Services are not enough

The problem with the kind of significant increases in public sector investment we have seen in the last decade is that it can take away the incentive to think differently about how we design and deliver services – or whether some of the services we have long provided are still making a positive difference. The temptation is to carry on doing things in much the same way but with more money.

The problem with reducing public expenditure is that we traditionally look for ways of making existing services more efficient or more productive while controlling their budgets ever more tightly. So we continue to deliver the same services with less money.

But while – richer or poorer– we carry on doing what we have always done, the world around us and the policy challenges it presents is changing – and it is changing in ways that can make a mockery of our plans and actions. Will we be able to resolve those problems, for example, by simply delivering more efficient, more expensive, albeit quite traditional public services?

If chronic disease continues to grow at the current rate, then the cost of the NHS will shoot up. Even relatively conservative estimates from ageing alone suggest extra spending of more than £1bn a year real just to stay still. Add in estimates from growing 'lifestyle'-related costs such as from obesity (in the form of diabetes, heart disease etc.) and the figures get really scary.

In the US, some analysts put the costs of obesity at $200bn per annum – while in the UK obesity has roughly doubled in the adult and child population over the past 15 years, a trend which shows no sign of slowing. But will the provision of more of the same stem that tide? And will more of the same make any significant impact on our professed determination to tackle climate change and create a more sustainable environment?

The growth of chronic disease
The reality is that unless we educate, persuade and influence people to change their lifestyles and eating habits, the growth of chronic diseases will continue. And until we persuade designers and their clients to take sustainability seriously, then our commitment to the environment will count for little when 80% of the environmental impact of products and buildings derive from the design phase. In these and in countless other policy areas, future success will depend more upon influencing and sometimes challenging accepted behaviour than it will on providing a service.

Some find difficult the very thought of the state, local or central, becoming involved in influencing personal behaviour even though it has happened down the ages, not least when church and state were more closely identified. More recently too, often by force of legislation, government has changed our behaviour and attitudes towards drink driving, shopping laws, smoking in public places, the availability of divorce, and the acceptability of single sex relationships. On other occasions, attempts to exercise influence have proved less successful, leading to accusations of 'nanny state' government.

The influence of the state

The influencing of behaviour by the state is more acceptable to people when it involves preventing someone else getting hurt, such as stopping anti-social behaviour or containing the spread of infectious diseases. The latter provides examples of some of the most effective behavioural interventions ever conducted, as well as offering useful clues about the kinds of approaches that work.

For example, the UK campaign to halt the spread of AIDS through changing sexual behaviour was one of the most effective of its kind in the world, and saved tens of thousands of lives. It involved adverts that were emotionally engaging and considered shockingly blunt at the time.

It involved unlikely coalitions between government and radical new campaign groups. It not only rapidly drove up public awareness about the transmission and impact of the disease, but succeeded in changing social norms around some of the most intimate aspects of our lives. Identifying effective advocates or messengers – often outside of government; using social networks; driving across messages on both emotional and cognitive levels; and sticking at it, are all lessons that apply equally to campaigns today.

It can be argued that the current crop of behavioural challenges we face are tougher, as the consequences are more diffuse and long term. The link between my driving a big car and global warming, or having an extra chocolate bar and getting diabetes, feels much looser than that between unsafe sex and getting (or spreading) AIDS. But current policy-makers do have least one advantage over their predecessors – the burgeoning field of behavioural economics.

The key insights of behavioural economics have their roots in laboratory based experiments from the 1970s and 80s onwards, not least in the work of Tversky and Kahneman for which the latter was subsequently awarded the Nobel Prize. But a series of recent books have poplarised these insights, and make excellent holiday reading for a chief executive and their team.

Perhaps most well-known is Nudge (2008) by Richard Thaler and Cass Sunstein, which explores the role and power of policy-makers as 'choice architects'. A tried-and-tested alternative, widely used by marketers, is The Psychology of Persuasion, by Robert Cialdini, and for those who want to show that they are one step ahead, Predictably Irrational, by Dan Ariely.

The basic idea is simple: we use mental shortcuts that make us liable to misremember, to misjudge in the present; and to mispredict our future. Policy-makers – and citizens – can respond to these insights in a number of ways:

• First, we can stick our heads in the sand and be buffeted around.

• Second, we can seek to arm citizens with the insights to resist 'behavioural predators' urging us to eat too much, spend too much, or consume in ways that will blight us all.

• Third, we can learn to be better choice architects – to shape situations and structure citizen choices leading us to more beneficial outcomes for all.
But a final word of warning. If policy-makers are to use these techniques and retain trust, they'd better get permission from their residents and constituents to do so. Behaviour change techniques can be powerfully effective, but citizens need to feel they are partners in the process, not rats in a laboratory maze.

Sir Michael Bichard is editor-in-chief of SFI.

David Halpern is Director of Research, Institute for Government, London. He previously worked as Chief Analyst in the Prime Minister's Strategy Unit (2001-2007).

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