Policy and Regulatory Dynamics of Behaviour Change in Health: Bottlenecks, Politics and Practicalities

The use of insights from behavioural sciences research in public policy to bring about desired behavioural change in the citizenry has recently achieved a prominent place on the political agenda. Most recently, behavioural techniques, known as nudges, have attracted significant political interest. Nudge strategies attempt to change a person’s behaviour by altering the contexts in which individuals make decisions, by trying to harness or eliminate cognitive biases. A particular focus of political interest in nudge strategies has been in the area of health. Public policy-making designed to bring about desired behavioural change in health is not new and has primarily focused on health promotion, with varying degrees of success. What we wish to consider in this paper is what this new political interest in the use of behavioural techniques, such as nudges, might mean in the health domain. We argue that academic discourse and debates regarding the use of behavioural sciences in policy-making in health are stuck. This takes the form of two argumentative bottlenecks that can be seen in the ethics and philosophy literatures in particular, and to a lesser extent in the policy and regulatory ones. They centre upon haggling over definitions and stipulations, in addition to overwrought concerns regarding principled ethical objections to the integration and/or use of behavioural science in policy-making and regulation. This has resulted in a lack of attention being paid to the dynamics of the political and practical contexts in which claims about the use of behavioural techniques are made. In particular, there has been insufficient attention paid to the empirical basis upon which the success of such claims must rely. More troubling, such claims serve to background normative claims regarding transparency, responsibility and legitimacy in the context of democratic politics, which we suggest are particularly important in public policy-making in health.