Long, happy and healthy lives should be the standard for everyone, but we are a long way from achieving this. However, we do know that the top contributors to years of life lost are almost all behavioural.
Around the world, healthcare systems face multiple pressures, from ageing populations to antimicrobial resistance. The COVID pandemic has stretched resources even further and highlighted challenges and weaknesses that need urgent attention.
Working closely with governments, public health bodies and charities, we use behavioural insights to improve policy and systems. We find ways to encourage people to make healthier choices for themselves, and make the healthcare they rely on more accessible and affordable. Our current priorities include antimicrobial resistance, vaccination, obesity and mental health.
Why is mental health important?
One in four UK adults will experience a diagnosable mental health problem in their life. These disorders are common and their effect is profound. At the individual level, people with mental health disorders experience distress, disability and discrimination.
This is compounded by low treatment rates – only 13.1 per cent of people with a mental health disorder report receiving any treatment, meaning the vast majority remain untreated. At the societal level, this translates into mental health disorders being the largest cause of disability and the greatest contributor to disease burden in the UK. Mental health disorders account for 23 per cent of NHS activity and £34bn in costs each year.
How behavioural insights can help
Although mental health is incredibly complex, there are ways in which behavioural insights can help, in terms of both prevention and treatment. In a large randomised controlled trial, we demonstrated that light-touch text messages to patients on waiting lists can improve engagement with Improving Access to Psychological Therapies (IAPT) services, but there is much more that can be done across different settings and with different groups of people.
Here are a few ways behavioural insights can help:
- Maintaining and promoting wellbeing through designing and implementing light-touch evidence-based preventative interventions.
- Informing environmental changes to improve behavioural and social factors that are correlated with mental health issues, such as obesity, physical activity and loneliness.
- Improving awareness of existing support, for example IAPT services, university counselling services or support provided by employers.
- Increasing the uptake of support, for example through simplifying the process of accessing it or through providing social norms information on take-up of support (i.e. telling people that others engage with mental health services).
- Improving engagement with mental health services, in particular those that may face increased demand over the coming year, through low-cost interventions to reduce dropout and missed appointments.
BIT would like to partner closely with NHS trusts, mental health services and other institutions involved in mental health support and provision (e.g. universities) to develop low-cost behavioural interventions aimed at improving mental health in children, young people and adults.
Please get in touch to discuss potential partnerships.
Vaccination is one of the most cost-effective and impactful public health interventions available – it is estimated that between 2 and 3 million deaths are prevented each year because of immunisation. However, more lives could be saved if more people were vaccinated. Each year, across the globe, children continue to die from outbreaks of diseases that can be prevented through vaccination, and uptake of new vaccines can be encouraged to counter emerging threats such as COVID-19.
Although the argument for vaccination is unequivocal from a public health perspective, at the individual level vaccination decisions can be complex and emotive. Some of the features of vaccines mean that people are at risk of bias about whether or not to choose vaccination for themselves or their children. For example, the benefits of receiving a vaccine are uncertain and occur at an undefined point in the future, whereas the potential downsides feel immediate and salient. Moreover, when many people participate, vaccines have the additional advantage of protecting the community as well as the individual, but this offers people the opportunity to be free-riders.
Behavioural insights are a valuable tool in encouraging vaccine uptake and maximising the benefits that immunisation can achieve. The ‘Increasing Vaccination Model’ is a helpful framework for categorising the barriers to vaccination and possible behavioural interventions. The evidence indicates that closing the ‘intention–behaviour gap’ in vaccination behaviour by improving ease of access (and thus removing practical barriers to vaccination) is the most effective type of intervention. In contrast, focusing on motivation or educational interventions appears to be less helpful.
Some studies have tried to change the way people think and feel about vaccines, but very few have been effective at changing people’s actual behaviour. Only a limited number of studies have explored the use of social norms interventions (e.g. telling people that others are getting vaccinated) to encourage vaccine uptake. However, correlational studies suggest that they might be effective.
Going forward, there are key opportunities to use a behavioural insights approach to increase vaccine uptake:
- Encouraging acceptance and uptake of COVID-19 vaccines when they are available. Developing one or more vaccines for Covid-19 is widely considered to be the only way we will return to some sort of normality. Alongside the crucial work to develop a vaccine, there should be ongoing research into how best to communicate about the vaccines’ development and encourage people to take up a vaccine once it is available. One recent survey found that 16 per cent of UK adults would ‘probably’ or ‘definitely’ avoid a COVID-19 vaccine. Compressed development timelines, misinformation and sensationalist media could all undermine confidence in a future vaccine.
- Developing, testing and scaling behaviourally informed solutions to encourage childhood vaccine uptake globally. Our recent report on vaccine update in low- and middle-income countries identified evidence gaps in the literature on what works to encourage vaccine uptake in these countries. There is a substantial opportunity to develop behaviourally informed solutions to increase childhood vaccine uptake and to use a behavioural insights approach to test, scale and increase the adoption of such solutions.
Globally, 700,000 people die each year due to drug-resistant diseases. Left unchecked, drug resistance could lead to 10 million deaths each year by 2050.
One of the causes of resistance is the use of antibiotics when they are not needed. In England, most antibiotics prescriptions are made by GPs, and BIT has conducted work to reduce unnecessary antibiotics prescriptions in this context.
By sending a letter to GPs whose practices were in the top 20 per cent of prescribers in their local area, BIT reduced unnecessary antibiotics prescriptions by 3.3 per cent. The letter used three approaches informed by behavioural insights:
- It highlighted that the vast majority of local practices prescribed fewer antibiotics per person than the recipient’s.
- It provided three suggestions to reduce antibiotic prescriptions.
- It was signed by an influential messenger (the Chief Medical Officer for England).
In real terms, we estimate that the letter saved more than 73,000 antibiotics items being dispensed during the six-month trial period. The intervention (or very similar) has now been replicated in a number of settings, where it has continued to prove effective.
There is still a great deal of scope for behavioural interventions to help reduce antimicrobial resistance, including scaling successful interventions to other contexts and trialling other new interventions.
The UK is getting fatter – 63 per cent of adults are overweight or obese and this number is going up every year. The result is a public health crisis. Excess weight increases our risk of diabetes, heart disease, cancer, and even critical illness from COVID-19. This increased risk is unfairly distributed, with the most deprived populations hit hardest, and the UK is not alone in facing this crisis.
Fundamentally, obesity is on the rise because most of us consume more energy from food than we burn through exercise. The narrative around obesity often assumes that people make a conscious choice to overeat and not exercise. However, the majority of us want to be healthier and many of us know how to be healthier.
The problem is that many of our choices are not conscious, deliberate decisions but instinctive responses to our environment. Our food environment has undergone a rapid transformation – it is now incredibly easy to access tasty, but unhealthy, food. Unhealthy food is also widely advertised and promoted, nudging us towards consuming excess calories. Add to this the stress and time pressures of modern life and it’s no surprise that making healthy choices has become particularly difficult. In short, willpower is no match for the modern obesogenic food environment.
To tackle obesity, we need to create a food environment that is designed with human behaviour in mind. Behavioural insights can help, as illustrated below, by ensuring the food we eat is healthier, our food environment is designed to make the healthy choice easier, and policy is designed to not only impact the individual but drive universal shifts in our food environment. Such measures will make it easier for everyone to live healthy lives.