Tuesday, 22 February 2011

Nudge versus Shove

Last week the British Medical Journal ran an article about nudging. Regular readers may recall that I'm in favour of nudging as defined in Nudge, partly because if the British government was to genuinely follow its doctrine of 'libertarian paternalism', it would be compelled to repeal a large swath of intrusive and illiberal legislation.

After flirting with Nudge a couple of years ago, the penny has now dropped amongst public health pro's that their agenda of limiting choice, raising prices and restricting availability cannot be dressed up as a friendly nudge. To highlight this, they show a table of nudges versus shoves (or velvet gloves versus iron fists, if you prefer). [Click to zoom]

Most of the so-called nudges would actually require regulation. Pubs are not going to, for example, serve drinks in smaller glasses because there is no demand for it. Others, such as "reduce cues for smoking by keeping cigarettes, lighters and ashtrays out of sight" would be enforceable even if regulated. And still others, such as "designate sections of supermarket trolleys for fruit and vegetables" are just stupid. Still, it gives you an idea of what these people would do if they could.

As for the shoves (regulations), most of them are already in place. Minimum pricing, a ban on trans-fats and raising the minimum age of alcohol purchase are the only policies to which the government has not yet capitulated. The rest would have to go under any government that took Nudge seriously.

The authors would like to see "regulations to limit the availability of alcohol" and "pricing interventions" on food. Since the desire to make it more expensive and inconvenient to eat and drink is at odds with a free society the Nudge agenda—coupled with the fact that the evil Tories have adopted Nudge to some extent—the demagogues of public health have gone off the idea. Their reasoning is that a system that has never been tried has never been shown to work.

Evidence to support the effectiveness of nudging as a means to improve population health and reduce health inequalities is, however, weak.

That's a bit rich coming from people who are still clinging to the belief that...

...increasing the price of tobacco may be more effective in reducing smoking among adults on lower incomes and in manual occupations than among those with higher incomes

There is a vast amount of evidence taken over decades to show that people on low incomes are the least responsive to prices increases. And there is increasing evidence that taxes in places like Ireland, Britain and Canada have already reached the tipping point at which smuggling and contraband make further tax hikes counterproductive.

It looks as if the attack on individual rights will be dressed up as an attack on the straw men of the drinks/food/tobacco industries in the future. And why not? It's a tactic that's been working ever since the Prohibition Party targeted the largely fictitious 'liquor trust' in the 19th century.

Without regulation to limit the potent effects of unhealthy nudges in existing environments shaped largely by industry, nudging towards healthier behaviour may struggle to make much impression on the scale and distribution of behaviour change needed to improve population health to the level required to reduce the burden of chronic disease in the UK and beyond.

This sounds to me like a door slamming. Farewell Nudge, we barely knew thee.


Mark Wadsworth said...

But if Ian Gilmore and Liam Donaldson were standing on the edge of a cliff, would you nudge them off or shove them off?

Chris Oakley said...
This comment has been removed by the author.
Chris Oakley said...

The public health industry were never going to support nudge Chris. Yesterday’s outpourings on alcohol demonstrate that the likes of Gilmore, Thompson and Shenker crave the power to force the UK public to bend to their will and their will only.

Throughout their discourse they refer to the public only in the abstract as some sort of mindless mass to be coerced and protected not by its elected representatives but by them. Unelected, unwanted and unsupported as they are, they have the arrogance to claim to represent us and our interests.

For decades now public health has dictated to governments, cost billions and delivered nothing except a more divided, more broken and more miserable society.

This appalling state of affairs is likely to continue as long as UK governments continue to fund pressure groups like Alcohol Concern and ASH consisting of people who are not actually experts in anything other than manipulating politicians and the media. And until:

• The public, the press and parliament understand that being a medic does not confer omniscience. Ian Gilmore for example is an expert on the consequences of alcohol abuse but is no better positioned than I am to talk about its causes. He simply isn’t an expert in that context.

• The mainstream press recognise that the “shove” strategy you refer to represents political rather than medical intervention and treats its protagonists with the same critical zeal that it applies to other political activists.

• Politicians accept that they are there to represent the people as a whole and not a tiny vociferous minority that is all too used to getting its own way.

• Politicians accept that the true health and happiness of the nation cannot be measured using public health statistics.

There seems a lack of will amongst the ruling elite to take on board any of the above issues in the longer term so RIP nudge and for that matter millennia of the advancement of society through evidence and reason. How wrong do people like this have to be before the media and politicians have the guts to take them on?

Anonymous said...

This post as been removed by the author as it may cause distress.

Ian R Thorpe said...

Sounds like the nudge has turned into a shove and the shove is turning into a kick in the bollocks.

I've noticed how keen the coalition are getting on collaborating with the Thought Police

Anonymous said...

Adding to Chris O's thoughts above, it is critical for the health zealots that 'The Public' should be thought of as an amorphous mass and that politicians and the MSM accept it. Once politicians discover (and find it to their political advantage) that 'The Public' is a group of independent, intelligent individuals, the zealots' time is up.

I think that this is a critical idea, and it is one that 'libertarians' should take every opportunity to push.