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«Query: To what degree has behavioural economics and, in particular, the concept of 'nudging' been understood and used in development interventions to ...»

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The Aims of Nudge One needs to be careful to distinguish cultural variance in the workings of nudging from the cultural variance in the aims for which nudges are enlisted. For example, we are clearly in need of T&S‘s Save More Tomorrow scheme (T&S, p. 112–7) in economies in the West, where saving rates for retirement are alarmingly low. But we would not need such a nudge in economies in the East in which the savings rate is too high, which may stand in the way of economic development. In such countries, we might use the very same behavioural bias and review retirement investments not 3 months before but rather 3 months after raises are being awarded, hoping that the endowment effect has taken hold and that they no longer want to part with their raises.

Reforming Development Economics With a Nudge: How Can the Policies Proposed by Behavioral Economics be Used to Improve International Development Policy?

Caroline Laroche, London School of Economics & Political Science (LSE) Department of International Development, July 31, 2010 http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1888758 With the deadline for the achievement of the Millennium Development Goals coming up, innovations are urgently needed in the fight for global development; behavioural economics have been put forward as one such innovation. After providing the reader with background on the current state of behavioural economics, this paper discusses the justifications for the wider use of behavioural policies based on the ways in which poverty affects economic behaviour in the context of developing countries. After doing so, and building upon those findings, the authors evaluate different proposals for the wider inclusion of behaviour-based elements in development settings and establish what behavioural economics‘ key areas of relevance in shaping development policy are. The paper shows that those areas are centred around two institutional factors – missing commitment devices and lacking market integration – and two behavioural traits – high preference for current consumption and high loss and risk aversion. Finally, we shortly assess the potential of those policy proposals in being scaled up and reforming development policy.

4. To what extent has nudging been used? Case studies

„It Only Takes a Minute Girl‟: Insights in Women‟s Perceptions of Cervical Screening in Blackpool M. Lyons, D. Neary, J. Harris, K. Jordan, J. MacIntosh, H. Carlin, C. leavey, Centre for Public Health, Liverpool John Moores University, August 2009 http://www.cph.org.uk/showPublication.aspx?pubid=599 NHS Blackpool has decided to embark on a social marketing programme in an attempt to improve cervical screening rates, especially in the groups where coverage is known to be low. This includes testing of strap lines and nudges, preferably delivering positive messages and possibly with some humour for use by a wide variety of media.

The National Social Marketing Centre (NSMC), a strategic partnership between the Department of Health and Consumer Focus, present a series of international, evaluated case studies displaying social marketing techniques which have achieved real behavioural change in a health care setting (National Social Marketing Centre 2009). Each of these case studies meets the social marketing benchmark criteria and can thus be viewed as examples of best practice.

In one case study from New Zealand, with the strap line ‗Don‘t just SAY they matter‘, cervical smear uptake among Pacific island and Maori women was significantly increased. The campaign was based on the finding that the women valued getting together with friends for food and to socialise. Health professionals worked with community leaders to initiate ―Tupperware‖ like parties, where the women all brought some food and they sat, chatted and ate together at a friend‘s house. The female nurse then went to the house and set up to take smears in one of the bedrooms.

Women then took turns to go in for their smears. There is no doubt that the success of this campaign revolved around not only the publicity and media, but also the willingness of professionals to completely revise the way they ran the service and go into women’s homes during evenings or weekends to take the smears.

‗What‘s pants but can save your life‘ was the first cervical screening initiative in the UK to link social behaviour research with audience segmentation and data trends. It was aimed at 25-29 year old women in the West Midlands with particular emphasis on those who fail to attend screening during these years. By the end of the first quarter, there was a 16 percent increase in the target group and a 4 percent increase across all age groups (National Social Marketing Centre). A mixture of humour and the honest acknowledgement that having a cervical smear is ‗pants‘ seemed to create the right message for these women.

Applying behavioural insight to health Cabinet Office Behavioural Insights Team, December 2010 http://www.wmpho.org.uk/lfph/docs/403936_BehaviouralInsight_acc.pdf Introduction This sets out the importance of behaviour in policy making, the role of the Behavioural Insights Team in the Cabinet Office and how behavioural science insights can be applied to health using the MINDSPACE framework.

1 Smoking: drawing on commitment and incentive devices, we are launching a new smoking cessation trial with Boots.

Organ donation: we are introducing a trial of ‗prompted choice‘ for organ donation, which we believe will significantly increase the number of donor registrations.

3 Teenage pregnancy: how teenagers who mentor toddlers are significantly less likely to become teen parents themselves.

4 Alcohol: Welsh universities will be trialling new methods to encourage students to drink less alcohol using social norm techniques.

5 Diet and weight: we will be establishing a partnership with LazyTown, the popular children‘s TV show, which will encourage healthier behaviour in children.

6 Diabetes: new devices are helping children to manage their conditions in ways that are practical and fun.

7 Food hygiene: how the new National Food Hygiene Rating Scheme will empower people to make better choices when it comes to the hygiene standards of food.

8 Physical activity: numerous innovative schemes have been set up, including the ‗Step2Get‘ initiative in London, which incentivises pupils to walk to school.

9 Social care: we have established a partnership to develop a reciprocal time credit scheme to help catalyse peer-to-peer provision of social care.

Conclusion These approaches show the effect that behavioural insights can have upon citizens‘ health and wellbeing. We must continue to grow and share our evidence base, evaluating new approaches as we go. In most cases, success will not come from a single ‗silver bullet‘. Instead it will come from a combined approach between many partners – local communities, professionals, businesses and citizens themselves.

A key objective of the coming years will be to try out behavioural approaches – to experiment at local level – to find the most effective ways of adjusting our lifestyles in ways that keep or put citizens in the driving seat and make it easy to live a happy and healthy life. The current state of our knowledge – about both health and behavioural science – gives us many powerful clues about what is likely to work, but there is a great deal that we do not know. In such cases, we must ensure we test new approaches in a robust way – preferably with randomised control trials and before and after measures – supported with evaluations that will help other areas learn the lessons. In recognition of this need, a new Policy Research Unit on Behaviour and Health was announced in the recent Public Health White Paper.

There is a great deal of energy and enthusiasm for the new health agenda. If we can combine the insights from behavioural science with this enthusiasm and professional expertise, the benefits are likely to be very substantial indeed – fewer lives lost, better value for money and better health.

Lobby watch: The Cabinet Office Behavioural Insights Team.

Cassidy J., BMJ, 2011;342:d1648 http://www.bmj.com/content/342/bmj.d1648 Media maladies: Nudging out the Nanny State Dr Rosalind Stanwell-Smith, Perspectives in Public Health 2011 131: 149 http://rsh.sagepub.com/content/131/4/149.full.pdf+html It can be hard to keep up with public health fashion. Just when we‘ve managed to get everyone chanting the ‗Five a Day‘ mantra whenever they see a stick of broccoli, it turns out that this is yesterday‘s thinking. The new idea, promoted by a unit in the Cabinet Office, is to create environments that help people choose what is best for themselves and society. Officially called the Behavioural Insight Team, they have been nicknamed the ‗Nudge Unit‘ of the bestseller of one of their key advisers: the other author is advising on similar techniques in the White House. The unit is exploring the use of market incentives rather than regulations, for example in projects aimed at stopping smoking and food hygiene. Don‘t worry whether this means the Big Society is in or out: it‘s probably in, helping to forge a society of trustworthy citizens committed to wellbeing. But you must drop ‗short termism‘ at once (as if public health people needed to be told that), because we now need to keep pace with the expansion of choice and nudge everyone towards the right long term choices. Promoting desirable social norms by appeals to egotism and peer pressure are central to the nudge philosophy.

Is nudge an effective public health strategy to tackle obesity? No http://www.bmj.com/content/342/bmj.d2177?tab=responses Nudge smudge: UK Government misrepresents “nudge” Chris Bonell, Martin McKee, Adam Fletcher, Andrew Haines, Paul Wilkinson, The Lancet, 17th January 2011 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60063-9/fulltext The White Paper presents nudging as being in opposition to what is termed ―Whitehall diktat‖, ―nannying‖, and ―banning‖, and as working in voluntary partnership with, rather than regulating, business. In his House of Commons speech, Health Secretary Andrew Lansley argued: ―Rather than nannying people, we will nudge them by working with industry to make healthier lifestyles easier.‖ The UK Government is already putting this new approach into practice. It is reconsidering the ban on the display of tobacco products that was due to have taken effect in 2011 and is delaying detailed proposals for a ban on below-cost selling of alcohol (having already rejected the strong evidence-based option of minimum pricing). The government has established a new public-health advisory body dominated by the food and drink industry, with additional contributions from alcohol producers and operators of private gyms.

But the government has misrepresented the nudge approach. Although Thaler and Sunstein argue that nudging does not involve compelling or placing excessive economic pressure on individuals to change their behaviour, they do not pit nudging in opposition to the government using its formal powers to influence the behaviour of business. Their book presents its case mainly through examples of practical action, including legislation (e.g. enacting cap-and-trade systems to limit pollution) and regulation (e.g. requiring businesses to inform consumers about harms from cigarettes and pesticides).

Superficially, nudging seems to resonate with Marmot‘s review in its emphasis on environmental influences. However, whereas Marmot considers upstream factors such as poverty, neighbourhood deprivation, and over-reliance on fossil fuels, nudging focuses on downstream factors such as how individuals absorb information and perceive choices.

Politicians might have decided that bland platitudes plus references to fashionable concepts and some misrepresentation of their implications for policy might make for more effective containment than old-fashioned suppression ever could.

Sendhil Mullainathan: Solving social problems with a nudge TED Talks http://www.ted.com/talks/sendhil_mullainathan.html This Talk discussed behaviour change and how the first 999 miles of a solution are about science but the last mile is about people, their beliefs and behaviour change.

Noone would say, "Hey, I think this medicine works, go ahead and use it." We have testing, we go to the lab, we try it again, we have refinement. But you know what we do on the last mile? "Oh, this is a good idea. People will like this. Let's put it out there." The amount of resources we put in are disparate. We put billions of dollars into fuel-efficient technologies. How much are we putting into energy behavior change in a credible, systematic, testing way?

Now, I think that we're on the verge of something big. We're on the verge of a whole new social science. It's a social science that recognises -- much like science recognises the complexity of the body, biology recognises the complexity of the body

-- we'll recognise the complexity of the human mind. The careful testing, retesting, design, are going to open up vistas of understanding, complexities, difficult things.

And those vistas will both create new science, and fundamental change in the world as we see it, in the next hundred years.

What economics can (and can‟t) tell us, part 2: Getting the best deals Hannah Ryder, Senior Economist, DFID Blogs, Posted 4 August 2011 http://blogs.dfid.gov.uk/2011/08/what-economics-can-and-can%E2%80%99t-tell-uspart-2-getting-the-best-deals/ Economics has a lot to say about ―best deals‖ – whether for individuals like me, businesses or entire countries. The framework it uses to analyse deals is ―incentives‖.

Incentives – how people benefit or lose out from small changes in their or other people‘s behaviour – are at the very core of economics. It sounds nerdy, but incentives really do make the world go around. For instance, Paul Collier‘s Wars, Guns and Votes outlines how elections and other democratic institutions can create more problems than good if the incentives aren‘t right. Richard Thaler and Cass Sustein's influential book ―nudge" focuses on creating and using small incentives to make big improvements to wellbeing. Sendhil Mullainathan did a videocast talk a couple of years ago applying these "nudge" incentives to climate change action.

Planned, motivated and habitual hygiene behaviour: an eleven country review Valerie A. Curtis, Lisa O. Danquah, and Robert V. Aunger Health Education Resources, 2009 August; 24(4): 655–673.

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