## Navigating Uncertainty with Nudges

In Risk Savvy Gerd Gigerenzer makes a distinction between known risks and uncertainty. In a foot note for a figure, he writes, “In everyday language, we make a distinction between certainty and risk, but the terms risk and uncertainty are used mostly as synonyms. They aren’t. In a world of known risks, everything, including the probabilities, is known for certain. Here statistical thinking and logic are sufficient to make good decisions. In an uncertain world, not everything is known, and one cannot calculate the best option. Here, good rules of thumb and intuition are also required.” Gigerenzer’s distinction between risk and uncertainty is important. He demonstrates that people can manage decision-making when making risk based decisions, but that people need to rely on intuition and good judgement when dealing with uncertainty. One solution to improved judgement and intuition is to use nudges.

In the book Nudge, Cass Sunstein and Richard Thaler encourage choice architects to design systems and structures that will help individuals make the best decision in a given situation as defined by the chooser. Much of their argument is supported by research presented by Daniel Kahneman in Thinking Fast and Slow, where Kahneman demonstrates how predictable biases and cognitive errors can lead people to making decisions that they likely wouldn’t make if they had more clear information, had the ability to free themselves from irrelevant biases, and could improve their statistical thinking. Gigerenzer’s quote supports Sunstein and Thaler’s nudges by building on the research from Kahneman. Distinguishing between risk and uncertainty helps us understand when to use nudges, and how aggressive our nudges may need to be.

Gigerenzer uses casino slot machines as an example of risk and for examples of uncertainty uses stocks, romance, earthquakes, business, and health. When we are gambling, we can know the statistical chances that our bets will pay off and calculate optimal strategies (there is a reason the casino dealer stays on 17). We won’t know what the outcome will be ahead of time, but we can precisely define the risk. The same cannot be said for picking the right stocks, the right romantic partner, or when creating business, earthquake preparedness, or health plans. We may know the five year rate of return for a company’s stocks, the divorce rate in our state, the average frequency and strength of earthquakes in our region, and how old our grandfather lived to be, but we cannot use this information alone to calculate risk. We don’t know exactly what business trends will arise in the future, we don’t know for sure whether we have a genetic disease that will strike us (or our romantic partner) down sooner than expected, and we can’t say for sure that a 7.0 earthquake is or is not possible next month.

But nudges can help us in these decisions. We can use statistical information for business development and international stock returns to identify general rules of thumb when investing. We can listen to parents and elders and learn from their advice and mistakes when selecting a romantic partner, intuiting the traits that make a good (or bad) spouse. We can overengineer our bridges and skyscrapers by 10% to give us a little more assurance that they can survive a major and unexpected earthquake. Nudges are helpful because they can augment our gut instincts and help bring visualizations to the rules of thumb that we might utilize.

Expecting everyone’s individual intuition and heuristics to be up to the task of navigating uncertainty is likely to lead to many poor choices. But, if we help pool the statistical information available, provide guides, communicate rules of thumb that have panned out for many people, and structure choices in ways that help present this information, then people can likely make marginally better decisions. My suggestion in this post, is a nudge to use more nudges in moments of uncertainty. When certainty exists, or even when calculable risks exist, nudges may not be needed. However, once we get beyond calculable risk, where we must rely on judgement and intuition, nudges are important tools to help people navigate uncertainty and improve their decision making.

## Asymmetric Paternalism

While writing about the book Nudge by Richard Thaler and Cass Sunstein, I have primarily focused on an idea that the authors call Libertarian Paternalism. The idea is to structure choices and use nudges (slight incentives and structural approaches) to guide people toward making the best possible decision as judged by themselves. Maintaining free choice and the option to investigate or chose alternatives is an important piece of the concept, as is the belief that we will influence people’s decisions no matter what, so we should use that influence in a responsible way to help foster good decision-making.

But the authors also ask if it is reasonable to go a step beyond Libertarian Paternalism. Is it reasonable for choice architects, governments, and employers to go further than gentle nudges in decision situations? Are there situations where decision-making is too important to be left to the people, where paternalistic decision-making is actually best? Sunstein and Thaler present an introduction to Asymmetric Paternalism as one possible step beyond Libertarian Paternalism.

“A good approach to thinking about these problems has been proposed by a collection of behavioral economists and lawyers under the rubric of Asymmetric Paternalism. Their guiding principle is that we should design policies that help the least sophisticated people in society while imposing the smallest possible costs on the most sophisticated.”

This approach is appealing in many ways, but also walks the line between elitism, the marginalization of entire segments of society, and maximizing good decision-making. I hate having to make lots of decisions regarding appropriate tax filings, I don’t want to have to make decisions on lots of household appliances, and I don’t really want to have to spend too much time figuring out exactly what maintenance schedule is the best for all of my cars. However, I do want to get into the weeds of my healthcare plan, I want to micromanage my exercise routine, and I want to select all the raw ingredients that go into the dinners and lunches that I cook. On some decisions that I make, I want to outsource my decision-making and I would often be happy with having someone else make a decision so that I don’t have to. But in other areas, I feel very sophisticated in my decision-making approach, and I want to have maximum choice and freedom. Asymmetric Paternalism seems like a good system for those of us who care deeply about some issues, are experts in some areas, and want to maintain full decision-making in the areas we care about, while exporting decision-making in other areas to other people.

Of course, prejudices, biases, and people’s self-interest can ruin this approach. What would happen if we allowed ourselves to deem entire groups of people as unworthy of making decisions for themselves by default? Could they ever recover and be able to exercise their freedom to chose in important areas like housing, retirement, and investment spaces? Would we be able to operate for long periods of time under a system of Asymmetric Paternalism without the system devolving due to our biases and prejudices? These are real fears, and while we might like to selectively trade off decision-making when it is convenient for us, we also have to fear that someone else will be making decisions for us that are self-serving for someone other than ourselves.

The point, according to Sunstein and Thaler, would be to maintain the freedom of decision-making for everyone, but to structure choices in a way where those with less interest and less ability to make the best decisions are guided more strongly toward what is likely the best option for them. However, we can see how this system of asymmetric paternalism would get out of control. How do we decide where the appropriate level is to draw the line between strong guidance and outright choosing for people? Would people voluntarily give up their ability to chose and overtime hand over too many decisions without an ability to get their decision authority back? Transparency in the process may help, but it might not be enough to make sure the system works.

## Influence is Unavoidable

The last several years has seen the rise of social media influencers across the globe. Regular people have been able to amass large numbers of followers on social media, gaining status, earning contracts with brands and advertisers, and of course, influencing people. Their influence is often times out in the open, like when they endorse a brand or product, but is often hidden, in messages about how life should be, about how one should look, and about the things that people should focus on in life. These hidden and secondary influences may also be intentional, but may also be subconscious, and ultimately, they are unavoidable. To go even deeper, these types of influences are not just limited to bona fide social media influencers, they are unavoidable aspects of all our lives and actions.

Whether we want to or not, we influence people’s choices. Some of us are in spaces where we are explicitly asked and expected to influence people’s choices, but many of us are not. Nevertheless, our conversations, decisions, and actions can still influence how people make choices. If we deliberately shape choice environments via a position of authority, we are a choice architect. Human resource managers, club leaders, and parents are all choice architects, with the direct mandate to shape the choices of employees, club members, and children respectively. Nevertheless, fellow employees, adjacent club members, and other kids also influence the decision spaces that choice architects create, regardless as to whether they ever intended to.

Cass Sunstein and Richard Thaler consider the implications of unavoidable influence in their book Nudge. The authors believe that choice architects have the responsibility to nudge individuals toward specific decisions and choices that the individuals themselves would deem to be the best outcome. That responsibility, according to Sunstein and Thaler cannot be shirked, because influence cannot be avoided. “It is not possible to avoid choice architecture, and in that sense it is not possible to avoid influencing people.”

Sunstein and Thaler are specifically writing about the impossibility of choice architects to tryÂ not to influence people. Most of this post has been about inadvertent influence from people who are not trying to influence others. The two ideas are separate, but important to directly connect and discuss. Choice architects still influence people and their decisions even if they try to pull back completely. Sunstein and Thaler would argue that in doing so they often end up creating decision situations where people make worse choices than if the choice architect had deliberately intervened in an attempt to help people make a better choice. One reason for this is that unintentional influence will play a greater role in the absence of choice architects actively trying to improve people’s decision-making. Imagine that your HR representative had gone through the effort of trying to map out possible health benefits scenarios for employees based on age, family dynamics, and potential health concerns. The way that employees select health insurance plans could be shaped by these mapping scenarios, deliberately trying to help people make better choices. Or, the rep could decide not to try to influence decisions and step back. By doing so, employees might hear from colleagues about a great option that worked for someone else, and select that option even if it doesn’t fit their family and health needs. Other employees may not have been encouraging everyone to select an option, but they still have the ability to indirectly and unintentionally influence the choices of others, potentially for the worse. The choice architect who tried not to influence the decision created a situation where outside uneducated voices were louder â€“ their actions still influenced the decision space.

Choice architects don’t exist in a vacuum. They are part of a larger ecosystem and the context for each choice matters. Choosing not to influence someone doesn’t mean that you don’t still influence them or their choices. Neither does being unaware that you influence others. Influence is unavoidable, and Sunstein and Thaler would argue that it is important that we therefore think about how we intentionally and unintentionally influence others, and for choice architects to be active in helping people understand the best option for themselves in a given choice.

## Open Defaults

Our society has a lot of defaults, and for many of us, we only opt out of the default in a narrow set of circumstances. Whether it is our mode of travel, how we pay for goods, or the type of health insurance plan we are enrolled in, the default option makes a big difference in our lives. Actors within our political and economic systems know this, and the choice of default can matter a lot to individual actors, political groups, and companies. Consequentially, what default is selected, and what story we tell about the default, is a constant point of argument and debate in our country.

In their book Nudge, Cass Sunstein and Richard Thaler discuss the importance of nudges and the ways that responsible choice architects should think about them. Choice architects may face pressure to select a default option that in one way or another benefits them personally or benefits the group or ideology they identify with. A state government may favor a default Medicaid option that is confusing and hard for individuals to use, meaning that fewer people will access services, and the state won’t have to pay as much for medical services for low income individuals. A corporate HR representative might feel pressured from a boss to have the default retirement savings rate for employees set at 2%, knowing that the company will spend less through retirement savings matching if the rate is lower.

But these types of defaults are not in the best interest of individuals. A health plan that is easy to use and facilitates access to necessary medical care is clearly in the best interest of the individual, but it may cost more for the government agency or corporation sponsoring the plan. A retirement plan that helps save above the rate of inflation is also clearly in the best interest of the individual, but might be more costly to a company’s bottom line.

As a guide for setting defaults, following with previous advice of ensuring that deliberate nudges employed by governments or corporations can survive open transparency, Sunstein and Thaler write, “The same conclusion holds for legal default rules. If government alters such rules â€“ to encourage organ donation or reduce discrimination â€“ it should not be secretive about what it is doing.”

The defaults we chose, and the reasons we select defaults should be open and transparent. If a choice architect cannot defend a default choice, then they should set an alternative default that can be defended in the open. Defaults that clearly benefit the choice architect or their interests at the expense of the individual making (or failing to make) a choice should be excluded. It is important to note that this means that choice architects have to actively make a decision with the default. Setting the default for a retirement savings plan if an individual never makes a selection to 0 is not in the best interest of the individual. An argument could be made that the choice architect attempted to remove themselves from the choice setting as much as possible by not providing a default, but that is still a choice, and will leave some people worse off than if the choice architect had selected a more defensible choice. Choosing not to set a default can be as indefensible as selecting a self-serving default.

## Acknowledging Nudges

In the book Nudge, Cass Sunstein and Richard Thaler argue that it is impossible to avoid and eliminate nudges. Whenever people have a choice to be made, someone else has a hand in shaping how that choice is presented and structured. Even if a choice architect were to strive to maximize choice and decision-making autonomy in the chooser, subtle factors will influence the chooser and nudge them in particular directions. Striving to eliminate nudges is likely to lead to worse potential outcomes and choices than acknowledging nudges and trying to employ them in ways that help people make good choices.

But how does a choice architect judge when a nudge is appropriate versus when a nudge goes too far? Again, Sunstein and Thaler recommend that first a choice architect acknowledge their nudge, and then ask themselves whether they could discuss the way they use nudges in public. The authors reference an idea from John Rawls called the publicity principle. If a choice architect feels comfortable with publicly acknowledging nudges and their choice to employ a given nudge, then their nudge is probably going in an appropriate direction. If however, the discovery of their nudges would lead people to shame them or if they would be embarrassed about their actions, then they have overstepped the bounds of an acceptable nudge.

Sunstein and Thaler write, “The government should respect the people whom it governs, and if it adopts policies that it could not defend in public, it fails to manifest that respect. Instead, it treats its citizens as tools for its own manipulation.”

Nudges are effective tools because we can understand how human psychology works and we can predict situations in which people are likely to make biased judgements or judgements based on cognitive errors. Appropriate nudges seek to improve decision-making by helping people overcome these biases and errors. Manipulative nudges are those which seek to exploit such biases. Governments are expected to be transparent, and more laws exist for transparency in the public rather than the private sector, meaning that government officials must be more considerate about their explicit nudges. If oversight bodies, reporters, or the general public were to learn of a practice that made an agency or official look good while failing to actually benefit the public, then it would be clear that an abuse of power took place. Choice architects who wish to serve the public rather than manipulate it should always consider acknowledging nudges, and whether they can safely do so publicly.

## Selfish Choice Architects

“So lets go on record,” write Cass Sunstein and Richard Thaler in their book Nudge, “as saying that choice architects in all walks of life have incentives to nudge people in directions that benefit the architects (or their employers) rather than the users.”

Choice architects are those who design, organize, or provide decision situations to individuals. Whether it is the person who determines the order for food on the buffet line, the human resources manager responsible for selecting health insurance plans for the company, or a bureaucrat who designs an enrollment form, anyone who influences a situation where a person makes a decision or a choice is architecting that choice. Their decisions will influence the way that people understand their choice and the choices that they actually make.

As the quote above notes, there can always be pressure for a choice architect to design the decision space in a way that advances their own desires or needs as opposed to advancing the best interest of the individual making a given choice. Grocery stores adjust their layouts with the hopes that displays, sales, or conveniently located candy will get customers to purchase things they otherwise wouldn’t purchase. A company could skimp on health benefits and present confusing plans to employees with hurdles preventing them from utilizing their benefits, saving the company money while still appearing to have generous benefits. A public agency could design a program that meets a political objective and makes the agency head look good, even if it gives up actual effectiveness in the process and doesn’t serve citizens well.

Nudges are useful, but they have the capacity to be nefarious. A buffet manager might want patrons to fill up on cheap salad, eating less steak, meaning that the buffet does better on the margins. Placing multiple cheap salads at the front of the line, and not allowing people to jump right to steak, is a way to nudge people to eating cheaper food. Sunstein and Thaler acknowledge the dark side of nudges in their book, and encourage anyone who is a choice architect to strive to avoid the dark side of nudges. Doing so, they warn, risks leading to cynicism and in the long run is likely to create problems when employee, customer, or citizen trust and buy in is needed.

## Avoiding Complex Decisions & Maintaining Agency

Two central ideas to the book Nudge by Cass Sunstein and Richard Thaler are that people don’t like to make complex decisions and that people like to have agency. Unfortunately, these two ideas conflict with each other. If people don’t like to make complex decisions, then we should assume that they would like to have experts and better decision-makers make complex decisions on their behalf. But if people want to have agency in their lives, we should assume that they don’t want anyone to make decisions for them. The solution, according to Sunstein and Thaler, is libertarian paternalism, establishing systems and structures to support complex decision-making and designing choices to be more clear for individuals with gentle nudges toward the decisions that will lead to the outcomes the individual actually desires.

For Sunstein and Thaler, the important point is that libertarian paternalism, and nudges in general, maintain liberty. They write, “liberty is much greater when people are told, you can continue your behavior, so long as you pay for the social harm that it does, than when they are told, you must act exactly as the government says.”Â  People resent being told what to do and losing agency. When people resist direct orders, the objective of the orders may fail completely, or violence could erupt. Neither outcome is what government wanted with its direct order.

The solution is part reframing and part redirecting personal responsibility for negative externalities. The approach favored by Sunstein and Thaler allows individuals to continue making bad or harmful choices as long as they recognize and accept the costs of those choices. This isn’t appropriate in all situations (like drinking and driving), but it might be appropriate with regard to issues like carbon taxes on corporations, cigarette taxes, or national park entrance fees.Â  If we are able to pin the cost of externalities to specific individuals and behaviors, we can change the incentives that people have for harmful or over-consumptive behaviors. To reach the change we want, we will have to get people to change their behavior, make complex decisions, and maintain a sense of agency as they act in ways that will help us as a collective reach the goals we set.

## Incentives for Environmentally Responsible Markets

When it comes to environmental issues, no single actor is completely to blame, and that means no single actor can make the necessary changes to prevent catastrophic climate change. This means we can’t put all the weight on governments to take actions to change the course of our climate future, and we can’t blame individual actors either. We have to think about economies, polities, and incentive structures.

In their book Nudge, economists Cass Sunstein and Richard Thaler look at what this means for markets and regulation as we try to find sustainable paths. They write, “markets are a big part of this system, and for all their virtues, they face two problems that contribute to environmental problems. First, incentives are not properly aligned. If you engage in environmentally costly behavior next year, through consumption choices, you will probably pay nothing for the environmental harms that you inflict. This is what is often called a tragedy of the commons.”

One reason markets bear some of the blame and responsibility for the climate change crisis is because market incentives can produce externalities that are hard to correct. Climate change mitigation strategies, such as research and development of more fuel efficient vehicles and technologies, are expensive, and the costs of climate change are far off. Market actors, both consumers and producers, don’t have proper incentives to make the costly changes today that would reduce the future costs of continued climate change.

A heavy handed approach to our climate change crisis would be for governments to step in with dramatic regulation â€“ eliminating fossil fuel vehicles, setting almost unattainably high energy efficiency standards for furnaces and dishwashers, and limiting air travel. Such an approach, however, might anger the population and ruin any support for climate mitigation measures, making the crisis even more dire. I don’t think many credible people really support heavy handed government action, even if they do favor regulation which comes close to being as extreme as the examples I mentioned. Sunstein and Thaler’s suggestion of improved incentives to address failures in markets and change behaviors has advantages over heavy handed regulation. The authors write, “incentive-based approaches are more efficient and more effective, and they also increase freedom of choice.”

To some extent, regulation looks at a problem and asks what the most effective way to stop the problem is if everyone is acting rational. An incentives-based approach asks what behaviors need to be changed, and what existing forces encourage the negative behaviors and discourage changes toward better behaviors. Taxes, independent certifications, and public shaming can be useful incentives to get individuals, groups, and companies to make changes. I predict that in 10-15 years people who are not yet driving electric cars will start to be shamed for continuing to drive inefficient gas guzzlers (unfortunately this probably means people with low incomes will be shamed for not being able to afford a new car). In the US, we have tried to introduce taxes on carbon output, but have not been successful. Taxing energy consumption in terms of carbon output changes the incentives companies have with regard to negative environmental externalities form energy and resource consumption. And independent certification boards, like the one behind the EnergyStar label, can continue to play an important role in encouraging technological development of more efficient appliances. The incentives approach might seem less direct, slower, and less certain to work, but in many areas, not just climate change, we need broad public support to make changes, especially when the costs are high up front. This requires that we understand incentives and think about ways to change incentive structures. Nudges such as the ones I mentioned may work better than full government intervention if people are not acting fully rational, which is usually the case for most of us. Nudges can get us to change behaviors while believing that we are making choices for ourselves, rather than having choices forced on us by an outside authority.

## Markets and Environmentalism – A Call for Better Incentives

Earlier I wrote that climate change and environmental concerns seemed to be too large of a problem to be left to nudges. Toward the end of Nudge, Cass Sunstein and Richard Thaler acknowledge the reality that nudges alone cannot tackle climate change, but they still encourage actions that follow the spirit of nudges, or at least learn from the psychology that makes nudges effective. Incentives play a huge role in behavior, andÂ  need to be considered when governments approach businesses in an effort to redress the harms of climate change. Markets and environmentalism cannot be separated if we are to have a sustainable climate. Better incentives need to be implemented within markets to adjust for environmental needs.

The authors acknowledge market failures related to climate change by writing, “when the air or the water is too dirty, the standard analysis says that it is because polluters impose externalities (that is, harms) on those who breath or drink. Even libertarians tend to agree that when externalities are present, markets alone do not achieve the best outcome.” Pollutants are common externalities, as are traffic congestion and decimated wildlife populations. The cost of negative externalities is squarely on the shoulders of the individuals in the market, either the consumer or the producer. Governments are necessary to deal with these externalities and prevent them from harming innocent bystanders.

Additionally, regarding market failures and climate change, the authors continue, “When people are not in a position to make voluntary agreements, most libertarians tend to agree that government might have to intervene.” Most libertarians agree that labor contracts should be voluntary, with an employer reserving the right to hire anyone, and laborers reserving the right to walk away if their wages or working conditions are unfair. In reality, many people would starve if they walked away from a job, or at least face serious challenges, so voluntary agreements are not always possible. Within the climate change arena, many people cannot simply chose to travel to work by more fuel efficient methods, many people cannot afford the switch to solar power, and many other potential solutions are similarly unavailable, meaning people and businesses are often stuck, involuntarily, with polluting norms for travel, work, and heating or cooling their homes and offices. Markets alone don’t provide the impetus to change the status quo to reflect the reality of climate change.

The next post will dive deeper into the incentives and solutions to these problems, but it is clear that markets alone will not direct society toward a climate change solution. The danger of climate change is a long-term danger, where the costs are not experienced in the immediate moment but are instead experienced years and decades later. However, the costs of making adjustments to limit climate change are experienced up front. Upgrading infrastructure, investing in electric and solar technology, and living in more economically friendly ways present immediate costs that nudges cannot overcome. Nevertheless, we can consider the ways in which nudges work and build on those principles to begin to make changes. We can start to better align incentives to limit externalities, and we can preserve choice structures as we move forward with investments and innovation to help us meet the needs of the climate crisis. Government will play a big role and can learns a lot from the psychology of nudges to help address the challenges we face.

## Can We Employ Simple Health Nudges?

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.