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'….for everything else, there's behavioural science'

When Public Health England (PHE) Chief Executive (PHE), Duncan Selbie, gave a keynote address at this year's conference, he presented the case for the future of behavioural science in increasing years spent in good health for our population. He challenged health psychologists to get organised and come together to work with public health and ensure we achieve the impact that research in our field needs to have. Professor Katherine Brown elaborates on his key messages......

Beginning by saying that 'the Golden years are ahead of us', Selbie explained that in relation to infectious disease, the 'other half ' of what PHE does, the organisation have around 3000 scientists working with dangerous pathogens to address a wide range of communicable diseases like tuberculosis, Ebola and Zika. They work to be prepared to address the next pandemic. He explained that the future of this work is mathematics, software engineering, some geography, genome sequencing and big data. The pace of change in this field is astonishing and transformational methods of outbreak control are developing at speed. Everything else, he said, is about behavioural science.

Selbie elaborated, when we think about health, we conflate good health with the NHS and what the NHS can do” – his point being that of course we need a strong, properly-funded and confident NHS, but that alone cannot improve the health of the people.
In the last century or so everyone's lives have improved: people live longer and healthier lives than ever before but health inequality – the difference between the affluent and the poor – is as high as it has ever been. Selbie cited PHE work which has established that around 10% of the contribution to health within the population is attributable to treating illness and the NHS, and that a much bigger percentage is about tackling health inequality and differences in socio-economic status (and a bit of genetics). For example, around 30% of health outcome is attributable to whether or not you smoke, what and how much you eat, whether or not you take exercise and how much you drink. He referred to these factors as 'choices' that can be influenced and this is the role of behavioural science.

Selbie talked about some of the successes to date for behavioural science from PHE including influencing members of target populations directly and partnerships with commercial players that influence the choices we make daily. PHE, he said, are getting better and more organised at trying to join things up.
Take ‘Stoptober’ – a campaign encouraging a mass quit-smoking attempt every autumn using behavioural science techniques to create a sense of being part of a community. It feels less daunting to be challenged to quit for one month rather than forever and if you can make it to 28 days smokefree, you’re five times more likely to never smoke again. So far over a million people have joined Stoptober since 2012.

nother example is the Change4Life snacking campaign which offers advice on healthier options to the parents and carers of primary school aged children. This age group of children in England are the most overweight in Western Europe and half of their sugar intake comes through snacking. Change4Life advises parents and carers to look out for snacks containing 100 calories or less, and to give children no more than two a day; this is likely to reduce their overall food and sugar intake each day.

In the commercial sector, organisations are keen to partner up with PHE because evidence suggests consumers want to see action on obesity. Greggs are going for healthier options and McDonalds, which has 3 million sales points every day, has been working on embedding PHE’s 400 600 600 calorie guidance for breakfast, lunch and dinner in their menu. Similarly, the Sugar tax has been influential. The intention of a tax on sugary drinks wasn’t to raise money but to change behaviour; to motivate the commercial sector to remove or reduce some of the sugar content in their drinks and some positive action has already been taken.

Selbie wants to bring the challenge of making the nation healthier to our door. He wants psychologists to pick up the reins and take a serious look at how we use behavioural science and bring the evidence to bear on closing the health inequalities gap. The big question is how we make the healthier choices the easier choices and recognising that people are at the heart of this. He warned that it's not sufficient just to be right. Our evidence may be strong, we may be building on it all the time, but we must ensure we also have the consent of the people and build this into our activities.

He commented on the importance of coming together during the conference to learn from each other and create new connections for working together. He said, you are in the foothills of the impact that you must have.  We need to think about how we shift behaviour and how we make it easier to make healthier choices, while keeping a focus on closing the gap between the affluent and the poor. Government can do certain things such as bringing in the sugar tax but we need to do the rest.

Written by Katherine Brown