People want a nudge

People around the world believe that governments should encourage them to lead healthier lifestyles according to a new report published today by the Ipsos Social Research Institute. National Health: Citizens views of health services around the world suggests people may be more accepting of interference than we might expect, with 52 per cent of Britons agreeing that government should take some responsibility. With certain exceptions (Singapore, India, Japan and Hong Kong), citizens are far more likely to say that the quality of healthcare is good than they are to trust the government to improve services. For example, in the UK four in five (79%) rate the overall quality of healthcare as good, yet only half (48%) trust government to improve the quality of services. Other Ipsos research shows that UK citizens’ individual experience is much more positive than their general views of the service, and that in turn is more positive than their rating of government health policies. The report found that informing and engaging citizens are key – governments that engage successfully with the public are better rated. People also increasingly recognise that they can lower the burden on overstretched services by changing their own behaviour and think that governments have a role to play in encouraging this positive behaviour change. Policymakers should take on board the following when making changes to their healthcare systems in the coming years:

• Globally, healthcare rates as the fifth most important national concern after unemployment, poverty and social inequality, corruption and crime and violence.
• The proportion who rate healthcare in their country as ‘good’ ranges from 87% in Singapore to 27% in Hong Kong.
• Involving the public in decisions about services is strongly related to trust in government to improve services. The analysis shows that three factors are key: providing clear explanations of how spending decisions are made; providing opportunities to take part in discussions about the quality of healthcare; and seeking views when making decisions on priorities for health services.
• Eight of 14 countries included in the study thought that requiring patients to change their lifestyle before being treated was one of the most acceptable ways of lowering costs (ranging from 21% choosing it in Japan to 42% in Australia).
• There is strong support for government to play a role in encouraging behaviour change: in all countries in the study other than Germany, the majority believe that it is the government’s responsibility to influence people’s behaviour to encourage healthy lifestyles (ranging from 52% in Japan to 85% in Singapore).

This relative openness among the public to the need for behaviour change is due to a widely-held belief that people should take care of themselves; our research shows that people agree that we have a responsibility to keep ourselves healthy. There is also some evidence the mood could shift further in the future; in particular, younger people are more convinced about the need for personal responsibility and less willing to pay for others who don’t look after themselves. Bobby Duffy, Managing Director of Ipsos Social Research Institute, said:

“It’s no surprise that in recent years we’ve seen soaring enthusiasm in policy circles for behaviour change. This is also having a real practical impact on government policy around the world. The UK government has just created a “Nudge Unit” – which is turning its attentions firstly to the problems of obesity, diet and alcohol. The main focus of this unit, is to use market incentives, subconscious cues and emotional reactions to affect peoples’ choices, in much the same way as advertisers and marketers have done for decades. “This is, of course, a difficult line for governments to tread – the pitfalls and reputational risks range from being accused of being overbearingly to engaging mind-games when they should be dealing with a real economic crisis. But the lack of outcry suggests concern may not be as great as we would have expected. This may not then be just another short-lived policy fad, but a real change to how governments operate in key areas like healthcare.”

Technical Note

1. The report contains findings from two surveys conducted by Ipsos Social Research Institute. 
2. The Global @dvisor survey is a monthly international survey carried out online in 24 countries and involving 500 to 1000 interviews in each country. 
3. The Accenture Citizen Experience Survey is an online survey carried out in 16 countries with over 1,000 interviews in each country.