Behavioural sciences bring rigour and discipline to intervention design, development, and evaluation. They use explicit theories and models, which can underpin interventions, and provide a cumulative evidence base of what works. Behavioural and social scientists have valuable research and methodological skills, in some cases these can lead to new avenues for public health, such as the ability to use large datasets to inform practice. They can contribute quantitative and qualitative skills for evaluation, to understand what works, how it works, why, and for whom. As noted earlier, we recommend that public health simultaneously draws on multiple skills and expertise from the behavioural and social sciences in a transdisciplinary approach.
In this section we demonstrate how the behavioural and social sciences have contributed to improving the public’s health and the opportunities they present to build on current practice and improve the effectiveness of interventions with two examples: tobacco control and tackling obesity.
Tobacco control
The biggest public health success story of the 21st century may very well be the reduction in tobacco use and smoking-related diseases. It also demonstrates how the behavioural and social sciences can be usefully applied to public health issues.
A broad range of insights and evidence from behavioural and social sciences have been used to understand and develop a range of interventions to address this significant public health issue. The interventions have been implemented at various levels, from the political, to the environmental, to the individual, and include informing the population of the risks associated with smoking, so that they would understand the problem, and then: providing evidence-based stop smoking services to support people attempting to go smoke free, providing a national accessible training programme for practitioners, increasing tobacco taxes, banning advertising, banning smoking in public places, and requiring plain packaging.
The greatest benefits to health are likely to result when social structural changes are combined with more targeted interventions. For example, in the case of tobacco control, raising tobacco taxes has clearly played an important role but when it was used as the only tobacco control measure in the 1990s there was no corresponding reduction in prevalence. The ban on smoking in indoor public spaces has been a huge success in protecting the health of non-smokers, but its effect on smoking prevalence remains uncertain. Social marketing campaigns, including No Smoking Day and Stoptober, have shown good evidence of being effective and highly cost-effective. Targeted clinical interventions, in the form of brief opportunistic advice from physicians and pharmacists, and provision of stop-smoking support, have led to a substantial increase in quitting. (26)
Tobacco control has also tackled health inequalities, when done in a targeted way. For example, Stop Smoking Services reduced health inequalities when they were well targeted to certain groups, such as the sick and disabled, manual workers, and those with mental health problems (29, 30, 31). The Marmot Review concluded that “Tobacco Control is central to any strategy to tackle health inequalities, as smoking accounts for approximately half the difference in life expectancy between the lowest and highest income groups” (2).
Upstream interventions
| Policy category | Intervention | Contributions from behavioural and social sciences |
|---|---|---|
| Policy level | ||
| Legislation |
|
Social science research contributed to the evidence base that led to the ban on advertising and restrictions on marketing (34, 35). Many studies have shown that legislative measures can increase smoking cessation (e.g., 36, 37). [note: The list of interventions on the left is only a sample of the extensive legislative framework that also includes a ban on sales from vending machines, minimum pack sizing, and product regulation] |
| Fiscal Measures |
|
Research has shown that reducing the affordability of tobacco can reduce smoking amongst young people and those of low socioeconomic status (38, 39, 40). |
| Guidelines |
|
Training programme underpinned by evidence from the behavioural and social sciences. The NCSCT website provides an overview of evidence in the area, including recommendations from academic work. |
| Environment level | ||
| Environmental/ Social Planning |
|
Restructuring the physical and social environment is a key strategy to influence smoking behaviour. As well as reducing exposure to harmful second-hand public smoke, which already suffices to justify the policy, it has two effects: (i) it makes smoking more difficult (e.g., by requiring individuals to go elsewhere to smoke or making the acquisition of tobacco harder) and (ii) it changes perceptions of whether smoking is a normal or acceptable behaviour (by reducing the visibility of smoking, both the smoking behaviour of others and the products themselves). |
| Communications/ Marketing |
|
The behavioural and social sciences have been used in a range of ways to improve communications and marketing campaigns. For example, the Stoptober campaign included insights about social networks, setting clear and specific goals, and moment-to-moment impulse management. |
| Individual level | ||
| Service Provision | The English model of smoking cessation is derived entirely from behavioural and social sciences with interventions being composed of individual empirically tested Behaviour Change Techniques. | |
Table 2. Upstream tobacco interventions and the contribution from behavioural and social sciences by ‘policy category’ of intervention as classified by the Behaviour Change Wheel (32, 33).
Downstream interventions
| Policy category | Level | Intervention | Contributions from behavioural and social sciences |
|---|---|---|---|
| Service Provision | Organisational | Commissioning effective evidence based stop smoking services. Providing evidence based stop smoking services to support people attempting to go smoke free. | As well as providing evidence to underpin their development, the behavioural and social sciences can contribute to the evaluation of services and interventions (e.g. 43, 44). |
| Health care professional | Health care professionals including GPs providing brief advice to smokers and referring into stop smoking services (45) | ||
| Fiscal measures | Individual/ patient | Incentivising pregnant women to stop smoking | Research has shown that incentives can encourage healthy lifestyle behaviours (although there are sometimes issues of relapse when the incentives finish) (46). One trial showed that incentives (shopping vouchers) delivered over the course of pregnancy significantly increased smoking abstinence amongst expectant mothers (47). |
| Organisations | Commissioning for Quality and Innovation and Quality and Outcome Framework | ||
| Health care professional | Payment by results | ||
| Guidelines | Improving identification, and retention across all levels | Improving access and referral pathway to stop smoking services | Techniques such as motivational interviewing have been trialled and integrated into services in order to improve retention on programmes (48). |
| Development of digital aides to support stop smoking services | Advisors from the behavioural and social sciences have worked in tandem with digital teams to ensure that tools are optimised, both in terms of efficacy and in terms of engagement (49). |
Table 3. Downstream tobacco interventions and the contribution from behavioural and social sciences categorised by ‘level’ of intervention as classified by the Behaviour Change Wheel (32, 33).
Tackling obesity across the life course
Obesity is a complex contemporary public health problem that involves a range of social, environmental, individual, physiological, biological and cultural components. Halting (and ultimately reversing) the current obesity epidemic requires systemic change by taking a holistic view that addresses the individual, social, environmental, and fiscal influences over the long term.
Strategies to tackle obesity, at a national and local level, include a mix of preventative population level approaches (e.g., the soft drinks industry levy, improving the nutrient content of food and drink at the point of purchase); curative secondary prevention services (e.g., family and adult weight management services); and targeted community asset based approaches. Alongside this, it is imperative to create local places that promote healthier defaults through our built, active, and food environment. Applying behavioural and social sciences and building behavioural insights into the design of these approaches is key, and is already contributing to the delivery of both population approaches at a systems level and targeted individual interventions.
| Policy category | Intervention | Contributions from behavioural and social sciences |
|---|---|---|
| Legislation | Restrictions on advertising of unhealthy food and drink to children | Helped to demonstrate that children are susceptible to food advertising, with adverts for energy-dense foods leading to an increase in calorie consumption (50, 51). A number of advertising strategies (e.g., using popular children’s cartoon characters) have been prohibited in order to minimise the impact of food advertising on children’s diets. |
| Regulation |
|
Consumers’ response to nutrition labelling on packaging has been investigated, with demographic characteristics also taken into account to help elucidate the effectiveness of labelling measures. |
| Fiscal Measures | Soft Drinks Industry Levy – as a policy lever to encourage reformulation. | The evidence package for the levy included behavioural insights about the use of fiscal measures as an incentive for companies to reformulate products to contain less sugar. |
| Guidelines |
|
PHE has developed evidence-based guidelines for retail, as well as for weight-management providers and commissioners. Healthier catering guidance has been developed that supports buying, making and serving healthier food that also provides environmental benefits. See above for additional comments on front-of-pack labelling. |
| Environmental/ Social Planning |
|
Restructuring the physical and social environment can have a large impact on healthy lifestyle behaviours. For example, changing the visibility and availability of products in retail environments (e.g., at supermarket checkouts) can impact upon sales of those products (52, 53). The NCMP, a national surveillance programme that weighs children in reception and in Year 6, was designed to enable management of local efforts to tackle child obesity. It has been evaluated by behavioural and social scientists and enhanced feedback has been tested by PHE Behavioural Insights. |
| Communications/ Marketing |
|
The behavioural and social sciences are used to develop effective communications and marketing campaigns. |
| Service Provision | Delivery of evidence-based effective weight-management services to support people to achieve a healthier weight | Behavioural science contributed to the development of guidelines for evidence-based weight-management services (54, 55). Behavioural science is contributing to the development of digital weight-management interventions. |
Table 4. Obesity interventions and the contribution from behavioural and social sciences by ‘policy category’ of intervention as classified by the Behaviour Change Wheel (32, 33).