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Antibiotic resistance, health inequality and the replication crisis

On Christmas Eve December 2020, the World Health Organisation named Antimicrobial Resistance (AMR)

and health inequities as 2 of the 10 global health threats to track in 2021. In 2019, we worked with the Health Quality and Safety Commission (HQSC) and PHARMAC to see how we can tackle both in Aotearoa New Zealand. The results of this work have just been published in the New Zealand Medical Journal, so we wanted to dedicate this episode of Inside the Nudge Unit to it. 

Peer-reviewed articles allow us to present the rigorous work that goes into running a Behavioural Insights (BI) project. However, journal articles often remove the work from its broader context and leave little space for describing the tribulations that go into running BI trials. In this episode, we cover the story of how the trial developed, and how it built on our earlier work in the UK and the work done by the Behavioural Economics Research Team in the Australian Department of Health (BERT) and the Behavioural Economics Team of the Australian government (BETA). 

We discuss how health inequities in Aotearoa New Zealand meant that we couldn’t just copy the letters used in the UK and Australia, and take a quick detour into the replication crisis. You’ll hear from Michael Hallsworth, who led the work in the UK, Janice Wilson, the CEO of the HQSC, Rawiri Jansen, a GP and member of the project’s working group, and Nathan Chapell, who developed the letters we used in the project. 

Further reading

If you would like to read more about health inequities in New Zealand, you can read the paper mentioned by Rawiri Jansen here, as well as its follow up here. You can also read about the follow up to the UK study here, and the follow up to the Australian study here

If you are interested in learning more about the replication crisis, we would recommend this article. And if you would like to learn more about issues related to generalising studies from one area to another, we recommend you read this. Chapter 5 of Behavioral Insights, which was co authored by Michael Hallsworth (along with Elspeth Kirkman) also gives an overview of the issues discussed. 

Thanks to the large team of people who were involved in the project, especially Janice Wilson, Catherine Gerard, Richard Hamblin, Carl Shuker, Janet Mackay, Rawiri McKree Jansen, Richard Medlicott, Aniva Lawrence, Sally Roberts, Jan White and Leanne Te Karu. 

Music by Rich O’Brien