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'Local government is about to get intensely personal'

Source: Public Sector Executive March/April 2013

Ben Page, chief executive at Ipsos Mori, discusses the importance of recognising the public’s sometimes irrational beliefs when it comes to public health.

Speaking at the Local Government Association (LGA) Public Health Conference on February 26, attended by PSE, Ipsos Mori chief executive Ben Page told delegates how public perception must be taken into account when designing and delivering health services.

“What people think and what people say are not always what people do. What people think can be wrong – this is absolutely seminal in terms of wellbeing; local government is about to get intensely personal.”

He used polling evidence to show how the British public are “resolutely in denial” about public health. Although people generally accept the reality of conditions that stem from unhealthy lifestyle choices, such as obesity and liver damage, they continue to believe that these only affect other people.

Knocking down silos

On the challenges ahead for the transfer of responsibility on public health from clinicians to councillors, Page said: “The cultural differences between the NHS and local government can’t be underestimated. The cultural differences just within local government and within the NHS have been huge; there are silos.”

He highlighted calls for more information to be delivered to the public, and noted that hospitals that spend more on communications tend to receive higher scores by regulators.

“It could simply indicate that those were more interested in the community they serve and spent a little more money trying to communicate with them. It’s not just about money; it’s not just about quantity. Spending on communication matters and that is always what people say: tell us about the risks, we’ll make up our minds.”

UK political culture tends to make banning ‘vices’ flat out a non-starter, although some east Asian countries have fewer scruples. The UK preference is for, at most, a ‘nudge’ approach, or ensuring greater access to information.

“Most people strongly believe that it’s the individual’s responsibility to keep themselves healthy – but at the same time the NHS is there to take care of people regardless of why they are ill,” Page said.

Tough times mean that the NHS has an imperative to cut costs, and public opinion suggests that changing people’s lifestyles before treatment is much more popular than introducing doctors’ fees, or any option which would threaten the cherished ‘free at the point of delivery’ tenet of the NHS.

Trust levels and culture shock

Page explained that levels of trust in NHS managers were higher than that of local government (38% against 26%), which could be “a key point” when responsibility for public health switched over.

Local government could use NHS branding on public health services, he suggested. A delegate later pointed out that the critical view of councils could in fact help their cause: the public may be more ready to listen to the case for change when the more emotional NHS aspect is removed from the equation.

Another interesting point awaiting local government was the cultural shock of NHS staff facing opposition for their decisions from alternative political parties.

“Will local government make a difference to public receptivity? The key has to be how people work together; understanding and anticipating those cultural differences and behaviours.”

“A key issue seems to be getting people to just wake up”, Page said. He highlighted the recent public health campaign in Blackburn with Darwen which publicised the fact that life expectancy was eight years lower than average. Resident responses to the campaign have demonstrated apathy and dislike for their area, summed up succinctly by one reaction: “Doesn’t matter, it’s sh*t here anyway.”

Page continued: “This is the kind of thing we seriously need to address. It’s really starting to understand your population’s level of fatalism.”

Hug, smack, nudge and shove

Councils must be aware of the number of ways in which people make irrational decisions, based on irrational processes.

Page explained the four main categories of incentives available to persuade people to make the right choices: hug, smack, nudge and shove.

Local government still holds a great deal of authority over its residents, he said, and this must be harnessed to drive good public health forward.

Different ways to influence decisions include a plethora of psychological tricks: anchoring, social bias (people tend to do what others do), reciprocity (it is easier to start with a little of the right action), framing, false memory, loss aversion, status quo, endowment, consistency, authority, and certainty preference.


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