CHAPTER 8: CONCLUSIONS AND RECOMMENDATIONS
Definitions, categorisation and the ethics of
behaviour change interventions (Chapter 2)
INTERVENTIONS AND ETHICAL ACCEPTABILITY
8.1. The idea of the Government intervening to
change people's behaviour will often be controversial, and so
it is important that ministers are always able to explain the
evidence-base of any proposed behaviour change intervention, and
why it is a necessary and proportionate means of addressing a
well-defined problem (paragraph 2.20).
Understanding what influences behaviour (Chapter
3)
APPLIED RESEARCH AT A POPULATION LEVEL
8.2. There is a lack of applied research at a
population level to support specific interventions to change the
behaviour of large groups of people (including a lack of evidence
on cost-effectiveness and long-term impact). This is a barrier
to the formulation of evidence-based policies to change behaviour.
To address this problem, the Government will need both to evaluate
their own behaviour change interventions rigorously and establish
new evidence by commissioning and funding more applied behavioural
research on this scale (paragraph 3.10).
Evidence-based policy (Chapter 4)
ARE GOVERNMENT POLICIES EVIDENCE-BASED?
8.3. We acknowledge that there will be occasions
when it is legitimate for a government not to implement behaviour
change interventions for which there is good evidence of effectiveness.
In these circumstances, however, we believe that ministers have
a responsibility to explain why they have decided not to do so
(paragraph 4.7).
8.4. We agree with the principle, stated in the
Government's Principles of Scientific Advice, that ministers
should explain publicly their reasons for policy decisions, particularly
when a decision is not consistent with scientific advice and,
in doing so, should accurately represent the evidence. This places
a responsibility on scientists and social scientists within government
to ensure that ministers are provided with accurate and up-to-date
advice on the available evidence about how to change behaviour
so that they can identify where and why they are not basing a
policy on the evidence (paragraph 4.8).
Addressing the barriers to evidence-based policy
8.5. We urge ministers to consult their departmental
Chief Scientific Advisers about whether the amount of money spent
on applied behaviour change research at a population level is
sufficient to meet their policy needs (paragraph 4.16).
Translation of research
ROLE OF GOVERNMENT SCIENTISTS
8.6. We recommend that, at the earliest opportunity,
the Government appoint a Chief Social Scientist who reports to
the Government Chief Scientific Adviser and is an independent
expert in social science research to ensure the provision of robust
and independent social scientific advice (paragraph 4.23).
8.7. We further recommend that the Government
consider whether existing mechanisms for the provision of social
scientific advice, in particular advice on behavioural science,
are fit for purpose. This should include consideration of how
departmental Chief Scientific Advisers and social scientists within
departments can best work together to provide up to date social
scientific advice to support evidence-based behaviour change interventions
(paragraph 4.24).
BETTER LINKS BETWEEN THE ACADEMIC AND POLICY MAKING
COMMUNITIES
8.8. Departmental Chief Scientific Advisers,
whether or not they have experience of the sciences of human behaviour,
should be responsible for establishing and maintaining contacts
with leading behavioural scientists with expertise relevant to
their policy areas and for consulting them as necessary (paragraph
4.30).
BEHAVIOURAL INSIGHTS FOR POLICY MAKERS
8.9. We recommend that the Cabinet Secretary,
in consultation with the Government Chief Scientific Adviser and
Chief Social Scientist, once appointed, should take steps to ensure
that civil servants with responsibility for policy making have
the necessary understanding of the importance of changing behaviour
and can identify the most appropriate people to consult in their
own departments about the development of behaviour change interventions
(paragraph 4.32).
GUIDANCE TO POLICY MAKERS
8.10. We recommend that the Cabinet Office, in
consultation with the Chief Social Scientist, once appointed,
consider how to consolidate the available guidance in a form which
is evidence-based and accessible to policy makers (paragraph 4.35).
8.11. We further recommend that the National
Institute for Clinical Excellence updates its 2007 Behaviour Change
Guidance and considers whether accessible, multi-disciplinary
guidance could be provided in relation to health-related behaviour
change policies, particularly to offer more explicit advice on
how behaviour change techniques could be applied to reduce obesity,
alcohol abuse and smoking (paragraph 4.36).
SHARING KNOWLEDGE ACROSS GOVERNMENT
8.12. We recommend that the Cabinet Office, together
with the Government Chief Scientific Adviser and Chief Social
Scientist, once appointed, review the current mechanisms for sharing
knowledge about behaviour change among government departments
with a view to introducing a more streamlined structure (paragraph
4.41).
8.13. We recommend further that this revised
structure should involve the continuation of work begun on the
"inventory of behaviours" in order to establish an archive
of behaviour change interventions. This archive should provide
accounts of the evaluation of the interventions and include unsuccessful
as well as successful interventions (paragraph 4.42).
The Government approach to changing behaviour
(Chapter 5)
THE NEED FOR A RANGE OF INTERVENTIONS
8.14. 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 (paragraph 5.13).
8.15. 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
policies (paragraph 5.14).
8.16. 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
measures alone (paragraph 5.15).
PARTNERSHIP WORKING AND VOLUNTARY AGREEMENTS
8.17. 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 (paragraph 5.25).
8.18. 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
their purpose:
- 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 outcomes
(paragraph 5.26).
8.19. Given that these principles do not appear
to have been applied consistently to the Public Health Responsibility
Deal Network, we urge the Department of Health, in particular,
to ensure that these principles are followed when negotiating
further voluntary agreements. In relation to the current agreements,
we recommend that the Department of Health 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 (paragraph 5.27).
THE ROLE OF LOCAL AUTHORITIES
8.20. 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, 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
and analysis;
- takes 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 (paragraph
5.30).
Evaluation of behaviour change interventions (Chapter
6)
ENSURING EFFECTIVE EVALUATION
8.21. Effective evaluation requires that:
- evaluation should be considered
at the beginning of the policy design process. External evaluation
expertise should be sought, where necessary, from the policy's
inception;
- relevant outcome measures—as distinct from
outputs—should be established at the beginning of the policy
development process;
- the duration of the evaluation process should
be sufficiently long-term to demonstrate that an intervention
has resulted in maintained behaviour change;
- pilot studies, using population-representative
samples, followed by controlled trials assessing objective outcomes
should be used whenever practicable; and
- sufficient funds should be allocated for evaluation,
recognising that establishing what works, and why, is likely to
result in better value for money in the long-term (paragraph 6.14).
8.22. We find however that, at present, evaluations
of Government behaviour change interventions often lack one or
more of these necessary elements. While we welcome the Government's
revision of the Magenta Book, the evaluation guidance for policy
makers and analysts, we believe that it could be further improved.
We recommend that the Government consult external evaluation experts
on the creation of a concise document for policy makers, containing
only the most important principles of evaluation. We further recommend
that they make clear what steps they will take to ensure that
the revised guidance leads to a change in evaluation culture across
Whitehall (paragraph 6.15).
Case studies (Chapter 7)
CASE STUDY 1: TACKLING OBESITY
Change4Life
8.23. It appears that the Change4Life programme
has, on the whole, been evidence-based and appropriately targeted.
We note the Government's commitment to continue using the brand
and urge the Department of Health to ensure that future evaluations
are robust and establish whether or not the programme is likely
to be successful in the longer term (paragraph 7.12).
Population wide interventions: advertising, marketing
and food labelling
8.24. We invite the Government to explain why
their policy on food labelling and marketing of unhealthy products
to children is not in accordance with the available evidence about
changing behaviour. Given the evidence, we recommend that the
Government take steps to implement a traffic light system of nutritional
labelling on all food packaging. We further recommend that the
Government reconsider current regulation of advertising and marketing
of food products to children, taking a more realistic view of
the range of programmes that children watch (paragraph 7.17).
Voluntary agreements
8.25. We draw attention to our recommendation
about the failures of all current pledges made by the Public Health
Responsibility Deal (see paragraph 8.19). Moreover, obesity is
a significant and urgent societal problem and the current Public
Health Responsibility Deal pledge on obesity is not a proportionate
response to the scale of the problem. If the Government intend
to continue to use agreements with businesses as a way of changing
the population's behaviour, we urge them to ensure that these
are based on the best available evidence about the most effective
measures to tackle obesity at a population level. In particular,
they should consider the ways in which businesses themselves influence
the behaviour of the population in unhealthy ways. If effective
measures cannot be achieved through agreement, the Government
must pursue them through other means (paragraph 7.20).
Weight management interventions
8.26. We recommend that the Department of Health
should commission a review of the provision of weight management
services, including the Health Trainers programme, across the
country. We recommend further that the National Institute for
Clinical Excellence should compile a list of approved weight management
services which adhere to their best practice guidance. If the
Health Trainers programme is included in this list, we recommend
that the Government should continue the programme, particularly
in the light of its focus on tackling health inequalities (paragraph
7.25).
CASE STUDY 2: REDUCING CAR USE
Weaknesses of the evidence-base
8.27. We recommend that the Department for Transport
should prioritise funding to research the most effective behaviour
change interventions to reduce car use for medium and longer-length
journeys and undertake pilots of those interventions as soon as
possible (paragraph 7.34).
Promoting and enabling choice: the role of regulation
and infrastructure
8.28. Bearing in mind our concern that the Government's
preference for non-regulatory interventions may lead officials
to give insufficient consideration to regulatory and fiscal interventions
(see paragraph 8.15), we urge the Department for Transport to
ensure that evidence for both non-regulatory and regulatory measures
is taken into account when formulating policies to reduce car
use (paragraph 7.36).
8.29. As the evidence suggests that good infrastructure
is a prerequisite for, and greatly enhances, the effectiveness
of other "smarter choices" measures, we strongly encourage
the Department for Transport to ensure that, wherever possible
in a time of financial stringency, a sufficient proportion of
funds is maintained to make effective improvements and changes
to infrastructure (paragraph 7.38).
Integrated policy packages
8.30. Whilst we welcome the Department for Transport's
emphasis on the use of policy packages, we note they do not include
regulatory and fiscal measures and so do not wholly reflect the
evidence about how to change transport mode choice. This suggests
that their effectiveness and, in turn, their cost-effectiveness
could well be limited (paragraph 7.41).
Localism and the Sustainable Transport Fund
8.31. Although we welcome the principle of the
Department for Transport's Local Sustainable Transport Fund, the
initiative is based on a pilot project which was incompletely
evaluated and so did not provide evidence about the long-term
effectiveness of interventions. Furthermore, (see paragraph 8.30),
the Sustainable Travel Towns pilot did not wholly reflect the
evidence about how to change transport mode choice (paragraph
7.46).
8.32. We commend the Department for Transport's
recognition that, if responsibility for interventions is to be
devolved to local agents, guidance to commissioners on the evidence
and an evaluation framework are necessary. We note, however, that
current guidance does not take into account the evidence about
the need for strong disincentives to car use needed to achieve
significant changes in behaviour and fails to provide any analysis
of the evidence associated with effective interventions (paragraph
7.47).
8.33. We recommend that the Government (a) establish
and publish targets for a reduction in carbon emissions as a result
of a reduction in car use; (b) publish an estimate of the percentage
reduction in emissions which will be achieved through reducing
car use and the timescale for its achievement; and (c) details
of the steps they will take if this percentage reduction is not
achieved by this time (paragraph 7.48).
| 
