In their book Nudge, Cass Sunstein and Richard Thaler write, “Libertarian paternalists see countless opportunities for improving people’s health. Social influences could obviously be enlisted: if most people think that most people are starting to avoid unhealthy foods, or to exercise, more people will avoid unhealthy foods and will exercise.” The book was published in 2008, and while the authors imagined many ways in which nudges could make a big impact for the health of individuals and populations, few nudges seem to be making an impact in the US today. The lack of successful nudges, and the health challenges of the last few years raise the question, can we employ simple health nudges to solve our problems?
The COVID-19 pandemic has shown us how hard it is to adopt simple healthcare practices in the United States. Nudges, like signs, reminders, and commercials about preventing airborne transmission of the virus through the use of masks doesn’t seem to be as effective as we would like. It has often taken mask mandates and fines for business to compel people to actually wear masks. Nudges, in the case of encouraging mask wearing in the face of a deadly pandemic and highly transmissible disease seemed to be ineffective.
Before the COVID-19 pandemic, two public health ideas that were being tested were limiting the size of sodas that people could purchase at restaurants and convenience stores and taxing sugary drinks. I’m not sure if Sunstein and Thaler would consider bans on overly large soda cups or taxes on sugary beverages as nudges, but I think they count. No one was limiting the number of sodas an individual could buy, and the taxes on sugary drinks were very low. The idea behind each measure was to marginally reduce some sugary beverage consumption, hopefully helping people reduce their caloric intake and improve their dental health. But even these small measures were met with fierce backlash. Very few people would really be impacted by the limited sizes of large soda cups, and few people would meaningfully feel the price of the soda taxes, but both measures were attacked and only a few places were actually able to pass such measures. If such limited actions are met with such strong resistance, then it doesn’t seem like we can rely on nudges that will meaningfully move people toward more healthy lives.
Sunstein and Thaler also write about social influencers as being important in nudging people toward diets and exercise, but in the years since 2008, social influencers have been less successful at encouraging diets than they have been at getting people to take cool pictures wearing athleisure wear. Body positivity movements have possibly encouraged people to be more accepting of non-model/Avenger body shapes, rather than encouraging them to spend more time at the gym and eat more salads. I think it is a healthy movement, but the nudge of body positivity movements are not tied to the same health goals that are written about in the book. From my perspective, it seems that there are larger structural issues that shape and limit our exercising and influence our diets beyond what nudges can hope to influence.
While I wish we could employ simple health nudges to improve individual and population health, I don’t think it is possible. We have trouble communicating the effectiveness of masks and encouraging people to wear masks during a global pandemic, and people will fight against marginal measures to limit soda consumption. Encouraging more exercise and getting people to eat healthier requires action beyond what a nudge can do, and require real structural changes to the systems and incentives that create our current health problems. Beyond nudges, we need larger creative solutions that will truly change people’s behavior.