Elsevier

Health Policy

Volume 104, Issue 2, February 2012, Pages 200-203
Health Policy

Nudge—A new and better way to improve health?

https://doi.org/10.1016/j.healthpol.2011.10.013Get rights and content

Abstract

Nudging, or libertarian paternalism, is presented as a new and ethically justified way of improving people's health. It has proved influential and is currently taken up by the governments in the US, the UK and France. One may question the claim that the approach is new, in any case it has many similarities with the idea of “making healthy choices easier”. Whether the approach is better from an ethical perspective depends on the ethical principles one holds. From a paternalistic perspective there could be no objections, but from a libertarian, there are several. Contrary to what the authors state, libertarian paternalism is an oxymoron.

Introduction

Nudging, gently helping people to make better choices, is an approach currently gaining ground in several countries as a new and better method to change people's behaviour in order to improve their health and wellbeing. Law professor Cass R. Sunstein and economist Richard H. Thaler have coined the term in their book “Nudge: Improving decisions about health, wealth, and happiness” [1] and on their website, nudges.org. They have also presented the approach in an article under the name of “Libertarian Paternalism” [2]. Cass R. Sunstein is advisor for president Barack Obama on regulatory affairs and Richard H. Thaler is advisor for Prime Minister David Cameron's Behavioural Insight Team also called the Nudge Unit. In the UK Institute for Government published a discussion paper in 2010 [3], where the approach is named Mindspace, which draws on and has many similarities to nudge, and The Cabinet Office published a programme with examples of nudging in 2011 [4]. Last year, a report about using nudge techniques was published in France [5] by the Centre for Strategic Analysis of the Prime Minister of France, which also refers to the two American authors. The reports also address health issues. Nudge is mentioned in the latest white paper on health promotion from England [6]. Thus, governments in three big Western countries are finding inspiration in the approach.

The statement in the title of the article mentioned above is “Libertarian Paternalism is not an Oxymoron”. In this paper I challenge that claim and try to show that the approach is well in accordance with paternalism but it cannot be defined as libertarian.

Section snippets

What is nudge?

The problem, which nudge addresses, is that people sometimes make decisions that are bad for them, and that they therefore should be helped to make better choices. According to the authors there are various reasons why people make bad choices: they do not give full attention to their options; they tend to follow the path of “least resistance”; “choices will inevitably be influenced by default rules, frames, and starting points” [2]; people lack complete information; they do not have unlimited

Is nudge new?

Not really. Most, if not all, of the measures suggested by nudge adherents have been used before, though maybe not always as systematically and not based on the same psychological insights about people's behaviour [8], [9]. Not least the policies represented by the slogan “Making healthy choices the easy choices”, which was launched by Nancy Milio in 1976 [10], and in the Ottawa declaration in 1986 [11] represent principles and measures very similar to those on which nudge is based: changing

Is nudge an ethically acceptable way of governing people's behaviour?

The answer to that question depends on the ethical principles one adheres to. While stating that their approach is paternalistic Thaler and Sunstein wish to show that it is also compatible with libertarian ideas (hence the term “libertarian paternalism”). The reason for this is probably that paternalism, especially in relation to health and medicine, has very negative connotations. It is mainly seen as depriving people of the freedom of choice. Paternalism can, however, also be seen as an

Conclusion

The nudge approach is new, in the sense that it is framed under a new heading and is more underpinned by empirical research in psychology and economics [7] than many previous health promotion initiatives following similar principles. Most of the measures suggested in the health field have, however, been suggested before. Whether the approach is better from an ethical perspective depends on the ethical principles one holds. From a paternalistic perspective there could be no objections, but from

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