Behaviour Change: Science and Technology Committee Report

Baroness Neuberger Excerpts

Wednesday 11th July 2012 Grand Committee

Moved by

[Baroness Neuberger]

That the Grand Committee takes note of the Report of the Science and Technology Committee on Behaviour Change (2nd Report, Session 2010-12, HL Paper 179).

[Baroness Neuberger]

My Lords, I wish to thank the members of the Science and Technology sub-committee, many of whom are here in the Moses Room, for their excellent contributions to this inquiry and to the report and for making it such fun. I also thank our specialist adviser, Professor Charles Abraham, for his advice and our secretariat, who were superb throughout.

The Science and Technology Committee chose to begin an inquiry into behaviour change because understanding behaviour and how to influence it is an integral part of effective and efficient policy-making. So much of what the Government do or want to do involves influencing human behaviour, so their success will depend on their ability to change people’s behaviour in ways that will help them bring about their goals.

We know, of course, that government can influence behaviour in many different ways using a broad set of tools, from the provision of information at one end of the scale, through persuasion, be it by a GP or a marketing campaign, the provision of financial and other incentives and disincentives, to regulation, including taxation, at the other end. We were prompted, in particular, to start the inquiry by the rise in popularity of nudging, and the considerable interest in the book of that name, Nudge, by Richard Thaler and Cass Sunstein, which draws on findings from behavioural economics. The committee sought to explore how understanding better the sciences of human behaviour and disciplines including neuroscience, psychology, sociology and behavioural economics can help Governments choose the best tools for the job.

I shall try to give an overview of our principal findings, and I know that many of my colleagues will say more, and I will say something about our reaction to the Government’s response to our report. Perhaps the single most striking thing to come out of this inquiry was the discovery that although scientists can tell us quite a lot about the theory of behaviour—the interaction between different internal and external influences which causes people to act in different ways—there is very little hard evidence about how to develop this into policy interventions that will influence behaviour on a large scale.

It seems that this lack of practical understanding is a result of barely any properly evaluated large-scale behaviour change interventions. The notable exception to this is smoking cessation services in the United Kingdom, which are not only very successful but, because of good evaluation that has been there since the beginning, are continually improving. Insufficient allocation of departmental budgets to research is a big part of the problem, but the problem has also arisen because previous government policies that have aimed to change behaviour have often not been evaluated to a sufficiently high standard. You might argue that the rollout of government policies is perhaps the most obvious location where applied research in how to change behaviour can be carried out. It became increasingly clear to the committee, however, that there simply is not a strong enough culture of evaluation within government. A number of our recommendations were targeted at rectifying this fundamental problem.

Of course, there is some evidence available about how to change behaviour. That evidence points very strongly to one important, though perhaps unsurprising, conclusion: usually the most effective means of changing the behaviour of the population, or a significant group within the population, is to use a whole range of policy tools in order to influence a number of the many factors which impinge on or cause our behaviour simultaneously. Each intervention must be designed based on what we know about the different factors that influence the behaviour we are seeking to change.

As part of our inquiry, we undertook two case studies, the first into changing behaviour to reduce obesity and the second into reducing car use. Other members of the committee will speak in more detail about these.

On the whole our findings in these more specific areas reflected what we had heard more generally. Strong disincentives to discourage particular behaviours and changes to the environment in which decisions are made will often be required in addition to other interventions in order to effect significant behaviour change when important societal challenges, which require a change in the behaviour of the population at population level, are being addressed. Although the use of disincentives or restrictions are more controversial than nudges and have to be justified to, and accepted by, the public we believe there is a need for a proper debate within wider society about how to intervene appropriately to change behaviours in order to tackle some of society’s biggest challenges.

We were pleased to read in their response that the Government agree with the majority of our conclusions and recommendations. I much look forward to hearing from the Minister about how the Government will be taking them forward. The committee welcomes the coalition Government’s attempts to raise the profile of behavioural science. We hope that their efforts, together with our report, will result in a greater emphasis on social science research within a whole range of departments. We were particularly comforted to note that the Government agreed that nudges in isolation will rarely, if ever, achieve the desired effect. We hope we will begin to see this translated into policy. We were told in terms by Ministers that nudging is good because it is cheap, and therefore efficient. We would argue that, however cheap it is to roll out, a policy is only good value for money if it works.

I hope that the Minister will be able to clarify in his response just how the Government intend to ensure that policy-makers are aware of the range of interventions available to them, not just nudging. There are, however, some outstanding areas of concern following the Government’s response. In particular, I would ask the Minister to explain more fully the Government’s decision not to make traffic-light food labelling mandatory, nor to reconsider their position in relation to extending the ban on marketing unhealthy food to children. I also seek some clarification on the outcomes expected of the public health responsibility deals.

We have also thus far heard nothing about the recommendation to appoint an independent government social scientist to champion the importance of social science research and to improve the quality of social science advice across government. I look forward to hearing from the Minister what progress has been made towards this appointment.

Regarding obesity, excess weight costs the NHS more than £5 billion a year. A study by Cancer Research UK published in December 2011 showed that nearly half of all cancer cases could be wiped out if we followed healthier lifestyles. The Government published their strategy on obesity, Healthy Lives, Healthy People in October 2011. We were delighted to see that the Government’s strategy was grounded in the available evidence on changing behaviours to tackle obesity, and that it emphasised the importance of evaluation and building the evidence base on the effectiveness and cost-effectiveness of different interventions. We will watch with interest to see how these initiatives develop.

However, we were really disappointed that the Government still failed to address the wider environmental issues that affect obesity, or to outline how the effectiveness of the responsibility deals would be assessed. Many witnesses felt, as Dr Ian Campbell, medical director of Weight Concern put it, that,

“confronting the real commercial and environmental stimuli of obesity has not yet been achieved”.

We found two areas in particular in our obesity case study where there was promising evidence about how to change the obesogenic environment: food labelling and marketing to children. We were particularly struck by what we heard from Asda and Sainsbury’s on food labelling, and it is really important that people realise just what was said. Justin King, the chief executive of Sainsbury’s, told us that on the introduction of multiple traffic light labelling, against a comparable 12-week period during which fresh ready meal sales grew by 26.2%, sales of a Be Good to Yourself salmon meal, mostly green labels, grew 46.1% and sales of a moussaka, mostly red labels, decreased by 24%. Even over a relatively short period, the majority of the evidence at the moment shows that people definitely understand labels with traffic lights far better than percentages of recommended daily allowances and other such information.

It is important to note that not much research has yet been done on the extent to which better understanding translates into different behaviour for any labelling, but better understanding in the first instance is arguably more likely to result in success. We thought that was really important and were surprised that not more is being done about it. The Government do not appear to be acting on this evidence, or seeking to carry out further research to test these potentially important effects. In fact, their response to our report did not engage with the question of why they failed to pursue these policies around labelling. We were particularly disappointed to see that traffic light labelling was not adopted throughout the EU in the new EU regulation on provision of food information to consumers. We were pleased to see that the Government are currently consulting on the inclusion of traffic light labelling, but it is as an additional form of expression under the regulation. As the Government themselves note, business will not be compelled to follow the recommendation, if adopted. How is that supposed to work, and what plans do the Government have to ensure that such labelling is used consistently across industry?

On marketing of unhealthy products to children, the Government again fail to justify not expanding the current restrictions on such advertising. For instance, they did not say why they had not accepted NICE’s report on the prevention of cardiovascular disease at the population level and its recommendations to extend the regulations restricting advertising during children’s programmes of products high in fat, salt and sugar to cover a greater number of programmes and types of advertising. Why are the Government not putting more effort into tackling the behavioural issues surrounding these preventable diseases, interventions which would save them money in the long term in costs of NHS treatment?

Our other big concern was voluntary agreements to help tackle obesity, particularly through the public health responsibility deal network. Certainly, the evidence suggests that getting businesses to change what they do will make a real difference to our behaviour; we know that our environment is a major influencing factor in our behaviour and that, in turn, businesses have a significant impact on shaping that environment. But concerns were raised by a significant number of witnesses about attempts to change behaviour through agreements with businesses when potential conflicts of interest may exist. We recommended that to guard against conflicts of interest. First, we said that engagement with businesses should be on the Government’s terms and should outline specific outcomes that are expected within any given timescale. Secondly, agreements should be evaluated properly to establish their effect. Thirdly, agreements should be backed up with contingency plans for further intervention if the voluntary approach does not work after a given length of time.

We received a disappointing response from the Government about how this will be taken forward, and perhaps the Minister can clarify what measurable outcomes the Government have agreed with participants in the responsibility deals, how their success will be measured, and over what timescale.

In the committee’s report, the Government were criticised for their policy on minimum alcohol pricing. It was stated that there was good evidence about the effectiveness of alcohol pricing on reducing alcohol-related harm but that it had not fed through to government alcohol policy. Subsequently, the Home Office announced a ban on the sale of alcohol below the rate of duty, plus VAT. This policy has been criticised, because NICE guidance on preventing harmful drinking published in 2010 shows that at the minimum price level proposed by the Government of 21p per unit for beer and 28p for spirits, a reduction in consumption of between 0.1% and 0.4% could be expected. However, a minimum price of 40p per unit would reduce consumption by 2.4%, while minimum prices of 50p and 60p would reduce consumption by 6.7% and 11.9% respectively.

In March this year, the Government published their alcohol strategy, which stated that they would,

“introduce a minimum unit price … for alcohol meaning that, for the first time ever in England and Wales, alcohol will not be allowed to be sold below a certain defined price”.

The Government committed to consult on the level in the coming months with a view to introducing legislation as soon as possible, and to consult on a proposed minimum unit pricing of 40p. This is to be welcomed, but is at a level below that passed in the Scottish Parliament, which will introduce a minimum unit price of 50p per unit. Could the Minister respond and clarify whether the Government are also considering a minimum unit price of 50p per unit, given the situation in Scotland?

The last point concerns organ donation. One nudge recommended by the Behavioural Insights Team in government has been to opt out of organ donation rather than opt in. Once again, I am puzzled by the lack of evidence base for this because it is clear from the House of Lords inquiry into organ donation in EU Sub-Committee G, and other evidence that is around everywhere, that it is the organisation of organ donation, harvesting and transplant services that are the key elements in changing behaviour, rather than opting out or opting in. It would be good to know whether the Government’s Behavioural Insights Team at the heart of government is subject to peer review in respect of its policy recommendations as the key to much of this is evidence, or indeed the lack of it. I commend the report to the House. I beg to move.

--- Later in debate ---

[Baroness Neuberger]

I thank all noble Lords who have spoken. There have been some memorable phrases. I am particularly interested in behaviour change for bankers and interventions will clearly be programmed as a result of today’s debate. I was slightly disappointed with the Minister’s response, particularly given that he is a social scientist. He did not answer the question put to him about when, if ever, a chief social scientific adviser will be appointed within government. I hope that he will deal with and answer that point.

[Lord Wallace of Saltaire]

I apologise. I should have answered it but so many points were made in the debate that it was extremely difficult to cover all of them. This question is being discussed within government and will shortly be decided on. It is not a dead question; it is a live one.

[Baroness Neuberger]

I thank the Minister very much indeed. We are much encouraged to hear that and I hope that we will continue to be brief on that subject. Will he perhaps take back the question on traffic light labelling of food, which was asked again and again, particularly as evidence came from some corporations that they were doing something about this? It is something that could be pursued through a business network and the Government could lean harder on that. We would still like a serious response on advertising on foods harmful to children. I hope that the noble Lord will write to me and other Members of the Committee. I thank everybody who spoke and the Minister for his response. I beg to move.

Motion agreed.