Solving the obesity crisis: knowledge, nudge or nanny?


BioMedCentral Blog: ” The 5th Annual Oxford London Lecture (17 March 2015) was delivered by Professor Susan Jebb from Oxford University. The presentation was titled: ‘Knowledge, nudge and nanny: Opportunities to improve the nation’s diet’. In this guest blog Dr Helen Walls, Research Fellow at the London School of Hygiene and Tropical Medicine, covers key themes from this presentation.

“Obesity and related non-communicable disease such as diabetes, heart disease and cancer poses a significant health, social and economic burden in countries worldwide, including the United Kingdom. Whilst the need for action is clear, the nutrition policy response is a highly controversial topic. Professor Jebb raised the question of how best to achieve dietary change: through ‘knowledge, nudge or nanny’?

Education regarding healthy nutrition is an important strategy, but insufficient. People are notoriously bad at putting their knowledge to work. The inclination to overemphasise the importance of knowledge, whilst ignoring the influence of environmental factors on human behaviours, is termed the ‘fundamental attribution error’. Education may also contribute to widening inequities.

Our choices are strongly shaped by the environments in which we live. So if ‘knowledge’ is not enough, what sort of interventions are appropriate? This raises questions regarding individual choice and the role of government. Here, Professor Jebb introduced the Nuffield Intervention Ladder.

 

Nuffield Intervention Ladder
Nuffield Intervention Ladder
Nuffield Council on Bioethics. Public health ethical issues. London: Nuffield Council on Bioethics. 2007.

The Nuffield Intervention Ladder or what I will refer to as ‘the ladder’ describes intervention types from least to most intrusive on personal choice. With addressing diets and obesity, Professor Jebb believes we need a range of policy types, across the range of rungs on the ladder.

Less intrusive measures on the ladder could include provision of information about healthy and unhealthy foods, and provision of nutritional information on products (which helps knowledge be put into action). More effective than labelling is the signposting of healthier choices.

Taking a few steps up the ladder brings in ‘nudge’, a concept from behavioural economics. A nudge is any aspect of the choice architecture that alters people’s behaviour in a predictable way without forbidding options or significantly changing economic incentives. Nudges are not mandates. Putting fruit at eye level counts as a nudge. Banning junk food does not.

Nudges are not mandates. Putting fruit at eye level counts as a nudge. Banning junk food does not.

The in-store environment has a huge influence over our choices, and many nudge options would fit here. For example, gondalar-end (end of aisle) promotions create a huge up-lift in sales. Removing unhealthy products from this position could make a considerable difference to the contents of supermarket baskets.

Nudge could be used to assist people make better nutritional choices, but it’s also unlikely to be enough. We celebrate the achievement we have made with tobacco control policies and smoking reduction. Here, we use a range of intervention types, including many legislative measures – the ‘nanny’ aspect of the title of this presentation….(More)”

Encyclopedia of Social Network Analysis and Mining


“The Encyclopedia of Social Network Analysis and Mining (ESNAM) is the first major reference work to integrate fundamental concepts and research directions in the areas of social networks and  applications to data mining. While ESNAM  reflects the state-of-the-art in  social network research, the field  had its start in the 1930s when fundamental issues in social network research were broadly defined. These communities were limited to relatively small numbers of nodes (actors) and links. More recently the advent of electronic communication, and in particular on-line communities, have created social networks of hitherto unimaginable sizes. People around the world are directly or indirectly connected by popular social networks established using web-based platforms rather than by physical proximity.

Reflecting the interdisciplinary nature of this unique field, the essential contributions of diverse disciplines, from computer science, mathematics, and statistics to sociology and behavioral science, are described among the 300 authoritative yet highly readable entries. Students will find a world of information and insight behind the familiar façade of the social networks in which they participate. Researchers and practitioners will benefit from a comprehensive perspective on the methodologies for analysis of constructed networks, and the data mining and machine learning techniques that have proved attractive for sophisticated knowledge discovery in complex applications. Also addressed is the application of social network methodologies to other domains, such as web networks and biological networks….(More)”

The Power of Heuristics


ideas42: “People are presented with many choices throughout their day, from what to have for lunch to where to go on vacation to how much money to save for emergencies. In many situations, this ability to choose enhances our lives. However, having too many choices can sometimes feel like a burden, especially if the choices are complex or the decisions we’re making are important. In these instances, we often make poor decisions, or sometimes even fail to choose at all. This can create real problems, for example when people fail to save enough for retirement or don’t make the right choices when it comes to staying healthy.
So why is it that so much effort has been spent trying to improve decision-making by giving people even more information about the choices available – often complicating the choice even further?
In a new paper by ideas42, ideas42 co-founder Antoinette Schoar of MIT’s Sloan School of Management, and ideas42’s Saugato Datta argue that this approach of providing more information to help individuals make better decisions is flawed, “since it does not take into account the psychological or behavioral barriers that prevent people from making better decisions.” The solution, they propose, is using effective rules of thumb, or ‘heuristics’, to “enable people to make ‘reasonably good’ decisions without needing to understand all the complex nuances of the situation.” The paper explores the effectiveness of heuristics as a tool to simplify information during decision-making and help people follow through on their intentions. The authors offer powerful examples of effective heuristics-based methods in three domains: financial education, agriculture, and medicine….(More)”

Nudge Concept App Hopes To Point Pre-Diabetics Toward A Healthier Lifestyle


at FastCompany: “A new concept app from the London office of design and innovation consultancy Smart Design aims to improve the health of a large portion of the world’s population, a segment for whom weight loss can be a matter of life and death: diabetics.
Nudge is a concept app aimed at pre-diabetics—people with a high risk of developing type 2 diabetes—to change their eating habits. Described as a “personal nutritionist disguised as a shopping assistant,” the app keeps track of a user’s weekly grocery shopping using a phone’s camera to scan products on store shelves. The app looks for purchasing patterns that can be improved, and suggests healthy alternatives—like substituting red rice for white rice, or maybe even quinoa—to nudge the individual toward making better decisions. The idea is to help pre-diabetics make small, incremental changes.

(More)”

The Trouble With Disclosure: It Doesn’t Work


Jesse Eisinger at ProPublica: “Louis Brandeis was wrong. The lawyer and Supreme Court justice famously declared that sunlight is the best disinfectant, and we have unquestioningly embraced that advice ever since.
All this sunlight is blinding. As new scholarship is demonstrating, the value of all this information is unproved. Paradoxically, disclosure can be useless — and sometimes actually harmful or counterproductive.
“We are doing disclosure as a regulatory move all over the board,” says Adam J. Levitin, a law professor at Georgetown, “The funny thing is, we are doing this despite very little evidence of its efficacy.”…
Of course, some disclosure works. Professor Levitin cites two examples. The first is an olfactory disclosure. Methane doesn’t have any scent, but a foul smell is added to alert people to a gas leak. The second is ATM. fees. A study in Australia showed that once fees were disclosed, people avoided the high-fee machines and took out more when they had to go to them.
But to Omri Ben-Shahar, co-author of a recent book, ” More Than You Wanted To Know: The Failure of Mandated Disclosure,” these are cherry-picked examples in a world awash in useless disclosures. Of course, information is valuable. But disclosure as a regulatory mechanism doesn’t work nearly well enough, he argues.
First, it really works only when things are simple. As soon as transactions become complex, disclosure starts to stumble. Buying a car, for instance, turns out to be several transactions: the purchase itself, the financing, maybe the trade-in of old car and various insurance and warranty decisions. These are all subject to various disclosure rules, but making the choices clear and useful has proved nigh impossible.
In complex transactions, we then must rely on intermediaries to give us advice. Because they are often conflicted, they, too, become subject to disclosure obligations. Ah, even more boilerplate to puzzle over!
And then there’s the harm. Over the years, banks that sold complex securities often stuck impossible-to-understand clauses deep in prospectuses that “disclosed” what was really going on. When the securities blew up, as they often did, banks then fended off lawsuits by arguing they had done everything the law required and were therefore not liable.
“That’s the harm of disclosure,” Professor Ben-Shahar said. “It provides a safe harbor for practices that smell bad. It sanitizes every bad practice.”
The anti-disclosure movement is taking on the ” Nudge” school, embraced by the Obama administration and promoted most prominently by Cass R. Sunstein, a scholar at Harvard, and Richard H. Thaler, an economist at the University of Chicago. These nudgers believe that small policies will prod people to do what’s in their best interests.
The real-world evidence in favor of nudging is thin. …
The ever-alluring notion is that we are just one or two changes away from having meaningful disclosure. If we could only have annual Securities and Exchange Commission filings in plain English, we could finally understand what’s going on at corporations. A University of San Diego Law School professor, Frank Partnoy, and I called for better bank disclosure in an article in The Atlantic a few years ago.
Professor Ben-Shahar mocks it. ” ‘Plain English!’ ‘Make it simple.’ That is the deus ex machina, the god that will solve everything,” he said.
Complex things are, sadly, complex. A mortgage is not an easy transaction to understand. People are not good at predicting their future behavior and so don’t know what options are best for them. “The project of simplification is facing a very poor empirical track record and very powerful theoretical problem,” he said.
What to do instead? Hard and fast rules. If lawmakers want to end a bad practice, ban it. Having them admit it is not enough. (More)”

Nudging and Choice Architecture: Ethical Considerations


New paper by Cass Sunstein at Yale Journal on Regulation (via SSRN): “Is nudging unethical? Is choice architecture a problem for a free society? This essay defends seven propositions: (1) It is pointless to object to choice architecture or nudging as such. Choice architecture cannot be avoided. Nature itself nudges; so does the weather; so do customs and traditions; so do spontaneous orders and invisible hands. The private sector inevitably nudges, as does the government. It is reasonable to worry about nudges by government and to object to particular nudges, but not to nudging in general. (2) In this context, ethical abstractions (for example, about autonomy, dignity, manipulation, and democratic self-government) can create serious confusion. To make progress, those abstractions must be brought into contact with concrete practices. Nudging and choice architecture take highly diverse forms, and the force of an ethical objection depends on the specific form. (3) If welfare is our guide, much nudging is actually required on ethical grounds, even if it comes from government. (4) If autonomy is our guide, much nudging is also required on ethical grounds, in part because some nudges actually promote autonomy, in part because some nudges enable people to devote their limited time and attention to their most important concerns. (5) Choice architecture should not, and need not, compromise either dignity or self-government, but it is important to see that imaginable forms could do both. It follows that when they come from government, choice architecture and nudges should not be immune from a burden of justification, which they might not be able to overcome. (6) Some nudges are objectionable because the choice architect has illicit ends. When the ends are legitimate, and when nudges are fully transparent and subject to public scrutiny, a convincing ethical objection is less likely to be available. (7) There is ample room for ethical objections in the case of well-motivated but manipulative interventions, certainly if people have not consented to them; such nudges can undermine autonomy and dignity. It follows that both the concept and the practice of manipulation deserve careful attention. The concept of manipulation has a core and a periphery; some interventions fit within the core, others within the periphery, and others outside of both….(More)”
 

Helping the Poor in Education: The Power of a Simple Nudge


The New York Times: “There are enormous inequalities in education in the United States. A child born into a poor family has only a 9 percent chance of getting a college degree, but the odds are 54 percent for a child in a high-income family. These gaps open early, with poor children less prepared than their kindergarten classmates.

How can we close these gaps?….

Yet as these debates rage, researchers have been quietly finding small, effective ways to improve education. They have identified behavioral “nudges” that prod students and their families to take small steps that can make big differences in learning. These measures are cheap, so schools or nonprofits could use them immediately.

Let’s start with college. At every step of the way, low-income students are more likely to stumble on the path to higher education. Even the summer after high school is a perilous time, with 20 percent of those who plan to attend college not actually enrolling — a phenomenon known as “summer melt.” Bureaucratic barriers, like the labyrinthine process of applying for financial aid, explain some of the drop-off.

While they were graduate students at Harvard, two young professors designed and tested a program to help students stick to their college plans. Benjamin L. Castleman, now at the University of Virginia, and Lindsay C. Page, at the University of Pittsburgh, set up a system of automatic, personalized text messages that reminded high school students about their college deadlines. The texts included links to required forms and live counselors.

The result? Students who received the texts were more likely to enroll in college: 70 percent, compared with 63 percent of those who did not get them. Seven percentage points is a big increase in this field, similar to the gains produced by scholarships that cost thousands of dollars. Yet this program cost only $7 per student.

The same researchers also tested a texting program to keep students from dropping out of college….(More)”

Wiser: Getting Beyond Groupthink to Make Groups Smarter


New publication by Reid Hastie and Cass Sunstein: “Why are group decisions so hard? Since the beginning of human history, people have made decisions in groups–first in families and villages, and now as part of companies, governments, school boards, religious organizations, or any one of countless other groups. And having more than one person to help decide is good because the group benefits from the collective knowledge of all of its members, and this results in better decisions. Right? Back to reality. We’ve all been involved in group decisions–and they’re hard. And they often turn out badly. Why? Many blame bad decisions on “groupthink” without a clear idea of what that term really means. Now, “Nudge” coauthor Cass Sunstein and leading decision-making scholar Reid Hastie shed light on the specifics of why and how group decisions go wrong–and offer tactics and lessons to help leaders avoid the pitfalls and reach better outcomes. In the first part of the book, they explain in clear and fascinating detail the distinct problems groups run into: They often amplify, rather than correct, individual errors in judgment; They fall victim to cascade effects, as members follow what others say or do; They become polarized, adopting more extreme positions than the ones they began with; They emphasize what everybody knows instead of focusing on critical information that only a few people know. In the second part of the book, the authors turn to straightforward methods and advice for making groups smarter. These approaches include silencing the leader so that the views of other group members can surface, rethinking rewards and incentives to encourage people to reveal their own knowledge, thoughtfully assigning roles that are aligned with people’s unique strengths, and more. With examples from a range of organizations–from Google to the CIA–and written in an engaging and witty style, “Wiser” will not only enlighten you; it will help your team and your organization make better decisions–decisions that lead to greater success.”

Look to Government—Yes, Government—for New Social Innovations


Paper by Christian Bason and Philip Colligan: “If asked to identify the hotbed of social innovation right now, many people would likely point to the new philanthropy of Silicon Valley or the social entrepreneurship efforts supported by Ashoka, Echoing Green, and Skoll Foundation. Very few people, if any, would mention their state capital or Capitol Hill. While local and national governments may have promulgated some of the greatest advances in human history — from public education to putting a man on the moon — public bureaucracies are more commonly known to stifle innovation.
Yet, around the world, there are local, regional, and national government innovators who are challenging this paradigm. They are pioneering a new form of experimental government — bringing new knowledge and practices to the craft of governing and policy making; drawing on human-centered design, user engagement, open innovation, and cross-sector collaboration; and using data, evidence, and insights in new ways.
Earlier this year, Nesta, the UK’s innovation foundation (which Philip helps run), teamed up with Bloomberg Philanthropies to publish i-teams, the first global review of public innovation teams set up by national and city governments. The study profiled 20 of the most established i-teams from around the world, including:

  • French Experimental Fund for Youth, which has supported more than 554 experimental projects (such as one that reduces school drop-out rates) that have benefited over 480,000 young people;
  • Nesta’s Innovation Lab, which has run 70 open innovation challenges and programs supporting over 750 innovators working in fields as diverse as energy efficiency, healthcare, and digital education;
  • New Orleans’ Innovation and Delivery team, which achieved a 19% reduction in the number of murders in the city in 2013 compared to the previous year.

How are i-teams achieving these results? The most effective ones are explicit about the goal they seek – be it creating a solution to a specific policy challenge, engaging citizenry in behaviors that help the commonweal, or transforming the way government behaves. Importantly, these teams are also able to deploy the right skills, capabilities, and methods for the job.
In addition, ­i-teams have a strong bias toward action. They apply academic research in behavioral economics and psychology to public policy and services, focusing on rapid experimentation and iteration. The approach stands in stark contrast to the normal routines of government.
Take for example, The UK’s Behavioural Insights Team (BIT), often called the Nudge Unit. It sets clear goals, engages the right expertise to prototype means to the end, and tests innovations rapidly in the field, to learn what’s not working and rapidly scales what is.
One of BIT’s most famous projects changed taxpayer behavior. BIT’s team of economists, behavioral psychologists, and seasoned government staffers came up with minor changes to tax letters, sent out by the UK Government, that subtlety introduced positive peer pressure. By simply altering the letters to say that most people in their local area had already paid their taxes, BIT was able to boost repayment rates by around 5%. This trial was part of a range of interventions, which have helped forward over £200 million in additional tax revenue to HM Revenue & Customs, the UK’s tax authority.
The Danish government’s internal i-team, MindLab (which Christian ran for 8 years) has likewise influenced citizen behavior….”

A Vision for Happier Cities


Post by at the Huffington Post:“…Governments such as Bhutan and Venezuela are creating departments of happiness, and in both the US and UK, ‘nudge’ teams have been set up to focus on behavioral psychology. This gets more interesting when we bring in urban planning and neuroscience research, which shows that community aesthetics are a key contributor to our happiness at the same time positive emotions can change our thoughts, and lead to changes in our behaviors.
It was only after moving to New York City that I realized all my experiences… painting, advising executive boards, creative workshops, statistics and writing books about organizational change…gave me a unique set of tools to create the Dept. of Well Being and start a global social impact initiative, which is powered by public art installations entitled Happy Street Signs™.
New York City got the first Happy Street Signs last November. I used my paintings containing positive phrases like “Honk Less Love More” and “New York Loves You” to manufacture 200 government-specification street signs. They were then installed by a team of fifty volunteers around Manhattan and Brooklyn in 90 minutes. Whilst it was unofficial, the objective was to generate smiles for New Yorkers and then survey reactions. We got clipboards out and asked over 600 New Yorkers if they liked the Happy Street Signs and if they wanted more: 92.5 percent of those people said yes!…”