What is nudge theory?

With countries such as China, South Korea, Italy and Iran locking down borders, shutting schools, banning gatherings and quarantining travellers, much has been made of the UK’s alternative approach to combating coronavirus.

The UK government is instead partly basing its plan on behavioural “nudges”, eschewing more extreme social distancing methods in favour of smaller social changes.

These behavioural changes include encouraging regularly washing your hands, not touching your face, not shaking hands with others, staying at home if you feel ill and self-isolating in response to a continuous cough.

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The UK government’s strategy is influenced by “nudge theory” – but is it the right approach?

What is nudge theory?

Nudge theory was first popularised by the behavioural economist Richard Thaler and political scientist Cass Sunstein in a 2008 book called Nudge: Improving Decisions about Health, Wealth and Happiness.

Writing in The Guardian, former economics professor and think-tank adviser Tony Yates explains that so-called “nudging” uses “insights about our mental processes to change our behaviour through coaxing and positive assertion”.

Rather than forcing us to do things, Yates says, nudging “tweaks the environments in which we make choices”.

As an example, Yates points to requiring people to opt out of organ donation (as opposed to opting in) to try to drive up donor numbers.

In the book, Thaler uses the example of Schiphol Airport in Amsterdam, where authorities etched the image of a black housefly into each urinal in the men’s bathrooms.

“It seems that men usually do not pay much attention to where they aim, which can create a bit of a mess,” Thaler writes. “But if they see a target, attention and therefore accuracy are much increased.”

How is the UK government using it to tackle coronavirus?

As Yates notes, nudge theory is not only informing what the UK government is doing, but also what it is not doing.

He notes that “the government’s strategy has at its heart predictions about human behaviour”, including insights that suggest early warning campaigns about social distancing and extreme measures can cause fatigue among the population, reducing their effectiveness.

“Behavioural science shows that people start off with the best of intentions, but enthusiasm at some point lags”, Chris Whitty, the government’s chief medical officer, has claimed.

Caroline Kamau, a senior lecturer in organisational psychology at Birkbeck, University of London, writes that the UK government consulted virologists, epidemiologists and behavioural scientists who said that the plan to combat the coronavirus should make “people individually responsible”.

This, Kamau writes, is why the government is encouraging methods of containment such as washing hands, coughing into tissues and self-isolating if you have symptoms, as opposed to closing schools, universities and large events.

Is it the right approach?

Only time will tell whether the approach is the right one; however, one medical expert has warned that “the government is playing roulette with the public”.

Richard Horton, editor-in-chief of medical journal The Lancet, wrote on Twitter: “The UK government – Matt Hancock and Boris Johnson – claim they are following the science. But that is not true. The evidence is clear. We need urgent implementation of social distancing and closure policies.”

Meanwhile, The Daily Telegraph’s global health security editor Paul Nuki has reported that medical experts have accused the government of being “seduced” by behavioural scientists who are “running a dangerous experiment” in nudge theory that could go “horribly wrong”.

Kamau notes that there is no published evidence showing that applying nudge theory to something like coronavirus is “empirically accurate”, adding that “using nudge theory to tackle coronavirus is a very risky gambit”.

In the Guardian, Yates also points out that the government has not disclosed what studies and past evidence are guiding their current approach.

“The evidence suggests that the impact of ‘nudge’ interventions on behaviour change is quite small,” Kamau writes. “The risk that the virus will spread is therefore likely to be much higher than the mathematical modelling used by the UK government’s experts.”

Speaking to the Telegraph, Martin Hibberd, professor of emerging infectious disease at London School of Hygiene and Tropical Medicine, said: “The UK response has clearly not been sufficient, as numbers are continuing to climb and we are at risk of following the trajectory of other European countries.”

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This warning was echoed by Devi Sridhar, professor of global public health at the University of Edinburgh, who tweeted: “Now is the time for UK govt to ban large gatherings, ask people to stop non-essential travel, recommend employers shift to home working & ramp up the response.

“Curve can only be shifted [like South Korea and Singapore] with govt action.”

The Washington Post has produced a number of graphics showing how “if people are less mobile and interact with each other less… [coronavirus] has fewer opportunities to spread”.

This followed advice by US health officials to avoid public gatherings, stay at home more often and to keep your distance from others.

So far, Boris Johnson and his advisers “respectfully disagree” with the criticism of their plan.

Patrick Vallance, the government’s chief scientific adviser, said last week that on average one person infects two or three others.

“You therefore have a very low probability of infecting a very high number of people in a stadium,” he added.

However, the situation is changing by the minute, with the government due to give daily briefings on its plans.