Changing behaviours

Using behavioural economics to improve healthcare

We’re all very much aware of a mid-life crisis, the partially balding 40 year old zooming along in a Porche Boxster with the top down on a freezing cold March morning. But don’t be too harsh on the chap, it turns out there is a very good reason for this behaviour. It all comes down to his (probably a tad chilly) frontal lobe.

Studies have elucidated the U-shaped happiness of people, where we are happiest when young and old. Even removing the obvious factors of difference — kids, career, income, geographic location, social standing, generation born in etc. — there is a very clear U-shaped trend in happiness. And this trend is seen in apes too. Yes, the great apes are partial to a mid-life crisis as well.

So, what does make people more, or less happy? Well to put it simply, it is how eager we are to believe the truth. You see our ability, or rather willingness, to take in and most importantly adjust to good or bad news alters with the formation of the frontal lobe. This part of the brain is in a state of development up to the age of 25 and deteriorates from the age of 45 — here lies our two happy groups then. The changes affect how well we take in different types of news. For example, if I asked you to estimate the likely percentage of you getting seriously ill and you answer with 60% and then I tell you it is actually only about 40%, the next time someone asks you the question you will adjust your estimate to 40%, maybe 42%. You have successfully taken on this good news and altered your perception because of it. Now let’s start again, say you had estimated only 20% before I informed you it was 40% — the next time someone asks you, you would say 25-30%. Despite the facts we would still rather believe it is not true. Turns out ignorance really is bliss.

“People almost invariably arrive at their beliefs not on the basis of proof but on the basis of what they find attractive.” Pascal

The lottery does very well off of this. We are quite happy to believe that we could be the next lottery winner, despite facing phenomenal probabilities to the contrary — after all “it could be you”. Yet flip this around and we are much less inclined to believe we could get cancer from smoking, attributing that fate to someone else — smoking kills, yes absolutely it does, but it kills someone else.

The lottery isn’t the only company that does well out of this, think about the number of phone-in competitions ITV has, how successful casinos are, horse racing etc. We are all suckers for the win. So if these companies have been using this for years, surely we can use this in healthcare; especially if it’s as simple as focusing on the benefits of quitting smoking, rather than the dangers of continuing.

We’re in a position where chronic conditions are a major threat to the health of most developed countries in the world, 70% of deaths in the US are from chronic conditions. Diabetes is in the spotlight at the moment, but asthma, eczema, stroke, Alzheimer’s, epilepsy and osteoporosis are but a fraction. Especially when you consider the ageing population, these conditions are increasingly prevalent. Obviously some of these are genetic so there’s no avoiding them, but let’s think about obesity, hypertension, high cholesterol and smoking-induced respiratory or cardiovascular diseases. These are generally preventable, but the only way they can be reduced is by focusing on people’s behaviour. Think how worthwhile it is to help change behaviours, think about the millions of pounds spent on one patient a year, then take into account their kids, or grandchildren even!

So we understand that people are more likely to be receptive to stories of positive changes, but there is more to it than that. Behaviour economics leverages how someone behaves and plays to this. Every single ‘3 for the price of 2’ or ‘50% off for today only’ discount appeals to our natural behaviour — it is hard for us to walk away from such temptation. So framing what we say in a sumptuous manner is only going to help the story. But there is one more factor and this is really the deal breaker — fun.

Volkswagen managed to change the behaviour of cities in Sweden by making tasks fun; 70% of people switched from the elevator to stairs after they became an interactive piano, bottle banks became arcade games and speed cameras became a lottery. But it worked — people are willing to be healthier — in themselves, to society and the environment, just because it is fun! We see the same with Nintendo Wii and Xbox Kinect — people are quite happy to do a workout if it’s fun, especially if you incorporate a nice load of gamification to add that addiction factor and encourage repeat participation!

We want to tackle the obesity epidemic, then let’s work on a fun and positive campaign highlighting what great things will happen if they lose weight, rather than focusing on the dangers of being overweight. We want people to keep up with their treatment plan, then let’s focus on a way for people to actually enjoy doing so, whilst talking about the possibilities it may create.

How do we make helpful change? Well, to me at least, it seems it all comes down to fun and games.

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