What is the next big thing in healthcare? It may not be a scientific or technological breakthrough but something as simple as changing our everyday behaviours.
Humans have good intentions around their health but very few of us are good at navigating the complexities of healthcare. Classical economics would suggest that information and appropriate incentives are enough. Behavioural economists know that isn’t the case. We need to understand human psychology and deploy the correct balance of behavioural change tools.
At our Future of Health conference in mid-November, I explained why I see a huge opportunity for healthcare to leap forward. It requires more effectively understanding why patients aren’t getting to the outcomes they intend and the psychological mechanisms that stand in their way.
Traits of human psychology
- Overweight the present, underweight the future: For example, we put more emphasis on the pleasure from eating chocolate cake now than on the future implications for our weight.
- Mindless behaviour: Such as devouring an entire bucket of popcorn at the movies rather than thinking about every bite. Switching into auto-pilot mode affects our behaviour over time.
- Social cues and default: We tend to take the option suggested such as the ‘special meal deal’. We are very sensitive to the patterns put in front of us.
- Choice architecture: The way opportunities and decisions are framed to us very much dictate our behaviour. Unfortunately, things are getting worse. For example, today’s hamburgers are five times larger than the ones our grandparents bought.
The behavioural economist’s toolkit
- Heavy handed: Coercion is the most effective but arguably the most controversial of the levers that I discussed. This recognises that humans can make mistakes so sometimes it is best we don’t have any choice. Hence seat belts are compulsory and texting while driving is illegal.
- Empowerment: Namely arming people with better tools to exercise their own agency. Calorie labels are one example. However, making informed decisions takes time, energy and attention. When it comes to healthcare it is beyond most humans’ ability to make all the calculations and trade-offs to achieve the best outcome.
- Nudging: A favourite of behavioural economists. It is about creating environments where it is easier to make the right decisions. One study found that when customers at a fast food outlet were routinely asked if they wanted to downsize their side order, 30% did so.1 This ties back to the social cues and default trait.
- The final lever I described was incentives, particularly the way they are framed. As we know, humans are highly motivated by a very slim chance of winning a huge amount of money. There is evidence that lottery-type incentives are very effective at changing behaviour. Another aspect is the power of anticipating regret. People respond very strongly if they are given a reward upfront knowing that they will have to return that reward if they fail to achieve a specified goal in the given timeframe.
The century of behaviour change
One study has suggested that up to 40% of premature deaths can be accounted for by behavioural patterns. That compares with premature deaths attributed to healthcare (10%), environmental exposures (5%) and social circumstances (15%). I see a powerful opportunity to change health outcomes by simply looking at our day-to-day behaviour and decisions.
Remembering the many lives saved during the 1800s due to understanding hygiene and the number of lives saved by medicines in the 1900s, could this be the century of behaviour change?3