Improving Value

Environmental Nudges

Our decisions are constantly shaped by subtle changes in our environment. Even choices that feel deliberate and conscious can be swayed by cues that we may not even notice, such as social norms or the setting of a default option. Behavioral scientists use the phrase “choice architecture” to describe the ways in which the environment influences how we decide.¹

What are Environmental Nudges?

Nudging refers to the promotion of desired behaviors through subtle changes in the choice environment.²

Environmental nudges can be distinguished into two categories; passive and active.

• Passive environmental nudges involve changing the architectural landscape to create unconscious bias towards unhealthy options. An example would be changing the layout of a cafeteria to promote healthier foods.³
• Active environmental nudges focus on promoting healthy choices when the person is deciding if they want to engage in a behavior. For that reason, active nudges require individuals to have a prior intention or plan to change behavior so that the prompts remind them of these prior plans.⁴ An example of this would be labeling the caloric content of food on menus. 

How do Environmental Nudges Impact Health Outcomes?

Behavior scientists have looked at how nudges can lead to better outcomes with respect to both patients and providers.

With respect to patients, multiple studies have looked at the impact environmental nudges could have on the rate of obesity and other chronic conditions, such as diabetes and chronic obstructive pulmonary disease. One study looked at the impact small passive nudges may have on weight loss in a work setting. They examined the effect of changing the accessibility of various foods in a pay-by-weight-of-food salad bar in a cafeteria.⁵ Their environmental nudges, such as making less healthy food more difficult to reach or changing the serving utensil, reduced consumption of high-calorie food by 8-16 percent.⁶ Another study examined the effects of pricing strategies on low-fat snacks in vending machines.⁷ Low-fat snacks were promoted with reduced prices, which inversely affected the rate of sales. Reducing relative prices on low-fat snacks was effective in promoting lower-fat snack purchases from vending machines in both adult and adolescent populations.⁸

All told, environmental nudges that affect personal health decisions can range from the  availability of green spaces for play and exercise, the ways in which entertainment media subtly promote healthy behaviors, portion sizes of meals, the layout of supermarkets and cafeterias, the availability of safe and accessible bicycle lanes and sidewalks, and many other factors.

To date, the use of environmental nudges has been at a small scale. But some argue that it is a missed opportunity if we do not prioritize broader legislative and regulatory actions, such as improving school nutrition, menu labeling, altering industry marketing practices, and the use of food taxes that create healthier defaults.⁹ The United Kingdom’s Behavioural Insights Team (BIT)--also known as the “nudge” unit--has found a variety of techniques to cue people to act in their own self-interest, and thus lessen the burden that bad habits place on society.¹⁰  The expanded use of environmental nudges could lead to improved population health and lower spending on healthcare.

There is No Neutral Choice Architecture

Some argue that it is inappropriately paternalistic to use nudges to influence consumers’ behavior. However, as many have pointed out, there is no such thing as neutral “choice architecture.”¹¹ Poor health options, such as fast food and binge-watching television have become a staple in our society and product advertising. The environment we live in inevitably influences our health choices whether that be good or bad. Nudging does not mean limiting consumer choices but providing them with information in order to make an informed health decision. Policymakers should give serious consideration to consumer-friendly, evidence-supported practices that retain choice but nudge consumers towards healthier behaviors

Notes

1. Jachimowicz, Jon, and Sam McNerney, Governments Need to Nudge Citizens to Make Good Choices, Scientific American, Washington, D.C. (July 2015). https://blogs.scientificamerican.com/mind-guest-blog/governments-need-to-nudge-citizens-to-make-good-choices/

2. Levy, Michael, Nudging Environmental Behavior, Center for Environmental Policy and Behavior, Davis, CA (September 2013). http://environmentalpolicy.ucdavis.edu/node/291

3. Kremers, S., et al., “Environmental changes to promote physical activity and healthy dietary behavior,” Journal of Environmental and Public Health. (2012).

4. Levy (September 2013).

5. Rozin, et al., “Nudge to nobesity I: Minor changes in accessibility decrease food intake,” Judgment and Decision Making, Vol. 6, No. 4, (2011).

6. Ibid.

7. French, et al., “Pricing and promotion effects on low-fat vending snack purchases: the CHIPS study,” American Journal of Public Health, Vol. 91, No. 1, (2001).

8. Ibid.

9. Brownell, Kelly D., et al. "Personal responsibility and obesity: a constructive approach to a controversial issue." Health Affairs, Vol. 29, No. 3, (2010).

10. Quigley, Muireann. “Nudging for Health: On Public Policy and Designing Choice Architecture.” Medical Law Review, Vol. 21, No. 4, (2013).

11. Kleimann Communication Group Inc and Consumers Union, Choice Architecture: Design Decisions That Affect Consumers’ Health Plan Choices, (July 2012).