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Singapore super-medics, notes from Down Under, and getting ready for a new PM

Our work with premiers past and present, around the world

23rd Jul 2019

It’s nearly a decade since BIT was formed in the newly minted Cameron-Clegg No10 of 2010. The UK’s new Prime Minister this week will be BIT’s third at home, though we’ve been lucky to work with Premiers’ offices around the world over the years since our formation. As the UK civil servants polish the preparatory notes for the new PM, and Australian civil servants put theirs away, it seems a good time to reflect back, and to look forward.

Being in Australia this week (feels a strange time to be away from Westminster!) brings back memories of a time well before BIT when our two countries were exchanging thoughts on ‘behaviour change’. 

In the UK Prime Minister’s Strategy Unit (PMSU), under Tony Blair, we’d written a paper on ‘Behaviour Change and Personal Responsibility’. It drew on conversations with Danny Kahneman (before his Nobel); on an obscure but interesting paper on ‘libertarian paternalism’; and on early evidence about the power of defaults. The ideas within it resonated with senior figures in the then Australian administration.

The basic notion the PMSU paper explored is now very familiar to BI teams across the world: if we wanted to take on the big policy issues, we needed solutions built around a better understanding of human behaviour. Health was the most striking example. The freshly minted Wanless review had laid the issue bare. The biggest gains in healthy life expectancy were to be had from shifts to healthier lifestyles. Indeed Wanless argued that if we failed to make this shift, the costs in our healthcare systems would soar. In the language of the time, citizens and businesses needed to take more ‘personal responsibility’ too. 

But as a public narrative, the argument didn’t go down particularly well. Media commentators had a field day with what was characterised as the ‘nanny state’, particularly around so-called ‘sin taxes’. Five PM’s later, and the issue is still live—as illustrated by concerns raised by the UK’s likely new PM, Boris Johnson.

Behavioural scientists, even with a decade of success under their belts, should not dismiss potential public concerns. In Richard Thaler’s foreword to Inside the Nudge Unit (an updated edition due out this week!) he talks about the power of hindsight bias to make us think that the path we have been on was inevitable, including the success of behavioural science. As more variants on the approach emerge, bolstered by sister disciplines such as data science and machine learning, we would do well to remember how past attempts to address the behavioural causes of social policy challenges have sometimes floundered.

With the Wanless report in mind, it was very exciting to be at the launch of an initiative by the National University of Singapore’s (NUS) Medical School. They are going to create a new Institute dedicated to bringing behavioural and implementation science into the heart of medicine. It is the brainchild of the School’s new Dean, Prof Chong Yap Seng

Imagine a world where medics are trained not only to treat the patient, but to address the deeper factors that caused it

It is a fabulous idea, and one that I hope other Schools of Medicine might study carefully. Imagine a world where medics are trained not only to treat the patient, but to address the deeper factors that caused it. As Theresa Marteau et al argued in their recent Lancet piece, to seek to address health issues such as obesity without addressing the wider drivers would be akin to treating a patient for cholera and then discharging them back into a community with contaminated water. I also look forward to working more closely with implementation scientist Robyn Mildon—implementation issues need to be treated with the same empirical rigour as the primary development of interventions and policy.

In the meantime, work continues in the UK—see the new green paper on preventative health measures, for example, released on Monday.

It’s also been interesting to see how the various BI units in Australia are getting on, on the other side of their recent elections. As readers will know, Australia was an early adopter of BI approaches, with BIT assisting New South Wales (NSW) to set up a team back in 2012. Sydney was also the first city to host the Behavioural Exchange conference, and to host it twice. NSW is now breaking new ground by incorporating its BI team in the heart of a new super-department of Customer Service. I was also intrigued that its new Minister Dominello has a track record of seeking to make markets work better, having put in place a tool to enable citizens to compare petrol prices before they fill-up (something we tried to do in No10, and didn’t really succeed).

The Victoria BI Unit and Commonwealth BETA teams followed not long after NSW, and are producing a steady stream of interesting results. Our team in Sydney is working closely with these Government teams as well as with other partners, like the Vincent Family Fairfax Foundation and VicHealth, to produce cutting edge work tackling complex problems like teenagers’ ethical use of technology and sexual harassment on university campuses. 

While in Melbourne I was particularly struck by the Victorian Government’s focus on rebuilding its transport infrastructure, strengthening its focus on place, and continuing the drive on efficiency.

It’s surprising how often it is overlooked that major infrastructure projects are never just about engineering. Infrastructure is also shaped by the decisions that citizens make about where to live and how far to commute. It is shaped by the value that citzens get from the time they commute as by the minutes saved: can they sit and work, or—shock horror—talk to their fellow commuter? And getting infrastructure built on time and on budget is strongly affected by whether communities are fighting for or against it, not least because of the perceived social impact it will have. There is behavioural science in all of this. 

We are a guest in people’s homes. The decisions and choices that we talk about are the fabric of people’s lives, decisions and hopes

A final reflection, as our new PM prepares for office, and other Premiers begin their terms: behavioural scientists, data analysts, innovation teams, and the latest kids on the block, must remember a key lesson of early failures. We are a guest in people’s homes. The decisions and choices that we talk about are the fabric of people’s lives, decisions and hopes. We have to be on their side, including against the abusive use of BI by businesses or governments.

We are their servants, not the other way round. Our place in governments—however good our technical methods and results—rests on that humility and compact.

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