“If knowledge can create problems, it is not through ignorance that we can solve them.”

~ Isaac Asimov

TTP reader Brandon McNamara asked the following question recently to the Theory to Practice Facebook group (I’ve taken the liberty of some re-phrasing and paraphrasing – any instance of atrocious grammar and/or mangled sentence structure is therefore squarely on me):

Hey All –

I was wondering if anyone was interested in exploring the possibility of submitting a proposal for a competition for designing better health. The idea is to create “nudges” (see description below if you aren’t familiar with the term) in order to help people make better decisions regarding their own health and the health of others.

I think we may have some good habits that could be applied to others in order to help them make better decisions when it comes to eating and exercise.

Here’s the competition description:

http://www.changemakers.net/en-us/designingforbetterhealth

What is a “nudge”?

A “nudge” is a subtle “carrot” (or, it could just as well be a stick) that serves to steer one toward a “middle way”, encouraging better decision making without taking away one’s freedom to choose. What is sought is a centrist path between the one side that believes freedom comes from having as many choices as possible, and the other side, that believes freedom comes from the simplicity of being able to accept or reject one good choice.

Here’s an example of a Nudge in action:

Take TB Meds, Get Mobile Minutes.

http://www.technologyreview.com/biomedicine/21945/

I look forward to the discussion!

While I can’t say that I’ve read the book, Nudge, by Thaler and Sunstein, (by the way, the provided link includes a couple of good interview video clips & a written interview/summary of the book), I have read extensively  (magazine, Internet) over the last week or so about the concept. In addition, the Nudge blog offers some good reading and insight to compliment that information contained in the Amazon, Nudge book link, cited above.

And after mulling over the concept, I’ve come away with a few ways to implement a “personal nudge” that I think would work (for me, personally at least); however, the “carrot and/or stick” concept falls to pieces when the attempt is made to morph this idea into a group dynamic. I’ve also found that it’s easier to come up with positive, or “do” nudges than it is to create a corollary, negative, “don’t” version. And dietary changes – at least in the initial stages – are usually more about “don’ts” and substitutions. This is especially true if we’re talking about eliminating certain foodstuffs – grains, refined carbohydrates, say — altogether, while retaining the good choices. Another major obstacle, of course, is that whatever defined “governing entity” – that “organization” which would ostensibly oversee the “nudging process”, would have to agree at the onset as to what, exactly, to nudge toward. Appropriately, a nudge in the broad direction of “better health” won’t work well, precisely because “good health” is too obtuse, too vague, and not easily defined. A good nudge needs to be readily (and narrowly) defined — and a little more concrete — to be effective in eliciting positive change.

I would suggest that, for a beginning point, common ground could be found in, say, identifying foods and actions that can be proven to promote favorable blood profiles – cholesterol levels, triglycerides, C-reactive protein and insulin levels, as an example – but as Richard (of Free the Animal) has so deftly pointed out in his LDL series, here (part 1, and part 2), do we really want to use the mainstream’s definition of a “favorable” blood profile to be used as a benchmark? The obvious answer is no, and herein lay the crux of the “group dynamic” problem vis-a-vis the nudge concept.

Now, it might very well be that “nudging” toward improved health may actually be a subsequent step (I’m speaking from, say, a national prospective) to first re-defining what a favorable blood profile really consists of in the first place. Readers of TTP are, of course, familiar with what constitutes a healthy blood profile, however, the mainstream is still largely aloof – not to mention clueless as to how a western diet serves to negatively affect these critical blood parameters. It seems to me then, that first pushing for a re-definition of measured “health” – maybe via a venue like Change.Gov, for example – is a sensible first step.  I think that it’s critical to first correctly define the goal, in no uncertain terms.  Then, let the war begin as to how best achieve those parameters.

But I am just one person, time restricted, and attempting to cobble together far-flung ideas.  What do you think? What are some personal nudges you’ve implemented to help guide you along your Paleo path? And could these same nudges (or tweaked versions of the nudges) work under the unique demands of a group dynamic? Where – and how – should the deck-plate level initiate on “overall health” be established? Assuming that for a wholesale change in the general population’s attitude to occur, first the mainstream scientific community’s mindset must be altered (knowledge trickle-down effect) – how best would an interest go about this?

Let me know your thoughts. Because, the truth of the matter is, like it or not, a more universal-style of health management is likely on the horizon. I don’t know about you, but I’d like to at least think that I publicly, and intelligently, voiced an opinion on the matter.

In Health,

Keith

14 COMMENTS

  1. Hey Keith,

    A couple of “nudges” that work for me:

    1) Don’t fill my cupboards with food that will tempt me in weak moments. Stick to real foods.

    2) Choose a gym as close to work as possible. I know that if I make it home first after work I could be tempted to be lazy.

  2. Keith, I’ll have to put more thought into the nudge idea, but there are a few aspects of the Paleo diet that play to ideas that simply ‘sell’ in America.

    ‘All natural.’ heh, to be cliche, focusing on the natural aspects of the Paleo diet might nudge our audience in the right direction.

    It’s Darwinian. In the past decade, the controversy of evolution seems to be growing issue, which is surprising. I’m Catholic, but have no problem accepting evolution as a sound concept, and I buy into it completely. I think that in this day and age, many of our audience would like to think of themselves as informed, and anything that allies itself with an evolution based line of reasoning might gain favor. I don’t know what to do about those who sit on the other side of the evolution argument, and I imagine there is a fair amount of obesity on that side as well. Perhaps put it in a biblical sense? I don’t know how much bread there was in the garden of Eden. Perhaps refined carbohydrates are a product of the fall of man, heh.

    As for incentive based choice architecture, I’ll have to think more on that.
    -bryce

    • Bryce,
      This is an interesting point you bring up (evolution vs. religious doctrine). I live in the “Bible Belt” south, so I feel the full impact of this. Check out this Pew study on American attitudes as related to science and belief. Personally, my spiritual leanings fully embrace evolution (and all other scientific fact), However, the Paleo diet and its underpinnings are, from what I’ve experienced, no match against fervent religious belief. It’s sad, but what can you do? Hell, there’s people running around who truly believe that the earth is 6-thousand years old. Kinda kicks the pins from beneath the old “advent of agriculture” argument, not to mention discussions of gene evolution.

      BC,
      Did you see the example of the credit card payment nudge? By placing the late fee policy in close proximity to the payment block, both late payment (and as an ultimate result, defaults) were substantially reduced. This is an example of a subtle, though effective, group nudge.

  3. I agree with bcornwright about peer pressure.

    Although a “public nudge” might be well intended in the end it would be US telling others what to do and what not to. I like going on your site because I can choose and I have the freedom to “pick out” what to take on board and QUESTION everything for myself. I don’t want to be told what to do but I want to experience it myself and due to the nature of the internet read/watch/listen to it.

    If there were nudges for people we would be something along the lines of a health police. I cannot see myself to become a preacher/police woman etc.

    We should only offer advice and lead by example I think.

    For personal nudges, now that is a whole different ballgame and highly individual. I agree with Brendon on his nudges and pretty much do the same but all in all, I am a pedantic/well organized/determined woman and nudges would just confuse me in a way. I am a doing person more than anything.

    Hope this makes sense!;)
    M x

    • Marianne, Brandon

      I’m much too much of a free-market soul than to want to get into to business of nudging those who don’t want to be nudged, however, I get the sneaking suspicion that the US will, in the very near future, adopt some form of socialized medicine. If that’s the inevitability, then I guess I want to have a say as to what the string-pullers will dictate for us — I want the nudges to be so that they favor my definition of health — not, God-forbid, what the USDA deems as healthy. I realize many people outside of the US read TTP, and that many of those people are satisfied with their version of socialized medicine. Be that as it may, this is strange territory for us here in the US. Foreign insight on this subject is hereby solicited!

  4. “I’m not sure how nudges would work in a group. Isn’t that peer pressure?”

    I can see how “nudges” may reach a slippery slope when you are trying to implement them. The key is to influence without force. You are still giving a choice, but you are trying to influence a “better” outcome.

    I guess better will have to be defined by those who are “doing” the influencing.

    Reports that Orbitz is trying to “nudge” you to choose airline insurance by defaulting options on ticket checkouts to be “opt-out” instead of the traditional “opt-in”. Now, if this is done in a manipulative way, you will alienate those you are trying to influence.

    A sample of a “nudge” in California:

    “Giving people information about their energy consumption and how it compares with their neighbors’ in order to cut back on energy use – and printing smiley faces and frowning faces on customer’s bills to emphasize the message. By subtly shaming or applauding individuals, the nudge taps “into a time-honored American passion: keeping up with the neighbors,” the Times writes.”

    Another nudge could be a company with a gym at their office, they could post usage statistics each month in the kitchen, which could start a friendly competition to get your name at the top of the list. This would be similar to “Biggest Loser” competitions that offices have.

  5. In post-Weimar Germany they used nudges very effectively; simply paint David stars on unwanted people and their property. It that they the informed citizen could choose who they wanted to associate and do business with.

  6. Urg. As much as I am usually loathe to do this, I’m going to go out on a limb and comment on something I’ve only just looked a little at (yes, I’m guilty of not reading this book yet…). Thank you Keith for introducing this topic; I’ll have to look more into it.

    But what I’ve gleaned from the little I’ve read is that “nudging” is social engineering in a somewhat subtle way by greasing the skids in one direction and putting up some blocks in another direction.

    This can be implemented on a personal level as evidenced by the “Getting Things Done” guys, who say to put what you need to do right out in front of you so you have to either take care of it or consciously decide not to, or what dating guru Dr. Alex Benzer calls “The Oddysseus Protocol,” which basically states right up front to set up your environment for your success.

    The example in a dating situation he gives is that if you are the nervous type and end up drinking too much, thereby making a butthead of yourself, then your default behavior should be to choose venues for the date that have little or no alcohol available. (http://taoofdating.com/2009/01/24/the-odysseus-protocol-or-how-to-bypass-willpower-to-get-more-out-of-life-dating-or-otherwise/). Don’t just leave it up to willpower–set up the environment to lead you in the direction you want to go.

    Brandon’s ideas of keeping only foods handy that you feel you “should” eat, and keeping your gym close by are excellent examples of personal nudges.

    On a social/interpersonal scale, we do this all the time already. Look at the blogroll to the right. Rarely are you going to put stuff in there that you don’t want people to look at. But you’re greasing the skids for visitors to hit the ones that you find valuable, like keeping cupboards full of “real” food.

    On a larger scale, I think we have the responsibility to fill up school cafeterias, or break rooms with easier choices for better food, for instance.

    I, too, and a huge free marketeer. The question, though, usually is not “if” nudging is occurring, but “who” is doing the nudging.

    In the school cafeteria, it might be worth it to look at a vote, or something, because as much as I like to think that it should be a free-market free for all, school is about training. And as such maybe just as we should debate and vote about the knowledge choices of young human cubs, we need to also guide their decisions about physical training and food selection, too.

    As they get older–and prove themselves responsible, then we open up the freedom to select what you want. Once you leave the training environment, then you’re on your own…

    On the far larger scale, this goes on with things like tax incentives.

    The problem will always be, again–who gets to choose? In our democratic system, this is about voting and influence. And that’s a really sticky issue.

    As with our earlier discussion, though, at least we have the power to vote with our feet, and with our dollars. Maybe I’ve been too focused, but I seem to notice that a lot more people are paying attention to this idea of paleo, or less processed food sources, etc.

    In large part due to blogs like yours, and De Vany’s, and the articles that come out that you all link to. Just as with energy (power) sources, I think that more and more people are becoming aware of the better variety around them, and I think society as a whole is moving toward that.

    The question is, how do we use the “nudge” idea to implement this? I’m not sure, but it’s an interesting question I’ll be pondering for a bit. I’ll let you know if I come up with anything!

    Cheers,
    Bill

    • feifvel, amphibiman
      Yep, that’s a good (relatively speaking) example (star of David) of a very effective nudge backed up by a stout dose of political propaganda. This is exactly the kind of thing that scares me with socialized healthcare, and the possibility of the low-fat zealots, the Oprahs, the Dean Ornishes having sway — or, in this case, the power to nudge. Right now I can laugh at their positions, and go on my own merry way with my stellar blood profile. But what if these folks are deemed the “authority”, and in the interest of “national healthcare”, I’m penalized via negative nudge (increased personal taxes levied on my “unhealthy” ways, maybe) and the supporting, budding “Paleo industry” — providers of grass fed livestock, say — are forced out of business due to burdens of newly imposed “sin” taxes (evil fat causes heart disease — tax it!). This has the possibility of becoming very ugly indeed. I concede that I might be a tad alarmist in my attitude, but control of my own health is very important to me.

LEAVE A REPLY

Please enter your comment!
Please enter your name here

This site uses Akismet to reduce spam. Learn how your comment data is processed.