Regulating Health (Choices): Nudges as Health Policy Instruments?

Dr Muireann Quigley (University of Bristol)

The Health Ethics, Law and Policy group at Flinders would like to invite you to attend our first talk of 2014, on Thursday the 20th of February  from 1 till 3 pm in room 1.09 in the Health Sciences Building on the Bedford Park Campus, Adelaide, Dr Muireann Quigley,  Senior Lecturer in Biomedical Ethics & Law in the Centre for Ethics in Medicine at the University of Bristol will give a talk entitled Regulating Health (Choices): Nudges as Health Policy Instruments? Abstract and details below.

Since space is limited Please RSVP to [email protected]
 

If you aren't usually at the Bedford park campus the best place to park for the Health Sciences Building is the entrance end of Carpark 1. A map can be found here:  http://www.flinders.edu.au/about_the_campus_files/Documents/campus_map.pdf Health Sciences Building is number 20.

Title: Regulating Health (Choices): Nudges as Health Policy Instruments?
Dr Muireann Quigley
Senior Lecturer in Biomedical Ethics & Law
Centre for Ethics in Medicine
University of Bristol
[email protected]

Interest by Government and policy-makers in behavioural approaches to health are not wholly novel. Nevertheless, they have of late displayed renewed attention to behavioural research in an attempt to achieve a range of policy goals, including health promotion. In particular, approaches which could be labelled as ‘nudges’ have gained traction with policy-makers. Nudge strategies attempt to change a person’s behaviour by altering the contexts in which we make decisions. To this end they try to harness or eliminate our cognitive biases. The layout of the cafeteria is the paradigmatic example of how we can be nudged. The simple measure of changing the cafeteria bar layout influences the choice of food which ends up on our plates. In the UK the Government has set up the Cabinet Office Behavioural Insights Team (COBIT) and, not without controversy, that team is now advising the government in New South Wales on a range of policy measures. Although sometimes presented as an alternative to regulation, I have argued elsewhere that nudging ought to be seen as a form of (design-based) regulation-lite. Where nudges are used in the health arena they ought likewise to be seen as part of the regulatory arsenal. Their attraction to government and policy-makers lies in the fact that such strategies are seen as a form of light-touch, low-cost regulation.

Whether this view of nudges is correct or not, their potential implementation has drawn opprobrium from certain quarters. One criticism in particular focuses on the epistemic challenge which regulators face. White, for example, maintains that regulators and policy-makers can never know our true preferences or interests. As a result, he argues that they ought not to be using such strategies. Moreover, he argues that, even if they could know these, their use still represents an objectionable form of paternalism. In this paper I examine these claims specifically in the context of health. I do this first because health-affecting choices are sometimes supposed by commentators to fall outside the legitimate ambit of the law and regulation. Secondly, the drive to use nudges to promote healthier lifestyles has gained a foothold in UK policy, with the usual culprits (alcohol, smoking, diet) looming large in the literature. The legitimacy of their use as a tool of government, therefore, warrants further examination. As part of examining this, I ask whether it matters that regulators cannot know each and every individual’s true interests, and whether claims of objectionable paternalism have any moral bite.