Shoving and doing nothing on child obesity (masquerading as nudging) – Health Policy Today, 5th August 2008

Tom Smith on plans to tell parents the weight of their 4 and 10 year old children, and on the continuing mislabelling of 'nudge' theory inspiring British social policy.

All of today’s papers report Government plans to write to parents of reception year children (4-5 years) and those in year 6 children (10-11) so as to enlist their support in tackling obesity.  The letter will label children are underweight, healthy, overweight or very overweight.  Nobody seems critical of the idea.  The only negative comment is that the language is not strong enough.  We should avoid the ‘prissy’ language of ‘overweight’ say the National Obesity Forum and instead use the label ‘obese’.  Others would go further - just call them ‘fat’ say some of the readers commenting on stories.

My first reaction was very personal.  As a child, my single-parent father would likely have received a letter saying I was ‘overweight’.  What would have happened?  Probably nothing, except my feeling awful and probably my Dad too.  Would it have changed his behaviour?  I doubt it.  He himself was a ‘healthy’ weight and we ate the same things, at home at any rate.  The only difference was the food I ate in the school canteen.  

Children of 4 and 10 make few choices about what they eat.  In the main, this is determined by their carers, at home and in their primary schools.  Although the letter is aimed at parents, there is little aimed at schools.  

These ‘new’ approaches are being labelled as giving parents information to make choices, to nudge them to change behaviour.  Almost every recent policy announcement is said to be influenced by the new book Nudge – see www.nudges.org.  Yet there is a huge misunderstanding of what this area of thinking proposes.  Ideas are being put forward as ‘nudges’ which are simply new forms of paternalism.

It is interesting that the announcement places the onus on parents rather than schools.

As the FT argues today, there is a risk that nudge theory - to give it a grand title - is being employed sometimes to excuse inactivity. Within primary schools, there is little onus on cooking or food preparation in the syllabus. In my younger daughter’s Wandsworth school, physical exercise is irregular as there is no space to hold the lessons.  Over the last six years, two big slices of the school fields have been sold off – first to a private nursery, then to a new autistic centre. In difficult economic circumstances, it is more important for the school to ensure a continued stream of new students than it is to have a sports or playing field they might exercise on.

Nudging, in the domain of obesity, it seems to me, would not weigh children and send a letter home to parents; it would, instead, assume that parents were feeding their children properly. The approach would be to inform parents of the healthy weight range. It would tell parents how many years a good diet would add to life - and how many years would be lost because of a poor diet.  

In the introduction to the book Nudge, the authors talk about the application of social psychology to school canteens, to illustrate the ‘libertarian paternalist’ approach it outlines, seeking to influence the choices people make, but not denying them. The school canteen, therefore, will offer unhealthy options, but these will not be at eye level or close to the front of the counter where, instead, the healthier options will be placed.  

In all the discussion of nudging as a policy approach, there is a lot of misunderstanding as to what it is and isn’t.  It is talked up and down by people not seemingly familiar with the content of the book.  

Ideas are there to be shot down, it is true, but James Hakin’s piece in the Guardian today - http://www.guardian.co.uk/commentisfree/2008/aug/05/conservatives.ukcrime - dismisses Nudge theory by taking a pot shot at another book.  In a nutshell the article says, ‘Nudge theory is a book a lot of people are talking about.  A few years ago a lot of people talked about another book (The Tipping Point), which there is little evidence to support’. Fair enough, but what’s that got to do with Nudge theory or any serious examination of its relevance to British public policy?  It is not obvious that JH has read the book.  He writes, ‘as with most of the new crop of ideas books, Nudge focuses on the foibles and idiosyncrasies of human behaviour and on how, with a little discreet encouragement, we can usually be ushered in the right direction.’

'The book tries to join social psychology with behavioural economics ... It agrues that the state can help people make better choices ... by better designing what the authors call "choice architecture".'

That’s not quite right.  The book tries to join social psychology with behavioural economics, and argues that in all aspects of life there are choices – whether it is choosing health insurance or opting in or out of a pension scheme – and that the evidence shows that too many people make bad choices, usually unwittingly or thoughtlessly. It argues that the state can help people make better choices, not by imposing these upon them, but by better designing choices – what the authors call ‘choice architecture’.    

What Hakin might think however, is that nudge is not a ready-made political economy, and this is right - but he is wrong to say it has nothing to offer.   It is not a book that can be consulted in order to address every aspect of social policy.  It is not a manual, but an interesting and pragmatic approach to exploring social problems.  As an FT leader points out today, and the Economist the week before last, the Conservatives have to be careful with it - it is no substitute for policymaking.

"The libertarian paternalists have made useful advances in policy. They are evidence-based, pragmatic and in favour of choice in public services. It would be excellent if politicians absorbed those principles, but they should not confuse nudging for a coherent political philosophy. Government action, regulation or doing nothing are still the weapons of choice for most issues" (http://www.ft.com/cms/s/0/ee1fcacc-6255-11dd-9ff9-000077b07658.html).

In an interview with the FT on Monday, Tory policy brain, Oliver Letwin revealed that Nudge has been included in a ‘required reading’ list given to every Tory MP this summer.  There is a risk that the Conservatives are jumping on nudge to give them a sexy new political outlook to fill the vacuum that is their policy manifesto.

The FT worries that nudge theory is being used either as an excuse for inactivity or as a cloak for paternalism.  And it is true that two of the problems with books like Nudge is that a whole load of people start talking about them without ever having read the book; and that all kinds of moves are being labelled as nudges, when they are simply traditional interventions.  

So David Cameron is apparently exemplifying nudge theory when he tells people that we need to stop blaming external circumstances for obesity and instead pin more responsibility onto individuals? Others would say this is akin to doing little.  And Alan Johnson is apparently nudging people by sending letters to parents telling them their children are very overweight, when this is less like nudging and much more like shoving.

Nudge theory risks being discredited before it is even understood.  It is being claimed by paternalists, keen to tell people what to do, and by libertarians, seeking to avoid intervention.