Health and well-being David Halpern

Transcription

1 Health and well-being David Halpern CEO, BIT National Advisor on What Works

2 Behavioural factors account for many years of healthy life lost Tobacco 12.2% High blood pressure 10.9% Alcohol 9.2% C holesterol Overweight 7.6% 7.4% Low fruit and vegetable intake Physical inactivity 3.3% 3.9% Illicit drugs Unsafe sex Iron deficiency 0.8% 0.7% 1.8% UNCLASSIFIED UNCLASSIFIED 2 WHO, 2000

3 Leading factors (Canada)

4 Our government will find intelligent ways to encourage, support and enable people to make better choices for themselves.

5 Can nudging help?

6 An everyday nudge

7 Nine out of ten people pay their tax on time.

8 Social norms to increase tax payment rates within 23 days (1 month) 33.6% 35.1% 35.9% 37.2% 39.0% Control (8,558) UK Norm (8,300) Local Norm (8,403) Debt Norm (8,779) Local + Debt Norm (8,643)

9 Doctors & Dentists response rate to different trial arms 4% 21% Personalisation and simplification can have big impacts 35% 35% Generic Letter Traditional Style Medics Simplified (We Know + Oversight) Simplified + Ipsos Mori data

10 Participation in workplace pensions 90% 80% 70% 60% 50% 40% 30% 20% 10% 61% 83% Autoenrolment led to more than 1million new savers in less than a year and especially the young 0% Before autoenrolment After autoenrolment

11 in health?

12 Suicide a mysterious reduction Hawton, 2007; Kreitman, 1976

13 Changing SMS reminder messages can reduce missed hospital appointments by a third % of patients missing appointments Fairness is less effective Specific costs ( 160 ) are more effective 3.8 % points or 40,800 missed appointments in one NHS trust in a year 11.7% 10.8% 7.6% 10.9% 7.1% Control (from previous trial) Missed appt wastes money (n=816) Missed appt costs 160 (n=845) Be fair to others (n=826) Recorded as missed appt (n=806)

14 Medical errors - Imperial College collaborated with us to simplify hospital prescription charts

15 Proportion of medication orders The revised chart reduced prescribing errors 100.0% Existing chart (n=174) 90.0% 80.0% 70.0% Improved chart (n=163) King et al. (2014) Redesigning the choice architecture of hospital prescription charts. Forthcoming. 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Dose entered correctly Prescriber's contact number entered Frequency of medications entered correctly

16 Digital makes trials even easier: eg we ran a trial to optimise the design of the Stoptober website Carousel Fact Preticked box Image Testimonial

17 15.1% 16.3% 17.2% Improving registration rates for the Stoptober campaign website Website version

18 Implementing the best performing variant led to net increase of 3,060 registrations by the end of the campaign

19 EASY ATTRACTIVE TIMELY SOCIAL

20 Your turn!

21

22 1. Control 2. Norm 3. Norm & Picture 4. Norm & Logo

23 5. Three Die 6. Nine Lives 7. Reciprocity 8. Action

24 Proportion joining the organ donor register after a simple online prompt 100,000 extra per year 2.3% 2.8% 2.9% 2.9% 2.9% 3.1% 3.2% 2.2% Control Take Action 1000s Heart Lives 3 Die Would you People

25 A different approach to policy

26 There has been a significant rise in smokers quitting since % of adults who smoked in last 12 months quitting (N=5959) 2008 (N=4602) 2009 (N=4973) 2010 (N=5775) 2011 (N=4892) 2012 (N=4726) 2013 (N=4710) 2014 (Feb) (N=678)

27 E-cigarettes are a major factor % of smokers trying to stop using e-cigs and NRT E-cigs NRT OTC NRT Rx Q Q Q Q Q Q Q Q Q Q Q Q1

28 Price when does it work?

29 Social isolation has major health impacts Meta analysis: comparative odds of decreased mortality Source: Holt-Lundstad et al, 2010 LGID: Wellbeing - why bother? UNCLASSIFIED 29

30 People helping people harnessing reciprocity and the economy of regard

31 Well-being

32 In 2010, the UK Government decided to take subjective well-being seriously...economic growth is a means to an end. If your goal in politics is to help make a better life for people which mine is and if you know, both in your gut and from a huge body of evidence that prosperity alone can t deliver a better life, then you ve got to take practical steps to make sure government is properly focused on our quality of life as well as economic growth, and that is what we are trying to do. 25 th November 2010

33 Measuring subjective well-being How satisfied are you with your life nowadays? To what extent do you feel the things you do in your life are worthwhile How happy did you feel yesterday? How anxious did you feel yesterday

34 Growth and well-being

35 Well-being and GDP by country

36 Rutland Wokingham Hartlepool Blackburn

37 Drivers of well-being? UNCLASSIFIED Source: BHPS; Cabinet Behavioural Office analysis, Insights 2011 ltd

38 Percent saying most important The Danish formula Denmark UK Bulgaria UNCLASSIFIED 38

39 What does this mean? Respect and dignity Supportive relationships Personal control Personal resilience Experience of natural world Employment

40 Do you think other people can be trusted?

41 At very least, we can use data to help inform personal choices in life UNCLASSIFIED 41

42 Conclusions

43 David Cameron s Vanity Project

44 Press coverage

45 Behavioural Insights powerful at micro and macro level encourages wider use of RCT s and what works promotes deeper thinking about well-being needs public permission.

46 David Halpern

47 Appendix

48 Example: Analysis of Airport Noise UNCLASSIFIED 48

49 Example: Analysing National Events UNCLASSIFIED 49

50 The number of visits to the Stoptober page, and the percentage who registered by Hour % 25% Mornings reduced signups from 17% to 16% 14% 18% 20% 15% AND 10% % A more complex website did worse particularly 5% in the morning 5% %

51 The lottery was highly cost effective (and the size of the prize didn t matter much) 44.8% 46.3% 46.7% Control 1,000 5,000

52 % Response Rates of Plumbers to HMRC Letters 17.3% 3.5% 8.3% Traditional Short + Soft Message Short + Hard Message

53 Increasing legacy giving 15.4% 10.4% 5.0% Control Just Ask Passion Ask

54 Re-shaping markets 1. Scan your bill 2. Switch & save

55 We introduced a pilot in a Jobcentre in Loughton, Essex. It encouraged planning

56 Our pilot showed that these things help people on benefits 5% Treatment effect 4% Benefit history difference 51% 60% Control Treatment Treatment Adjusted

57 Removing small frictions seems to make a disproportionate difference 19.2% 23.4% Webpage Direct to Form

58 Dr D Halpern 1 Plough Place London EC4A 1DE Dr D Halpern 1 Plough Place London EC4A 1DE David, You really need to open this

59 Response to white, personalised envelopes vs. brown envelopes with no message 21.8% 26.0% Brown Personalised

60 Simplifying letters from HMRC to those suspected of not paying capital gains tax helps to bring in millions Average return to HMRC per letter sent ( ) The more complex letters result in fewer payments, but MORE phone calls (22% for Control vs 16% for Simple + Direct) Would have raised an extra 2.5million if the simple + direct letter had been used Control Simple Simple + Direct Revised Total number of letters sent = 37,966