can leapfrog old, inefficient approaches for more modern methods to collect and manage data. Verifying receipt of service via biometric ID and beneficiary fingerprint at the point of service? India’s already doing it.

To better make the case for routine data, two questions need to be answered—what exactly can be learned from these data and how difficult are they to use?

In a paper just published in Health Affairs with collaborators from the World Bank and the Government of India, we probed these questions using claims data from India’s National Health Insurance Program, Rashtriya Swasthya Bima Yojana (RSBY). Using the US Medicare program as a comparison, we wondered whether reimbursement claims data that RSBY receives from participating hospitals could be used to study the quality of care provided. The main goal was to see how far we could push on an example dataset of hospital claims from Puri, a district in Orissa state.

Here’s what we learned…(More)”

The Architecture of Innovation


Hollie Russon Gilman, and Jessica Gover at the Beeck Center: “Technology is transforming how we live our lives—from new solutions in health, education, defense, and beyond. The private sector provides user-centric, digital, customer-oriented solutions—in real time. We should expect the same from government. The government needs to evolve to keep up with these rapid changes in technology and data use. We need a government that is nimble and adaptive to change. More importantly, we need to create a culture within government that allows for a culture of innovation that leads to outcomes. At the same time, innovation—new technologies, data, and partnerships—have also triggered a need for rapid change in governance and public policy. With the election only a month away, the next president has the opportunity to pivot—to adopt a governance structure that proactively drives change and delivers results.

Today, we are thrilled to announce the release of our latest publication,The Architecture of Innovation: Institutionalizing Innovation in Federal Policymaking,” produced in partnership with The Massive Data Institute at Georgetown University’s McCourt School of Public Policy. The report provides recommendations for how the next administration can pilot, iterate, and scale innovative approaches to more effectively serve the needs of the American people. “The Architecture of Innovation” offers recommendations for how government can structurally organize for change at the highest levels to not only adapt and meet the challenges of today, but also anticipate and meet the needs of tomorrow.

We are launching the report today at our Fall convening, Data for Social Good: Innovation in the Next Administration. The report launch will be bookended by a fireside chat retrospective on innovation in the Obama Administration and a panel discussing innovation in past, present, and future administrations.

As presidential transition teams on both sides are building out their plans for the next administration, they have an unprecedented opportunity to maximize and grow the strides made by the Obama administration to create impactful change. For federal policymaking to create lasting outcomes, we believe that creating a holistic culture of innovation in government is the key to solving some of our biggest civic challenges. We hope that our report and today’s convening will provide a helpful roadmap as to best organization for innovation in government for 2016 and beyond…(More)”

Nudge Theory in Action: Behavioral Design in Policy and Markets


Book edited by Sherzod Abdukadirov: “This collection challenges the popular but abstract concept of nudging, demonstrating the real-world application of behavioral economics in policy-making and technology. Groundbreaking and practical, it considers the existing political incentives and regulatory institutions that shape the environment in which behavioral policy-making occurs, as well as alternatives to government nudges already provided by the market. The contributions discuss the use of regulations and technology to help consumers overcome their behavioral biases and make better choices, considering the ethical questions of government and market nudges and the uncertainty inherent in designing effective nudges. Four case studies – on weight loss, energy efficiency, consumer finance, and health care – put the discussion of the efficiency of nudges into concrete, recognizable terms. A must-read for researchers studying the public policy applications of behavioral economics, this book will also appeal to practicing lawmakers and regulators…(More)”

Europe Should Promote Data for Social Good


Daniel Castro at Center for Data Innovation: “Changing demographics in Europe are creating enormous challenges for the European Union (EU) and its member states. The population is getting older, putting strain on the healthcare and welfare systems. Many young people are struggling to find work as economies recover from the 2008 financial crisis. Europe is facing a swell in immigration, increasingly from war-torn Syria, and governments are finding it difficult to integrate refugees and other migrants into society.These pressures have already propelled permanent changes to the EU. This summer, a slim majority of British voters chose to leave the Union, and many of those in favor of Brexit cited immigration as a motive for their vote.

Europe needs to find solutions to these challenges. Fortunately, advances in data-driven innovation that have helped businesses boost performance can also create significant social benefits. They can support EU policy priorities for social protection and inclusion by better informing policy and program design, improving service delivery, and spurring social innovations. While some governments, nonprofit organizations, universities, and companies are using data-driven insights and technologies to support disadvantaged populations, including unemployed workers, young people, older adults, and migrants, progress has been uneven across the EU due to resource constraints, digital inequality, and restrictive data regulations. renewed European commitment to using data for social good is needed to address these challenges.

This report examines how the EU, member-states, and the private sector are using data to support social inclusion and protection. Examples include programs for employment and labor-market inclusion, youth employment and education, care for older adults, and social services for migrants and refugees. It also identifies the barriers that prevent European countries from fully capitalizing on opportunities to use data for social good. Finally, it proposes a number of actions policymakers in the EU should take to enable the public and private sectors to more effectively tackle the social challenges of a changing Europe through data-driven innovation. Policymakers should:

  • Support the collection and use of relevant, timely data on the populations they seek to better serve;
  • Participate in and fund cross-sector collaboration with data experts to make better use of data collected by governments and non-profit organizations working on social issues;
  • Focus government research funding on data analysis of social inequalities and require grant applicants to submit plans for data use and sharing;
  • Establish appropriate consent and sharing exemptions in data protection regulations for social science research; and
  • Revise EU regulations to accommodate social-service organizations and their institutional partners in exploring innovative uses of data….(More)”