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Chapter 2: Nudging For Good – How Governments Use Behavioural Science

How to change an irrational behaviour: smoking

To demonstrate how governments have been leading the way in applying behavioural science, let’s look at an example of a behaviour successfully addressed using these principles: smoking.

Smoking is the single largest driver of health inequalities in the UK, killing nearly 78,000 people every year in England alone.19 I spent a large part of my public service career addressing this challenge. In 2006, I first joined the public sector as a campaigns manager at the Department of Health, and my role was delivering public information campaigns designed to encourage people to quit.

Smoking is in many ways the quintessential, irrational behaviour. Spock would never touch a cigarette. The legacy of consistent government campaigning for over 40 years means virtually all smokers know it is bad for them. Most want to quit. But lack of willpower, plus the chemically addictive and habit-forming nature of smoking, means they find it hard to do so. Focusing on rational drivers of behaviour – simply providing the logical reasons for quitting – was not going to achieve our campaign objective to reduce overall adult smoking rates to 21% or less by 2010.

All of our work was couched in terms of behaviour. Everything we did was assessed on the basis of whether it was likely to influence people to quit smoking, and stay that way. The metrics for policy and campaigns were mostly in terms of smoking-related behaviour – overall smoking rates, people attending NHS Stop Smoking Services, and calling our helpline or visiting our website.

Much of the evidence of efficacy was based on flawed data – on what smokers were telling us, which was not necessarily an accurate reflection of what was driving their behaviour, as we will see in part five. The principles we were applying were from social marketing, or how to use established marketing techniques to change behaviour for good. Much of the theory that informed this was based on psychology, and understanding the irrationalities of human behaviour.

To build a new departmental tobacco marketing strategy, our team worked with an external strategist, the leading ad planner Kate Waters, now director of client strategy and planning at the UK broadcaster, ITV.

As Waters put it when I interviewed her in early 2019 at Now, the advertising agency she co-founded: “I did a psychology degree and I never imagined that it would be particularly relevant or useful – in fact I think I managed to forget most of it – until about ten years later when I was working on a brief from the British Heart Foundation, where I had a hunch that psychology might be useful. It was an amazing brief which was essentially ‘the government wants to get more people to stop smoking, and think we should scare people into doing so, but they are concerned that the NHS as a brand is too nice and caring and sharing to do that.’ So they asked the British Heart Foundation to think about what we could do to add another voice to the debate around tobacco control.

“The ad that resulted is what became known as the fatty cigarette campaign, which I think was probably the most disgusting ad – and I mean that quite literally, as in to elicit disgust – that TV had seen for some time. Possibly ever.

“Smokers have a very deep relationship with the act of smoking, but interestingly they have a slightly more ambivalent relationship with the cigarette itself, and we wanted to turn the venom on the cigarette. We wanted to get to the point where smokers had a ‘Pavlovian’ response so whenever they saw a cigarette they couldn’t help but think of the gunk collecting in their arteries.”

Several years later, this was still the most recalled campaign amongst smokers. More than 14,000 people gave up smoking as a direct result of the campaign.20

Source: BHF Fatty Cigarettes Campaign Ad, 200421

When Waters compiled our department’s marketing strategy a few years later, she brought in insights like this from behavioural science to help people quit more successfully. The strategy changed from simply giving people rational reasons to quit based on the long-term consequences of smoking (e.g. increased risks of heart disease, stroke, and lung cancer), to more emotive and immediate short-term effects that leverage heuristics and biases, as in this example.22 Additionally, the campaign put equal focus (and budget) on providing tools to help people stay smoke-free, after the initial attempt to quit. These included a number of psychologically informed nudges at relevant times to boost quitters’ motivation and willpower, delivered by text messages and email, including positive messages about the health benefits that non-smokers experience.

This worked spectacularly. Over 100,000 people responded to our 2008 campaign to seek NHS help to quit, and we delivered the 21% target by 2009 – a year early. And it personally inspired me to start applying these principles more regularly in my work, in both the public and private sectors.

Nudging for good

A few months later in 2008, the book Nudge was published. Written by Cass Sunstein, a Harvard law professor, and Richard Thaler, a University of Chicago economics professor, this showed how insights from behavioural economics could be used to encourage better behaviours, through ‘nudging’ or ‘libertarian paternalism’.

Few books have had such a widespread impact on the practices of governments and beyond. The premise is relatively simple. Using their Spock and Homer analogy, Thaler and Sunstein demonstrated the most effective way to change behaviour is often to ‘nudge’ our desired behaviours – eating better, saving for retirement, donating our organs – because we lack the ability or willpower to achieve this due to our innate biases.

Rational appeals to our system-2 processes will be ineffective in those situations. In the smoking example, a smoker’s Spock brain knows it is better for them to quit – but Homer stops them doing it.

They define a nudge as a subtle, often seemingly insignificant, change to the ‘choice architecture’ – the way a choice is presented – which influences the choice taken. The numbers of people registered as organ donors, for example, can be significantly increased by moving to an ‘opt-out’, not ‘opt-in’, model, i.e. everyone is assumed to consent to be an organ donor unless they explicitly say otherwise, typically when completing a government form.23 Similarly, putting healthy food on more accessible (e.g. lower) shelves in a supermarket increases the number of people buying those products rather than unhealthy snacks.

The visceral warnings on cigarette packs also qualify as a nudge, because they do not restrict the ability to buy cigarettes, but instead make it more cognitively difficult to buy (less attractive). Similarly, making cigarettes more physically difficult to buy (putting them in an unmarked locked cabinet, for example) is another nudge.

The approach gained instant favour among government policy-makers. The advantages are clear: firstly, it does not force citizens to change behaviour, as their ability to choose is maintained and their individual liberty is upheld; secondly, changes to choice architecture are typically low-cost, low-impact interventions; and thirdly, by ‘going with the grain’ of peoples’ desired behaviour, nudges are unlikely to cause widespread objection or unrest among citizens.

As we will explore throughout this book, these are also significant benefits to business. If nudging behaviour is easier, cheaper and reflects sentiment towards the business and brand, then, by definition, it is a more profitable approach than the alternatives. That is, a shove (forcing people into a particular action, such as removing a product from sale) or what Sunstein calls a ‘sludge’ (making it harder for people to achieve a desired outcome, such as making it difficult to unsubscribe from a service).

Behavioural government

In 2009, the Cabinet Office produced a report with The Institute for Government called ‘MINDSPACE’, which sought to guide policy-makers on how to use these principles. Sunstein became a key advisor to the Obama administration, and Thaler was integral to the establishment of the Behavioural Insights Team (BIT) – the new ‘nudge unit’ strategy team created under David Cameron’s government in 2010, led by David Halpern (one of the authors of ‘MINDSPACE’).

A number of the founding personnel and principles for the BIT were from the Behaviour Change Unit previously established at the COI, the centralised government marketing department where I was working as a communications planner at the time.24 Using these insights from behavioural economics, social marketing and social psychology, the COI had also produced a report in 2009 on best practice communications and behaviour change. With my colleague, Guy Dominy, we designed a training program for government communicators based on principles from this and ‘MINDSPACE’ – drawing on examples from the tobacco campaign, in particular, to illustrate how a focus on nonconscious influences can successfully drive behaviour change.

From here, the BIT has grown to have a presence in five countries globally, and the model has been adopted in a widespread fashion elsewhere, with the creation of numerous ‘nudge units’. This growth has been driven by a scientific application of the findings of behavioural science.

In government, where accountability is paramount, this evidence-based approached has proven revolutionary. As Halpern puts it: “This is just a glimpse of an exciting and important future: where policy and practice is based on hard evidence, not just instinct or history, and where public money can go further and outcomes continually improved.”25

Guided by successes such as the reduction in smoking prevalence, governments have moved from a narrow application of the insights from behavioural science in (social) marketing to a much broader, scientific, outcome-based application. There is much that business can learn from this approach.

Nudging through technology: My QuitBuddy

In 2012, I moved to Australia to take up a role as strategy director at the media agency (UM) for the Australian Federal Government.

As in the UK, smoking was the single biggest preventable cause of death in Australia. And despite a long heritage of effective behaviour change campaigns giving Australia one of the lowest smoking rates in the developed world, smokers continued to smoke despite being aware of the risks. It was clear, as in the UK, that focusing on the desired behavioural outcome (getting people to quit and stay quit) would be more effective at reducing smoking rates than simply giving rational reasons to give up – giving them the how, rather than telling them why. It would also be considerably more efficient (i.e. cheaper) than an expensive advertising campaign – an example of what Thaler calls “making it easy”, his three-word summary of Nudge.

When I joined, my new colleagues at UM had talked to our government clients about using then-new mobile app technology to help people quit. Bringing insights into effective ways of nudging behaviour – such as the importance of social proof (i.e. seeing that others had successfully quit using the app) and saliency (i.e. providing bespoke information to each user) – we built an app with development partners The Project Factory called My QuitBuddy.

The first version was built in a mere eight weeks and was very much based on an MVP (Minimum Viable Product) approach,26 with fairly limited functionality. It included motivational messages of support, a game that smokers could use to distract themselves when experiencing cravings, the ability to record motivational messages from loved ones and provided up-to-date data each time a smoker opened the app on how much money they had saved, toxic tar they had avoided and so on.

After launch, My QuitBuddy quickly achieved the number-one ranking in the Health and Fitness category on the iOS app store, with over 100,000 downloads in the first year. Seven years on, it is still going strong. It has been downloaded over half a million times, and the quitting success rate of users is eight times higher than smokers without support. The app has been white-labelled for use by a number of other governments and is still a key part of Australian government stop-smoking campaigns. It is probably the most effective stop-smoking intervention employed to date by the Federal Government.

Why has it proven so successful? The initial insight behind developing an app was that most quit attempts fail because cravings can hit at any time, so timely support needs to be within arm’s reach at any moment. For most of us, the only thing within arm’s reach 24 hours a day is our mobile phone. The technological solution was therefore built around an insight into the desired behaviour – and not created for its own sake.

But, more importantly, we were able to create a more effective, addictive and usable app because we had data on what parts of the app people were using. It has been continually updated over the last seven years based on data on actual behaviour.

For example, we found app users were screen-grabbing the homepage (which showed how much money they had saved, how long they had been smoke-free, etc.) and posting it to social media accounts. In the spirit of making it easy, we updated the app to allow users to directly link it to their Facebook and Twitter accounts, so that with one tap they could post an update. This leveraged two behavioural biases: commitment bias (making a public commitment makes us more likely to stick to a behaviour, in this case telling all your friends you have quit); and social proof (showing how popular the app was would encourage others to download and use it).27

The app was continually optimised based on actual user data and behavioural science best practice, a distinct advantage over a traditional, one-hit advertising campaign.

I think this example of how behavioural science has been used to address an important societal problem can tell us a lot about how to solve business problems, as well as save lives, and has been hugely informative in my own work. It tells us about the importance of focusing on (behavioural) outcomes, like helping people quit rather than simply telling them why they should. Similarly, it shows us how behavioural science can lead to a better evidence base and enable more creative solutions (such as the fatty cigarette campaign), as well as how technological solutions work best when grounded in a behavioural insight, rather than simply a desire for novelty or innovation. We shall explore this more in part two.

In the next chapter, we will see how this kind of scientific approach – based on testing, learning and optimising – is fundamental to building a successful behavioural business.

19 NHS England, Statistics on Smoking – England, 2018.

20 www.thirdsector.co.uk/change-makers-british-heart-foundation/communications/article/1192942

21 If you are curious, Waters told me that the ‘fat’ in the cigarette was made using a combination of hummus and wallpaper paste. Which must have smelt disgusting.

22 In part five we shall see that the motivational messaging subsequently centred on the consequences of smoking on smokers’ families.

23 However, this does not necessarily increase the number of people who receive organ donations. The issue is a complex one, as it is also heavily determined by the processes employed by hospitals when a donor dies – as they need to then obtain consent by the next of kin, and have the right staff and logistics in place to ensure the organ can be received and transported in time to be used by the donor. The single biggest improvement in live organ donation success rates in the UK was actually achieved by having a dedicated donor nurse active in each NHS hospital. Obviously having more people on the register is helpful to increase the pool of donors, but the debate is whether a mandated opt-in (so that everyone has to state their preference, and let their next of kin know their intention) is preferable to an opt-out system, which leaves potential doubt about their wishes in the event of their death, and so leads to more next-of-kin refusals. Scotland and Wales have moved to an opt-out system in recent years, and at time of writing England has stated an intention to do the same.

24 The now defunct COI (Central Office of Information) was established shortly after the Second World War, as the successor to the Ministry of Information (the propaganda department), initially to inform the nation about the newly created NHS. It is perhaps best known for producing much-loved public information films such as ‘Charlie Says’ and ‘The Spirit of Dark Water’, as well as for well-respected evidence-based best practice in behaviour change communications. Despite its integral role in the creation of the BIT, it was closed by Cameron’s government in 2012 as part of austerity measures. Following a public vote of no confidence in its successor by the Institute of Practitioners in Advertising (due to its procurement processes), a new Government Communications Service was subsequently established – effectively a COI 2.0. Meanwhile, nearly all COI staff had either left (like me), taken redundancy, or moved on to other departments.

25 www.theguardian.com/public-leaders-network/small-business-blog/2014/feb/03/nudge-unit-quiet-revolution-evidence

26 This was mainly because the minister for health wanted a major announcement she could make on World No Tobacco Day on 31 May 2012 – which was eight weeks away. Whilst it was a stretch to make this target, it was the right thing to do in hindsight. The minister had an eight-minute slot on primetime TV programme The Project (the Australian version of The One Show) where she talked about the app for most of that running time. This PR exposure was hugely effective at driving downloads, which snowballed from there.

27 See page 10 for an explanation of social proof.