Changing People
There is no greater task in this world than to change the way someone behaves. And yet this is probably the key to solving the next 20 years of western healthcare problems.
For the first time in history, more people are dying from preventable diseases than infectious ones — this is almost entirely down to the obesity epidemic.
We’re all aware of the seemingly simple solution. Type 2 Diabetes, heart disease and various cancers could have their impact minimised if people changed their diet and exercised. But people don’t.
In the UK, 1 in 3 people are ‘pre-diabetic’. This means they’re on their way to type 2 diabetes — and 70% of them will go on to eventually develop it. This costs the NHS, the UK healthcare system, almost 10% of it’s entire budget — £10 billion per year. This is consistent across the entire western world.
The Social Network
The term ‘Behavioural Change’ has become 2015's healthcare buzz word as ‘Big Data’ was yesteryear’s. To change a person’s behaviour, you have to realign the building blocks of who they are. Their upbringing, education, genetics, social circles and day to day interactions all combine to create their routines, actions and behaviours.
You won’t have much luck changing someone’s upbringing and genetics, so you’re left with their education and social circles. Unfortunately, ‘education’ has been shown to do very little in isolation. It’s why doctor’s smoke, well aware of the risks. Most of the population know instinctively which foods are ‘bad’, they’ve had it drilled in to them through years of government healthy eating campaigns, but it hasn’t been enough to make a dent in obesity.
A growing body of research suggests that social circles are the lead determinant of behaviour. If your office culture is Friday lunchtime pizza, you will probably indulge. If your family takes Sunday morning bike rides, you’ll probably partake. We seek acceptance by our peers so it’s only natural to conform to our surroundings.
Nudging
The current in vogue healthcare intervention is ‘nudge theory’. Nudge theory, at its core, aims to change behaviour by altering how choices are presented to us.
The Behavioural Insights Team (BIT) — aka the “Nudge Unit” — were brought in by the UK’s coalition government in 2010 to help change public policy through nudge theory. Many of the policies that they have brought about have been as simple as changing the default option on an organ donor form or reminding people to pay their taxes by text, but the results have often been profound and statistically significant.
The BIT team have oft been cited as the the paragon of behavioural change, but unfortunately, this kind of intervention does not work with lifestyle interventions. Dr Tammy Boyce, from the UK public health foundation The King’s Fund, has criticised nudge theory as not effecting lasting change, merely acute adaptations in behaviour.
And this is the biggest downfall of any healthcare programme. How do you keep someone making the right decisions and build routine.
Sustaining Change
Motivation comes and goes. A temporary ‘health drive’ will do little in the long run, but by changing the way someone thinks, you may have a chance.
To create lasting change, involve the social circle of the individual, and most importantly, be empathetic with their emotional state. Without the support of those around them, any change is extremely difficult. Secondly, if an intervention is not aligned with how someone feels, they’re likely to feel alienated and disconnected with what they’re undertaking.
If you can’t change their existing relationships, then make new ones. Create relationships in which they respect and can empathise with each other — that they’re likely to mimic.
If we can do this, we’re going to avoid a lot of unhappiness for a lot of people. And probably save the NHS too.
