October 31, 2016, by Suzanne
Do people really want to be nudged towards healthy lifestyles?
People can expect longer and healthier lives if they make certain kinds of lifestyle choices. This is known not only to health specialists, but also to the general public. The considered advice of medical and public health experts is readily available in forms that are designed to be easily understood. In the UK, for example, you can consult an accessible website maintained by the NHS, with the banner ‘Your health, your choices’. A few minutes browsing will be enough for you to learn some simple guidelines: you should eat at least five portions of a variety of fruit and vegetables a day; you should not drink more than 14 units of alcohol each week; you should have at least 150 minutes of physical activity each week. These guidelines are widely known and are frequent topics of media attention. Nevertheless, many people do not follow them.
Behavioural economists often argue that governments should respond by nudging people towards healthy lifestyles. The idea is to design the environments in which choices are made in ways that engage with psychological mechanisms that economists have traditionally regarded as non-rational, but which are known to influence actual choices. These mechanisms are to be used to increase the likelihood of healthy lifestyle choices while not restricting other opportunities. One common justification for such nudges, made for example by Richard Thaler and Cass Sunstein in their best-selling book Nudge, is the claim that most individuals want to make healthy lifestyle choices but at crucial moments (in a bar, in a restaurant, thinking about taking a run on a cold, damp morning) they are unable to resist the temptation to choose unhealthy options which, even at the time, they do not really want. People are making choices that they themselves would acknowledge to be mistakes.
As an aid to thinking about this claim, I offer a thought experiment. Consider Jane, a cafeteria customer who is currently in good health but seriously overweight. Despite knowing what dieticians advise, she chooses the cafeteria’s cream cake rather than its fresh fruit option. Imagine that, in an attempt to uncover the reasoning that leads people like Jane to ignore dietary advice, we are designing a questionnaire which asks: ‘Which of the following statements best represents your reasons for choosing cake rather than fruit, contrary to the recommendations of health experts?’ The thought experiment is to produce statements that Jane might plausibly assent to, and that could be used to diagnose her mode of reasoning. My list of statements includes:
(a) I always go into the cafeteria having resolved not to choose cake, but when I see the cake at the front of the counter, I can’t resist the temptation.
(b) I get a lot of pleasure from eating sweet and fatty foods, and the thought of living to a great age doesn’t appeal to me.
(c) When I am a few years older I will adopt a healthier diet, so my current eating habits are not a problem.
(d) The expert advice sets unrealistic standards. Most of the people I know eat at least as much sugar and fat as I do.
(e) All my grandparents were thin but died relatively young. It’s quite likely that I will die young too, whatever I eat.
(f) Whatever I eat, I put on weight, so for me there is no point in trying to eat more healthily.
Thaler and Sunstein’s implicit hypothesis is that most respondents will choose (a), revealing a self-acknowledged problem of self-control. But behavioural science provides a lot of evidence of other psychological mechanisms that might induce other answers. These include lack of empathy for one’s older self (b), procrastination (c), matching one’s behaviour to that of others (d), over-weighting personal experience (e), and self-deception (f).
The point of this thought experiment is that there are many ways in which a person can explain why she knowingly acts against well-grounded but unwelcome recommendations from experts. My conjecture, based both on casual social experience and on knowledge about the findings of behavioural science, is that lack of self-control would not be particularly common as a self-ascribed explanation. Each of the six statements in my questionnaire represents a mode of reasoning, heuristic or bias that is known to be a common property of human psychology. However, only (a) admits to a failure on the part of the respondent herself. All the other statements maintain that the error is in the experts’ recommendation, applied without recognition of the respondent’s circumstances. Normal human psychology, one might well think, would favour explanations of one’s own behaviour that do not involve admissions of error.
The claim that individuals want to be nudged away from what they are in fact inclined to choose depends on the assumption that self-acknowledged self-control problems are the main cause of unhealthy lifestyle choices. I suggest that this assumption should be treated with scepticism. I urge advocates of nudging to come clean about the paternalism of their position and defend it directly.
by Robert Sugden, University of East Anglia