Friday, 2 June 2017

Sticks, Carrots and Nudge - a Proposal

The British government's so-called 'Nudge Unit' is well-known among policy makers. The idea that giving citizens a slight nudge in the right direction rather than using proscriptive laws or behaviour-changing taxes - has taken hold in many governments.

I'd like to propose an idea that came to me as I hurried through St Pancras station this morning on my way to a meeting. I walk a lot - since 1 January 2014, my daily average has been 10,491 paces. How do I know this? At first, a pedometer, now replaced with an accurate health app in my phone, logged on a spreadsheet.

Walking is good for us, says the NHS, the World Health Organisation and the Surgeon-General of the USA. All set a target 10,000 paces (around 8km) a day. Now, I'm doing this. Thus reducing the costs of my long-term healthcare costs. And yet, paying into a healthcare system remains a one-payment-fits-all model. Now, I'm all in favour of those with healthy genes to subsidise the healthcare of those not so favourably born. But surely governments should be able to differentiate those who actively take care of their health, and those that neglect it?

To what extent could a carrot be offered to those prudent with their health?

Long-term research clearly shows the benefits of regular exercise. So how about - on a voluntary basis - offering a discount on monthly payments (National Insurance in the UK, ZUS in Poland) for people who agree to have their activity monitored?

I'd happily share data from my phone with the state to prove that I indeed walk my 10,000 paces a day. Connect my smartphone to a government server, and let it see my daily walking.

Furthermore - how about an incentive not to drive your car into town? My health app verifies my walking, but the GPS in my phone also shows that I travel to work exclusively by public transport. If a city can calculate the true cost of a commuter driving to town each working day, in terms of congestion, pollution and the opportunity cost of the real estate on which the car rests for eight working hours, then it can share some of that cost with citizens who forego the car.

All of this can be worked out these days by GPS, by ANPR (automatic number-plate recognition), by your health app in your phone or watch, by public transport revenue-collection equipment such as Metro gates. The technology is easy.

As well as penalising those who insist on driving with a congestion charge, paying the rest of us a decongestion reward would be beneficial in the drive to unclog our cities.

More and more commentators and futurologists are talking about taxing the robots and artificial intelligence systems that will take over so many jobs in our economy over the next 20-30 years. From those taxes, a basic citizen's income (already under discussion in countries like Switzerland and Norway) can be paid. And this tax can be tweaked by the value that a citizen adds to their economy.

Behavioural value - leading a healthy lifestyle, polluting less, recycling more, activities that are useful to society and to the environment should not go unrewarded. Behaviour can be monitored, and - provided this is done with the citizen's consent - good behaviour should be turned into monetary reward.

How does that sound?

This time two years ago:
London vs. Warsaw pt 2: the demographic aspects


whitehorsepilgrim said...

The key to this, as with any project, would be to make sure that the benefits are realised. So greater exercise (or less smoking and drinking, better diet, or whatever) would need to result in a real and measurable reduction in healthcare expenditure (or an increase avoided). One issue is that the benefits might only be realised after years have passed. So, in the short term, those with unhealthy lifestyles would need to be charged more so that others could be offered a reduction.

I'd nominate another area where people might be nudged to individual and general benefit - getting a good night's sleep. This would make quite a difference to the physical and especially mental wellbeing of this sleep-deprived nation.

Michael Dembinski said...


Ensuring benefits are realised - Tech is making this foolproof. Want to get someone to take your health app 'for a walk'? One simple algorithm compares results from (consenting) participants' apps and concludes that two were taken on exactly the same route, walking at exactly the same pace. Fail.

More difficult to account for diet, smoking/drinking. The supermarkets that'll be offering health insurance products can tell from your loyalty card how much you spend of fresh fruit & veg and how much on vodka and fags. And price your premium accordingly.

SLEEP! YES!!! A brilliant idea. I'll start logging my sleep on my all-purpose health spreadsheet that I've been using since Jan 2014. This will be very interesting! Simply put in time of going to bed, time of waking up and tot up hours spent sleeping. Very interesting to then correlate sleeping time vs performance (mental and physical) the next day. Thanks for that!

whitehorsepilgrim said...

The issue, I think, is making sure that the financial benefit (such as reduced NHS expenditure) gets realised. We can measure whether people walk more, or even eat more fruit, but what about fewer visits to the doctor? Especially if more walking now means fewer medical issues well into the future. Otherwise it's all a bit academic. Plus, the current UK government seems rather keen on handing over risk to others, not carrying risk (the degree to which a healthy lifestyle benefits the exchequer) which it can get others to price for. (That's why train companies operate on franchises rather than concessions, for example.)

A private insurer might be quicker than the state to try your approach, if the data shows a benefit, rather like black boxes monitoring driver behaviour which is reflected in insurance premiums.

There's another factor in play. Once 'good behaviour' is monetised, poor behaviour might increase. For example, a school that started 'fining' parents for collecting their children late (meaning that staff had to stay on to supervise them) saw an increase in late collection. (This is a real example, not a hypothesis.) "£5 more a week in tax to cover drinking and smoking - a bargain." Human behaviour can be a peculiar thing.

Ian Wilcock said...

I would also question the access, legal or not, to what is extremely personal and to the corporate world of big data, valuable information. Governments world wide have not been effective at this to date.