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Ivey International Centre for Health Innovation

Nudge, Nudge

  • Tina Tran
  • |
  • Oct 16, 2018
Nudge, Nudge

“Reward and punishment…are the only motives to a rational creature” – John Locke, physician and philosopher

Here is a novel concept: if people regularly made healthier decisions for themselves, everyone would have better health outcomes. This represents the core premise of economics: people optimize their life through the choices they make. Health professionals certainly have been supporters of this intuitive idea by promoting the philosophy of “carrot and sticks” in both clinical and public health settings.

This standard of carrots and sticks represents a dichotomous rationale – one, which dangles the carrot, and the other that brandishes the stick. Carrot-centric approaches incentivize individuals with rewards for adhering to health recommendations (investment costs), such as eating right and exercising. Stick-centric approaches are more punitive, blaming those who do not adopt socially desirable behaviours.

Beyond Carrots and Sticks

If all humans want to maximize the quality of their lives, then why are we all not swayed by the rewards of carrots, if not motivated to avoid sticks? A study on reducing cocaine addiction supports that directed rewards and punishment has no significant effect on behaviour. Rewarding good behavior resulted in the desensitization to the consequences of poor decisions, while punitive training had no effect on behavior. Hence, long-term solutions using carrots and sticks are not effective, unless rewards and costs are consistently both immediate and of high magnitude. “That does not mean something is wrong with us as humans, but it does mean that our understanding of human behaviour can be improved by appreciating how people systematically go wrong.”

What makes carrots and sticks fundamentally ineffective is the implicit assumption that humans are rational beings. Even if we do have the appropriate resources (e.g. education, income, time) to make wise decisions, we usually make poor decisions anyways. The rewards of healthy behaviour are delayed while its costs are immediate. Alternatively, the rewards of unhealthy behaviour are immediate while its costs are delayed. For example, reaching for another cookie immediately rewards you with the pleasure of eating a delicious snack, while its cost on your health will appear years later. Flossing your teeth, however, is immediately unpleasant and its benefits are only reaped later on.

A Prescription for Behavioural Economics

“Nudging” (developed by Nobel Prize winner, Richard Thaler) is a theory in Behavioural Economics that is a part of the solution to better facilitate health-promoting behaviour. Nudging is a tool used in public policy to influence people into making better decisions for themselves while preserving their autonomy to act in otherwise less beneficial ways.

Decisions are influenced through the strategic placement of products or information. An example of a successful health nudge is the new Canadian policy that standardizes plain cigarette packaging. By removing attractive packaging elements (e.g. logos, slogans), buyers pay more attention to elements communicating the risks of smoking such as cancer and blindness. As a result of this nudge, smoking becomes even more discouraged – consumers end up valuing plain packages for $0.59 less than traditionally attractive packaging.

Healthier Decisions on Autopilot

The potential for applying nudges in health promotion is boundless. Take Google Maps. If nudges were applied while making navigation decisions, we could optimize our health wherever our day takes us. For instance, nudges could suggest alternative walking routes that avoid areas with high crime. Citizens in busy metropolitan cities like Toronto would find this nudge useful because of the city’s increasing gun presence and the current period of heightened concern for personal safety when travelling alone.

Being Human

The heart of health promotion is to enhance an individual’s capacity to make better choices so that the optimal choice becomes the easier choice. Achieving this goal requires an understanding that we are working with the human condition and not against it. As seen in carrots and sticks, our decisions as leaders may ironically reflect the opposite of our best intentions for those we serve. Maybe Behavioural Economics was the nudge we needed to remind us of our purpose.

Tina Tran is a Research Analyst at Ivey Health and an Undergraduate Accounting and Health Sciences student at Western University.