CHAPTER 5: THE GOVERNMENT APPROACH
TO CHANGING BEHAVIOUR|
5.1. In their evidence to us, the Government
emphasised three aspects of their general approach to policy making
which impact on the use of behaviour change interventions: a preference
for non-regulatory policy tools, engagement with a range of organisations
through partnership working, and a greater role for local authorities.
In this Chapter, we consider the implications of each of these
aspects on the effectiveness of interventions to change behaviour.
An emphasis on non-regulatory
5.2. The Government's emphasis on non-regulatory
behaviour change interventions can be traced back to the coalition
"The Coalition's Programme for Government
rejects 'the assumption that central government can only change
people's behaviour through rules and regulations' and promises
that 'our government will be a much smarter one, shunning the
bureaucratic levers of the past and finding intelligent ways to
encourage, support and enable people to make better choices for
5.3. The Minister, Oliver Letwin MP, echoed
this sentiment, noting that "over very many years, governments
of different persuasions have assumed that the way you achieve
change ... is to legislate and then administer".
He said that while "there is a considerable place for legislation
and regulation ... where we can achieve an effect that otherwise
you would achieve by legislation, either directly or through nudge,
without having to regulate, we prefer that route ..."
BIT was established in order to help achieve this (see Box 7,
page 32 below). Dr Halpern, Head of BIT, agreed that governments
have tended to use "a relatively limited menu" of policies
to influence behaviour and that this meant that an "additional
suite of approaches" which reflected a "more nuanced
model of what actually drives behaviour change" had been
The role of the Behavioural Insights Team
|BIT, a small team of civil servants and academics, is based in the Cabinet Office and led by Dr David Halpern. BIT has a steering group chaired by Sir Gus O'Donnell, Cabinet Secretary, and works with a variety of external experts, including Professor Richard Thaler, co-author of Nudge. BIT was established with a two-year sunset clause and so will cease to exist in the summer of 2012.
At present the team is working, in particular, on promoting organ donation, smoking cessation, car labelling, food hygiene and charitable giving. The commonality between the projects, according to the Government, is that they do not involve regulating and involve both prompted choice and partnership with the private sector.
Dr Halpern identified the origins of what is now BIT in "deregulatory thrust", in part linked to the Better Regulation Executive. He understands the team's role as raising awareness of "less cognitive, less familiar approaches" as alternatives to legislation, pricing mechanisms and advertising and social marketing. Mr Letwin said that BIT was created in order to help Government departments think about "non-regulatory means of achieving behaviour change".
5.4. Mr Letwin gave four reasons for emphasising a non-regulatory
approach: effectiveness, cost-effectiveness, less rigid imposition
on individuals and reduced burden on business.
We discuss the latter within the section on voluntary agreements
(see paragraph 5.20 below).
THE GOVERNMENT'S ARGUMENTS FOR A NON-REGULATORY APPROACH
The effectiveness of non-regulatory and regulatory approaches
5.5. Occasionally, non-regulatory approaches might be the
only reasonable way to achieve behaviour change. Professor John
Britton, Director of the UK Centre for Tobacco Control Studies,
gave an example: "we cannot legislate to stop people smoking
in their home but we can educate and nudge people to change".
In some policy areas, particularly crime prevention, legislation
might already prohibit certain behaviour and the challenge is
to achieve greater compliance. In these cases, further regulation
may not be a realistic option.
5.6. Aside from these sorts of circumstances,
we were given no examples of significant change in the behaviour
of a population having been achieved by non-regulatory measures
the view of some witnesses that non-regulatory measures in isolation
could have little or no effect and that the most effective means
of changing behaviour at the population level was a package of
different types of interventions. Findings from our case studies
supported this view, as did Defra's work on energy efficient labelling
(see Box 6, page 27). Professor Michie also observed:
"... usually examples of legislation being
maximally effective are when there is also work done on persuasive
communicationfor example, seatbelts and the smoking ban.
If these legislative measures had been taken out of the blue,
I don't think they would have been as effective as having a big
communications campaign at the same time. On the other hand, if
one just did the persuasive communication, it wouldn't have been
5.7. Similarly, as Professor Michie suggested,
regulatory measures may also be less effective when used in isolation
rather than in a comprehensive package of interventions. Professor Kelly
and Professor Britton agreed that legislation is likely to
be more effective when the public understand the reasons behind
it; this means that non-regulatory measures should be used as
a means of "explaining and promoting the idea beforehand".
Professor Kelly cited the "Clunk Click" marketing
campaign encouraging people to wear seat belts, which accompanied
seat belt legislation, as an example of such a measure.
Mr Letwin made the further point that regulatory measures
could sometimes have unintended consequences: that sometimes governments
"have discovered, to their horror, that the effect that they
sought to achieve has not been achieved and that instead some
other effect has occurredperhaps benign, perhaps counterproductive".
Professor Kelly agreed and referred to the counterproductive
effects of using strict controls on the price and availability
of alcohol in Scandinavia (see Box 3, page 21).
5.8. Nudges are a subset of non-regulatory interventions
(see Table 1, page 9) and the points made above about non-regulatory
interventions apply. Several witnesses told us that, though some
nudges reflect experimental evidence about what influences behaviour,
they would be unlikely to have a significant effect if used in
isolation. Dr Anable, University of Aberdeen, said in relation
to reducing car use, for example, that "nudging will achieve
nothing ... over the longer term [and] at the bigger scale".
Professor Ray Pawson, Professor of Social Research Methodology,
University of Leeds, agreed that "sustained behavioural change
is difficult to accomplish and requires more than a well aimed
'nudge' in the right direction".
Sara Eppel, Head of Defra's Behaviour Change Centre of Excellence,
also said in relation to nudging: "I don't speak up its success
you often need some behavioural intervention to make your
policy easier to implement, but you may also end up going for
the much harder and faster policies at the end of the day".
The cost-effectiveness of non-regulatory interventions
5.9. The Government have suggested that non-regulatory
interventions are a more cost-effective way to change behaviour.
Mr Baker, for example, said that "... in terms of value
for money, the use of nudge and encouragement, apart from being
sometimes as effective as regulation, can also be far more cost-effective
for the public purse".
The MINDSPACE report also suggests that non-regulatory policy
tools could lead to better outcomes at a lower cost.
In contrast, Professor Marteau and others, writing for the
British Medical Journal, noted in relation to nudges that "[lower
cost] cannot be assumed because the cost-effectiveness of nudges
has not been evaluated".
5.10. Effectiveness is a necessary prerequisite
of cost-effectiveness. If an intervention has no effect then it
cannot be cost-effective. Given Mr Letwin's view about nudging
that "it is of course open to question whether any of this
will have any effect whatsoever",
we find it surprising that the Government judge that they are
in a position to assert that nudging is generally cost-effective.
Respecting the freedom of the individual
5.11. Finally, the Government argue that non-regulatory
approaches are more "respectful of the freedom of the individual".
We believe that this is misleading. For example, there is a difference
between regulation of the individual and regulation of businesses
and only the former will tend to restrict the freedom of the individual
(see paragraph 2.18 above). Indeed, an argument can be made that
regulating businesses might increase the freedom of individuals
by preventing businesses from influencing their behaviour and
so creating a more neutral environment in which to make choices.
We also draw attention to our conclusion in paragraph 2.20 that
the Government should be able to explain why an intervention is
a necessary and proportionate means of tackling a problem.
THE NEED FOR A RANGE OF INTERVENTIONS
5.12. Whilst the Government have emphasised non-regulatory
approaches, Mr Letwin acknowledged that there were circumstances
when regulation was appropriate. The Government, he said, were
not arguing "that we can substitute behavioural science and
behavioural insights for the entire panoply of regulation. It
may well be that there are all sorts of domains in which regulatory
action is required to make major shiftseither only regulatory
action, or regulatory action allied to other things".
As we have said (in paragraph 2.4 above), however, the evidence
of officials suggests that the understanding that regulation has
its place is not fully appreciated throughout Government departments.
Ms Eppel, Head of Sustainable Products and Consumers at Defra,
for example, told us:
at the moment, we're giving a much
bigger priority to looking at whether behaviour change [non-regulatory
and non-fiscal measures] can contribute, because the Government
is less willing to do regulation and that is a stated objective
... previously, we'd probably have looked at regulation more methodically".
5.13. In general, the evidence supports the
conclusion that non-regulatory or regulatory measures used in
isolation are often not likely to be effective and that usually
the most effective means of changing behaviour at a population
level is to use a range of policy tools, both regulatory and non-regulatory.
Given that many factors may influence behaviour, this conclusion
is perhaps unsurprising.
5.14. We welcome efforts by the Government
to raise awareness within departments of the importance of understanding
behaviour, and the potential this has for the development of more
effective and efficient policies. We are concerned, however, that
emphasising non-regulatory interventions will lead to policy decisions
where the evidence for the effectiveness of other interventions
in changing behaviour has not been considered. This would jeopardise
the development of evidence-based, effective and cost-effective
5.15. We therefore urge ministers to ensure
that policy makers are made aware of the evidence that non-regulatory
measures are often not likely to be effective if used in isolation
and that evidence regarding the whole range of policy interventions
should be considered before they commit to using non-regulatory
5.16. The Government told us that "the involvement
of private and Voluntary, Community and Social Enterprise sector
organisations will be crucial" when they are trying to change
of the evidence we received highlighted the benefits of partnership
working, where Government initiatives are supported by other organisations,
and suggested that the Government could do more to work with industry,
the third sector and local communities to deliver multi-faceted
behaviour change interventions through the most appropriate messengers.
5.17. Numerous reasons were provided in favour
of partnership working: that interventions undertaken by local
communities and social enterprises were an effective way to change
behaviour because those who are affected by an issue are the most
likely to be able to solve it;
that individuals often respond best to messages about behaviour
from those within their local community;
that the resources of businesses and the third sector were not
time-limited in the same way as Governments, enabling greater
consistency in their work;
that other sectors have a range of expertise about how to influence
behaviour which the Government could take advantage of;
and that the third sector were particularly good at harnessing
community spirit and were trusted messengers for behaviour change
Rory Sutherland, President of Independent Practitioners in Advertising,
noted that, in the business world, some brands also engendered
trust in a way that governments often do nota
point borne out by the contribution of businesses during the Change4Life
(see Box 8, page 37) programme in communicating messages to consumers.
|The Change4Life campaign involved over 200 partners drawn from the voluntary sector, businesses and local government. The campaign also involved over 50,000 local community groups. The Change4Life One Year On report noted that a number of health charities, including Cancer Research UK, Diabetes UK and the British Heart Foundation ran their own campaigns in support of Change4Life. Businesses also supported the movement, for example by providing free gym access, discounted fruit and vegetables and low-cost bikes. A number of witnesses agreed that the campaign had used partnership working effectively. Tim Duffy, Chief Executive of M&C Saatchi, noted that the Change4Life campaign minimised conflict and Paul Kelly, Head of Corporate Affairs at Asda, said that the campaign worked because there was clarity around the role and responsibilities of all of the partners.
5.18. Witnesses from businesses and the third sector observed,
however, that partnerships worked most effectively where there
was little or no conflict of interests or "internal conflict".
Tony Hawkhead, Chief Executive of Groundwork, agreed, suggesting
that the Green Deal was a good example of effective partnership
working because everybody involved got something out of it (see
Box 9, page 37).
By contrast, voluntary agreements, which are established between
the Government and businesses to change the way in which businesses
operate without regulation, were cited as a particularly controversial
form of partnership working because of potential conflicts of
The Green Deal
|The proposed Green Deal allows businesses to offer energy efficiency improvements to homes, community spaces and businesses at no upfront cost, and recoup payments through a charge in instalments on the energy bill. Mr Hawkhead argued that the Green Deal provides an example of a partnership where there is a clear role for Government, businesses and the third sector and no conflict of interest:
"The role for the Government ... is quite clearly setting a framework and creating a clear vision for how the Green Deal will work: negotiating with private financiers, setting out the legislation. Business's role ... will be quite clearly to install the home insulation
and probably to lead on some of the behaviour change work because they will be in there ... Where the third sector can come in there is the whole area around fuel poverty. The Green Deal will not work for fuel poverty, we will need to use the levy on our fuel bills to try and deal with that
That is where the trusting relationship that the third sector has uniquely in poorer communities can make the difference
Voluntary agreements between Government and
5.19. Some witnesses from both the business sector and the
Government favoured voluntary agreements. Officials from DH cited
a report from the Organisation for Economic Co-operation and Development
(OECD) which concluded that cooperation between governments and
the food industry would be crucial if the problem of obesity were
to be tackled successfully.
Mr Letwin argued that the Government should try to get businesses
to work with them because "one of the very few pieces of
extremely strong evidence
is that you can easily create
regulations that people will observe in the letter but not in
Voluntary agreements were not, he said, a means of "handing
[businesses] the power". A number of witnesses also referred
to work on salt reduction as an example of an effective voluntary
note, however, that the salt reduction campaign also publicly
named and shamed products particularly high in salt and so its
effectiveness cannot be attributed only to the voluntary agreement.)
BURDEN ON BUSINESSES
5.20. The Government also argued that voluntary agreements
would be less burdensome on businesses than legislation. The evidence
we received from businesses themselves was mixed on this point.
Paul Kelly, Head of Corporate Affairs for Asda, agreed that Asda
had had only positive experiences of voluntary agreements.
In contrast, Justin King, Chief Executive of Sainsbury's, said
that voluntary agreements could be burdensome on businesses,
and that, furthermore, Sainsbury's were "not against legislation"
and would in some instances "positively encourage it"
if it was easy for businesses to work with.
Mr King emphasised that voluntary agreements tended to be
short-term, making them more difficult for businesses to engage
with properly, and that although legislation could be burdensome,
it was more "consistent for everybody" and tended "to
stand more the test of time than a voluntary agreement".
Dr Susan Jebb, Chair of the cross-Government expert advisory
group on obesity, agreed that voluntary agreements could "be
much more onerous" and said that it was an issue that the
food network of the responsibility deal was thinking about.
CONFLICT OF INTERESTS
5.21. Many witnesses expressed scepticism about the effectiveness
of voluntary agreements because of the overriding commercial interests
of businesses. Mr King, for example, said that they were
the "refuge of scoundrels", tending to appeal to the
lowest common denominator,
and were often overtaken by political events.
Others went further, suggesting that businesses would never be
motivated to do anything which impacts their success. Professor Vivienne
Nathanson, Head of Science and Ethics at the British Medical Association,
for example, told us about her experience of the alcohol network
of the Public Health Responsibility Deal (see Box 10, page 39):
"... the industry, which is at least two thirds of the
... group, is not motivated so far to really look for things that
hurt them. They are looking at completely protecting their bottom
line which I can understandthey are businessesbut
from the health side we want to hurt their bottom line."
Professor Nathanson said that the health organisations on
the responsibility deal "believe that, inherently, voluntary
agreements won't work and particularly in the alcohol sector.
They may have more chance in the food sector'may' being
an important caveat there".
The Public Health Responsibility Deal
The Public Health Responsibility Deal is an example of the Government pursuing voluntary agreements with businesses and other organisations to help achieve policy goals. The Deal was launched by DH to "[tap] into the potential for businesses and other organisations to improve public health and tackle health inequalities through their influence over food, alcohol, physical activity and health in the workplace". It is overseen by a plenary group chaired by the Secretary of State for Health and includes five networks. Four work within a particular area of public healthfood, alcohol, physical activity, health at workand involve representatives of the Government, businesses and health non-governmental organisations (NGOs), who work together to establish "pledges for action".
There is also a fifth network on behaviour change, which
"... seeks to put behavioural science expertise at the disposal of the other networks, enabling them to push the boundaries of their work. The network is also exploring ways in which Responsibility Deal partners can help build the evidence-base for more ground-breaking future work to change behaviour in environments including the retail sector."
Pledges under the deal were published on 15 March 2011 and six health organisations did not sign up. They expressed particular concern with the alcohol network pledges, arguing that they: were too limited with little or no evidence of effectiveness; prioritised industry views; were not specific or measurable and did not indicate what would be a success. They also noted that there had been no commitment made on alternative actions if the pledges did not reduce levels of alcohol-related harm.
5.22. Other witnesses echoed Professor Nathanson's view.
Richard Wright, Director of Sensation, Perception and Behaviour
at Unilever, told us that "the reality ... is that any business
is in business to make money"
and that opportunities to influence behaviour will be taken if
they are a means to selling more products.
Mr King said that decisions taken by Sainsbury's that might
discourage consumption of unhealthy products, for example removing
confectionery from their checkouts in some stores, were taken
when they were what the customer wanted rather than on the basis
of any judgement about improving the health of consumers.
Mr Letwin indicated a similar view when he said that working
with businesses through voluntary agreements involved thinking
about whether the agreement was "possibly in their commercial
EVALUATION, TIMELINES AND REGULATION
5.23. A number of witnesses were concerned that mechanisms
should be in place to ensure that voluntary agreements were subject
to rigorous evaluation, with clear outcome measures and timelines.
Dr Jebb said that "it is ... vital that public health
bodies and institutions are charged with monitoring and evaluating
the success or otherwise of ... delivery".
Professor Lindsay Davies, President of the Faculty of Public
Health, said that voluntary agreements were an "experiment"
and so should not be allowed to "drift on and on and on as
a substitute for ... taking harder action, because the obesity
epidemic can't wait",
a point also made by Professor Nathanson.
Other witnesses emphasised the importance of timelines, arguing
that if agreements could not be reached or were not effective,
then the Government had to be prepared to regulate. Professor Nathanson
said, for example, that the Government should be prepared to say
"if we don't get a sufficiently challenging-to-the-industry
... agreement, then we would be prepared to regulate on the areas
that the voluntary agreement should cover, as well as the areas
that will only happen through regulation".
Mr Letwin acknowledged this point when he said "we may
need to regulate [businesses] and not merely do deals with them".
5.24. Anne Milton MP, Parliamentary Under
Secretary of State for Public Health, provided some reassurance
in relation to these concerns:
"... when we publish our response ... and
set the outcomes down fairly clearly, we will need to give an
indication as to when we would step in. That is quite important,
setting clear outcomes, and some timeframes that we can be judged
on as a Government. Also, it is an indication to industry as to
where we will step in, if they do not help us get along to that
As we note in Box 10 (page 39), some organisations
do not feel that these measures were present in the published
Public Health Responsibility Deal. The pledge about reducing obesity
made by the food network of the Deal does not set outcomes relating
to changes in behaviour and does not reflect the available evidence
about how to tackle the problem of obesity (see paragraph 7.20
5.25. The involvement of other organisations
to support the Government's behaviour change initiatives may provide
valuable opportunities to improve the effectiveness of behaviour
change interventions, in particular by allowing a range of messengers
to be used to deliver them. We welcome the Government's intention
to use such collaborations.
5.26. However, we have major doubts about
the effectiveness of voluntary agreements with commercial organisations,
in particular where there are potential conflicts of interest.
Where voluntary agreements are made, we recommend that the following
principles should be applied in order to ensure that they achieve
- The Government should specify
clearly what they want businesses to do based on the evidence
about how to change behaviour, and what steps they will take to
achieve the same result if voluntary agreements are not forthcoming,
or prove ineffective.
- Voluntary agreements should be rigorously
and independently evaluated against measurable and time-limited
5.27. Given that these principles do not appear
to have been applied consistently to the Public Health Responsibility
Deal Network, we urge DH, in particular, to ensure that these
principles are followed when negotiating further voluntary agreements.
In relation to the current agreements, we recommend that DH should
state for each pledge what outcomes are expected and when, and
provide details of what steps they will take if the agreements
are not effective at the end of the stated period.
The role of local authorities
5.28. Mr Letwin told us that the Government
"are very determined to ... decentralise power and to leave
local communities and local governments as free as possible to
make their own decisions about how they do things".
In our two case study policy areas, the role of local authorities
in delivering behaviour change interventions has been emphasised
in recently published white papers.
BENEFITS OF DECENTRALISATION
5.29. Witnesses described two major benefits
of a local approach to changing behaviour. First, different local
areas have different local needs and so interventions should reflect
In relation to sustainable transport, much of our evidence agreed
that local authorities were best placed to design behaviour change
interventions because they were most qualified to assess the need
for, and implement, interventions.
Similarly, witnesses were mostly positive about the proposed reforms
to public health which would move Directors of Public Health into
local authorities, suggesting that they would provide opportunities
to coordinate behaviour change activity across a range of areas.
Professor Dame Sally Davies noted that this shift should
mean that local authorities will start to "look at all the
things they doeducation, planning, cycling paths, transport
through a health lens as well as through the cost lens
and the service lens".
Dr Frank Atherton, Chairman of the Association of Public
Health Directors, told us that "Directors of Public Health
[were] ... universally welcoming the move into local authorities,
because that's where the levers of change actually exist".
5.30. Secondly, some witnesses suggested that
the devolution to local authorities of responsibility for designing
and implementing interventions would provide an opportunity to
help build the evidence-base for the effectiveness of population
Mr Letwin said that, in principle, the decentralisation of
power should provide a "rich field" for evidence generationalthough
he acknowledged that it would be important to ensure that mechanisms
were in place to take advantage of it.
5.31. Some witnesses expressed doubts about decentralisation
however. They questioned whether there were the requisite levels
of skill in designing and evaluating interventions at a local
level, or adequate mechanisms in place for the dissemination of
knowledge, to allow the Government to make the best use of what
is learnt about the effectiveness of interventions. In relation
to the use of evidence, Paul Sacher, Chief Research and Development
Office for MEND Central, and Zoe Hellman, Company Dietician for
Weight Watchers, said that commissioners of weight management
programmes within Primary Care Trusts did not review evidence
accurately and appeared not to understand the most important measures
A similar view was reflected in the evidence we received in relation
to our case study on reducing car use to limit carbon emissions
(see paragraphs 7.42-43 below). In addition, witnesses suggested
that local authorities may not have the range of skills and resources
necessary to interpret the available evidence.
5.32. Witnesses also expressed concern that devolving
responsibility for behaviour change interventions in some policy
areas might have a detrimental effect on evaluation.
The National Obesity Observatory noted, for example, in relation
to the commissioning of weight loss interventions, that:
"Although quantitative data are lacking,
indications are that very few interventions are evaluated to an
adequate degree. Problems include: lack of skilled staff; confusion
over appropriate evaluation methods; lack of validated measurement
tools; insufficient emphasis in the commissioning process; insufficient
budgets being allocated to the evaluation component of a programme
5.33. The Government acknowledged the importance
of effective evaluation of local initiatives. Mr Letwin told
us that the Government had discussed setting up some research
apparatus at low cost to "investigate what had been done
by one local government in one place, and enable it to be evaluated
and transmitted to other local governments in other places".
Mr Dowie said the DfT recognised that it had "a responsibility
through the ... sustainable transport fund to ensure there is
a proper evaluation framework in place".
To that end, the department has "published impact evaluation
guidance aimed at scheme promoters and evaluation practitioners
to help them choose an evaluation approach which is best suited
to their evidence needs and helps them design an evaluation which
enables the observed impacts to be attributed to the scheme".
They have also developed a framework "for evaluating schemes
aimed at encouraging sustainable and active travel behaviours".
5.34. In relation to sharing knowledge at a local
level, witnesses who had designed and commissioned local interventions
told us that there was no mechanism for the broader dissemination
of the lessons learnt from their behaviour change programmes.
Robin Gargrave from Central YMCA said that while there was some
informal knowledge exchange among local organisations, there were
no "national data that shows the direction of travel, and
also indicates what's working, what's not working and why".
He added: "anything that the Government can do to help facilitate
that would be most welcome".
The DfT stated in its Sustainable Transport white paper however
that it would be "stepping back from monitoring" and
that "the Local Government Association and local authorities
themselves will be responsible for spreading best practice, sharing
what works and developing a framework that improves capability
across the local transport spectrum".
5.35. Finally, a number of witnesses cautioned
that localism should not detract from the important role central
government still had to play. Lynn Sloman, Director of Transport
for Quality of Life, said for example that the DfT should continue
to foster experimentation and that it should "provide a consistent,
long-term direction of travel so that the local authorities and
everybody else knows where they are".
This was supported by other witnesses in relation to public health.
5.36. Although decentralising responsibility
may provide a useful opportunity to tailor local behaviour change
initiatives and to help build the evidence-base for applied behaviour
change research at the population level, steps should be taken
to ensure that interventions are evidence-based and properly evaluated.
To this end, we recommend that the Government:
- produce guidance for local
authorities on how to use evidence effectively to design, commission
and evaluate interventions and on the need to involve experts
in the design and evaluation process (see paragraphs 4.25 and
6.3), and provide advice on how to best use the tendering process
to ensure value for money;
- take steps to ensure that evaluation of interventions,
including data collection and reporting of behaviour change outcomes,
across local areas is of sufficiently high quality to allow comparisons
- take steps to ensure that what is learnt by
a local government in one place can be readily transmitted to
other local governments; and
- provide funding only for those schemes which
are based on sound evidence. Demonstration of rigorous evaluation
and contribution to the evidence-base should be a requirement
for future funding for behaviour change interventions.
118 BC 114. Back
Q 703. Back
Q 706. Back
Q 703. Back
Q 19. Back
Q 8. Back
Q 703. Back
Q 703. Back
Q 153. There has of course been legislation to encourage people
to stop smoking, such as the Health Act 2006 which banned smoking
in enclosed public places. This legislation appears to have had
an effect on the numbers of individuals who smoke, and consequently
who smoke in their homes. Professor Britton was instead referring
to a direct ban on smoking in homes. Back
We were given the example of the relatively small changes made
to letters sent out by Her Majesty's Revenue and Customs (HMRC)
which seem to have had a substantial impact on the levels of response
to tax collection letters. We note however that HMRC cannot be
sure that the increased response was wholly a result of changes
to letters, as other changes to the tax collection process were
made simultaneously (BC 114). Back
Q 129. Back
Q 158. Back
Q 164. Back
Q 703. Back
Q 182. Professor Kelly noted that "in certain parts of Scandinavia,
this has brought down consumption in terms of people buying alcohol,
but it's led to an increase both in people brewing their own and
indeed in smuggling". Back
Q 585. Back
BC 6. Back
Q 299. Back
Q 710. Back
MINDSPACE, op. cit,
p. 10 Back
Judging Nudging: can nudging improve public health, Marteau
et al (BMJ, 2011). Back
Q 703 Back
BC 114, QQ 54, 58, 77. Back
Q 715. Back
Q 294. See also Professor Dame Sally Davies' comments in Q 355. Back
BC 114. Back
BC 76, BC 83, BC 84. Back
BC 41. Back
BC 41, BC 89, BC 96, Q 638. Back
Q 259. Back
QQ 479, 500. Mr Baird provided the example of Diageo's work with
Drink Aware on the 'Why Let the Good Times Go Bad' campaign to
illustrate this; the campaign was designed by one of Diageo's
senior designers. Back
BC 48. Back
Q 525. Back
BC 102. Back
Q 83. Back
Change4Life One Year One, DH (2010). Back
BC 83, BC 102, QQ 259, 524, 532. Back
QQ 259, 532. Back
QQ 259, 279. Back
Q 279. Back
Q 355. Back
Q 738. Back
BC 16, BC 58, BC 108, QQ 355, 560. The Food Standards Agency noted
that "the dietary evidence suggests that population salt
intakes have seen, on average, a 0.9g reduction from 2001 to 2008"
(BC 16). An extra 15% reduction in salt has been promised by manufacturers
through the Responsibility Deal Network. Not all witnesses were
positive about the voluntary agreement on salt however. Dr Atherton
noted that the change in salt consumption achieved so far was
"fairly marginal" (Q 455). Back
QQ 544-5. Back
Q 466. Back
Q 456. Back
Q 467. Mr King cited the example of a voluntary agreement on reducing
the use of plastic bags to demonstrate this point. Back
Q 562. Back
Q 456. Back
Q 561. Back
Q 558. Back
Q 561. Back
The public health responsibility deal, DH (March 2011). Back
The organisations were: Alcohol
Concern, British Association for the Study of the Liver, British
Liver Trust, British Medical Association, Institute of Alcohol
Royal College of Physicians. Back
The press release by the organisations concerned can be found
Q 516. Back
Q 226. Back
Q 462. Back
Q 738. Back
Q 558. Back
Q 738. Back
Q 710. Back
Q 739. Back
Creating growth, cutting carbon op. cit; Healthy lives,
healthy people op. cit. Back
QQ 322, 407. Back
BC 116, BC 121, BC 127, BC 136, BC 141. Back
QQ 449, 573. It was also noted however that these reforms did
carry risks.Professor Nathanson, for example, suggested that "the
risk in the short term is of fragmentation and ... the ... loss
of a really expert resource" (Q 573). Back
Q 377. Back
Q 449. Back
Q 630. Back
Q 739. Dr Atherton made a similar point about building the evidence-base
at a local level for health interventions (Q 452). Back
Q 442. Back
BC 121, BC 127, BC 136. Back
BC 42, BC 121, BC 127, BC 131, BC 136, Q 452. Back
BC 42. Back
Q 739. Back
Q 663. Back
BC 138. Back
QQ 269, 395, 398, 400. Back
Q 400. Back
Creating growth, cutting carbon, op. cit, para 3.26. Back
Q 631. Back
QQ 446-7, 573. Back