Healthy Nations: Behavioural Approaches in Public Health Policy
This chapter explores the rise of behavioural approaches to public health policies in different nation-states, exploring these in the context of contrasting efforts to address the social and spatial determinants of health and well-being. It examines how moral and political arguments for health promotion have given way to ‘simpler’ health strategies, albeit those which are based on increasingly sophisticated evidence and data relating to human behaviour and decision-making. In highlighting place-based and geographically variable understandings of health inequalities, the chapter considers how behavioural public health policies, which are growing in global significance, recast notions of health citizenship and governance towards behavioural, universal and marketised ideals. Using case studies from Singapore, the UK and the USA, the chapter explores the wider ethics of the behavioural turn in terms of its unintended consequences, its long-term sustainability and its capacity to transform health inequalities in different geographical contexts.
KeywordsPublic policy Urban health Social determinants of health Lifestyles Practices Human geography
- Commission on the Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: World Health Organization.Google Scholar
- Department of Health. (2011). Changing behaviour, improving outcomes. A new social marketing strategy for public health. London: Department of Health.Google Scholar
- Hallsworth, M., Snijders, V., Burd, H., Prestt, J., Judah, G., Huf, S., & Halpern, D. (Behavioural Insights Team). (2016). Applying behavioural insights. Simple ways to improve health outcomes. Doha: World Innovation Summit for Health.Google Scholar
- Halpern, D. (2015). Inside the nudge unit. How small changes can make a big difference. London: WH Allen.Google Scholar
- Halpern, D., Bates, C., Mulgan, G., Aldridge, S., Beales, G., & Heathfield, A. (2004). Personal responsibility and changing behaviour: The state of knowledge and its implications for public policy. London: Cabinet Office.Google Scholar
- Jaspen, B. (2017, September 1). Billionaire Bloomberg spends millions to rescue Chicago-area soda Tax. Forbes. Available at: https://www.forbes.com/sites/brucejapsen/2017/09/01/billionaire-bloomberg-spends-millions-to-save-chicago-area-soda-tax/#265be4b31238. Accessed 05 Oct 2017.
- Khullar, D. (2017, April 13). How behavioral economics can produce better health care. New York Times. Available at: https://www.nytimes.com/2017/04/13/upshot/answer-to-better-health-care-behavioral-economics.html. Accessed 28 Nov 2017.
- Lansley, A. (2010). Secretary of State for Health’s speech to the UK Faculty of Public Health Conference – ‘A new approach to public health’. Available at http://webarchive.nationalarchives.gov.uk/+/http://www.dh.gov.uk/en/MediaCentre/Speeches/DH_117280. Accessed 28 Nov 2017.
- Lourenço, J. S., Ciriolo, E., Almeida, R. S., & Troussard, X. (2016). Behavioural insights applied to policy: European report. EUR 27726 EN. https://doi.org/10.2760/903938.
- McDaid, D., & Merkur, S. (2014). To nudge, or not to nudge, that is the question. Eurohealth, 20(2), 3–5.Google Scholar
- National Health Service. (2014). Five year forward view. NHS England, at: https://www.england.nhs.uk/five-year-forward-view/. Accessed 14 Sept 2018.
- OECD. (2017a). Behavioural insights and public policy. Lessons from around the world. Paris: OECD. Available at: http://www.oecd.org/gov/regulatory-policy/behavioural-insights-and-public-policy-9789264270480-en.htm. Accessed 28 Nov 2017.
- OECD. (2017b, May). Behavioural insights in public policy: Key messages and summary from OECD international events. Paris: OECD. www.oecd.org/gov/regulatory-policy/OECD-events-behavioural-insights-summary-may-2017.pdf. Accessed 28 Nov 2017.
- Ong, P. (2015). Speech by Mr Peter Ong, head of civil service Singapore at “Frontiers of behavioural economics: Choice and well-being in the Asia Pacific”. https://www.cscollege.gov.sg/About%20Us/newsroom/2015/Pages/Speech-by-Mr-Peter-Ong,-Head-of-Civil-Service-Singapore-at-Frontiers-of-Behavioural-Economics.aspx. Accessed 02 Nov 2017.
- Porter, D. (1999). Health, civilization and the state. A history of public health from ancient to modern times. London: Routledge.Google Scholar
- Rosen, G. (2015 ). A history of public health (Revised expanded ed.). Baltimore: Johns Hopkins University Press.Google Scholar
- Sunstein, C. (2011). Empirically informed regulation. University of Chicago Law Review, 78(4), 1349–1429.Google Scholar
- Tan, V., Utravathy, V., & Ling, C. (2017). Healthy living, everyday. In Ethos 17 (pp. 44–51). Singapore: Civil Service College.Google Scholar
- Thaler, R. (2015). Foreword. In D. Halpern (Ed.), Inside the nudge unit. London: W H Allen.Google Scholar
- Thaler, R., & Sunstein, C. R. (2008). Nudge. Improving decisions about health, wealth and happiness. London: Yale University Press.Google Scholar
- Theseira, W., & Qiyan, O. (2017). The hidden costs of behavioural interventions. In Ethos 17 (pp. 68–75). Singapore: Civil Service College.Google Scholar
- White House. (2015). https://www.whitehouse.gov/ostp/nstc#Committees
- Whitehead, M., Howell, R., Jones, R., Lilley, R., & Pykett, J. (2014). Nudging all over the world: Assessing the global impact of the behavioural sciences on public policy. Available at: https://changingbehaviours.files.wordpress.com/2014/09/nudgedesignfinal.pdf. Accessed 28 Nov 2017.
- World Bank. (2015). Mind, society and behaviour: World development report. Washington, DC: World Bank Group.Google Scholar
- World Health Organisation. (1993a). Social marketing for health. Geneva: World Health Organisation.Google Scholar
- World Health Organisation. (1993b). Behavioural science learning modules. Geneva: World Health Organisation.Google Scholar