nudge to eliminate pudge

I just finished the book Nudge: Improving Decisions About Health, Wealth, and Happiness, written by economics professor Richard Thaler and law professor Cass Sunstein, both of the University of Chicago. Lovers of Freakonomics or Blink will definitely appreciate Thaler and Sunstein's look into the field of behavioral economics. In one sentence, Nudge is about why people make the decisions they make and how policy can "nudge" people into making better choices.

I realized that the ideas in this book are the theoretical basis for many disease prevention government public health programs. These programs are attempts to improve "choice architecture" - that is, many public health initiatives attempt to redesign the context in which people make choices about their health behaviors in order to improve the chances that people will make the most healthy choice possible (while still giving people freedom of options).

Here's one of Thaler & Sunstein's examples of "nudges":

"[Nudging] is a relatively weak, soft and nonintrusive type of paternalism because choices are not blocked, fenced off, or significantly burdened. If people want to smoke cigarettes, to eat a lot of candy, to choose an unsuitable health care plan, or to fail to save for retirement, libertarian paternalists will not force them to do otherwise - or even make things hard for them. ... [Libertarian paternalists] are self-consciously attempting to move people in directions that will make their lives better. They nudge." (pg 11-12)

I can't stress enough how great this framework can be for public health professionals. We don't want to force people to make a certain health choice - we want to make it easier for people to make good choices, we want to provide incentives for people to make these types of choices, we want people to have as few barriers as possible. What we don't want to do is penalize those who make "the wrong" choices, because taking away someone's choices to behave as they wish infringes on personal liberties.

How about a more concrete example of public health "nudging"?

Like every other man and woman in America, I absolutely adore Michelle Obama. She's young, beautiful, and smart as hell. And, like many of the First Ladies before her, she has taken a national-level role in promoting a cause: encouraging Americans to improve nutrition and increase physical activity. Last week she spoke at the Grocery Manufacturer's Association, calling for major food manufacturers like ConAgra, Kraft & General Mills to reinvent the products that they sell in grocery stores - especially those products that are marketed toward children.

Michelle is asking these food producers to chance the choice architecture for people who shop in grocery stores and restaurants, especially for parents shopping for their kids. Children are drawn to food that's marketed to them during youth television programming, or that's marketed to them by colorful, cartoon packaging. But the food kids gravitate toward are *overwhelmingly* some of the most unhealthy food in the store. Margo Wootan, of the non-profit Center for Science in the Public Interest in Washington, said, "If companies were marketing bananas and broccoli, we wouldn't be concerned. But most marketing is for sugary cereals, fast food, snack food and candy."

The idea here is that childhood obesity has become such a national epidemic because of the availability and affordability of unhealthy food that children want to eat. Michelle is, first, trying to encourage these manufacturers put less salt, fat and sugar in the food marketed to children. Secondly, Michelle is calling for these companies to make labels less confusing for the average shopper - many foods with the word "healthy" on the box aren't. Hopefully, the changes for which Michelle is advocating will (1) make children want to eat food that's better for them, and (2) make it easier for parents to pick out and purchase the healthy food options.

There's an important but subtle point in all of this. Michelle is not trying to ban unhealthy food. People can still go to the grocery store and buy their kids donuts if they wish. But if healthy food is marketed to children, and parents can easily understand the nutritional value of the food they're purchasing, they just might be persuaded to put the donuts back and buy some fruit instead. No options are being eliminated - certain options are simply being nudged.

From start to finish of the book, I began to look at public health news with these "nudge" concepts. I think this book could be incredibly important for professionals and students in this field, because it made me understand from a theory-based perspective how public health programs should influence behaviors: through conscious structuring of a people's choice architecture to "nudge" them towards healthy decision-making. Loved the book. And I think anyone in a policy role (or aspiring to be in one) should give it a read.

(And a special shoutout to Brian Merry, second-year public health student, who let me borrow Nudge. Sorry about the coffee stains in Part IV ... turbulence + coffee from the flight attendant = minor spillage.)