Today marks World Diabetes Day. Diabetes is a growing health issue in Singapore and is associated with poor dietary choices and habits. In a previous opinion article, I wrote about the use of a conventional and comprehensive tool, a sugar tax, to reduce unhealthy sugar consumption A sugar tax considers the aggregated decisions of producers and consumers to change behaviour. Given that it is a one-size-fits-all solution, the tax may be a blunt instrument for affecting the behaviour of a population with diverse individuals. The forceful restraining nature of the tax may also cast a negative impression of the campaign against diabetes. Are there contrasting solutions that can help incrementally nudge people towards making healthier diets and choices?

Economics Nobel Laureate Daniel Kahneman frames this question beautifully by mentioning the words of eminent psychologist Kurt Lewin: Instead of a forceful and top-down way of asking “How do we get people to do what we want them to do?”, can the question be rephrased as a situational, self-determinant and incremental “Why are they not already doing what we want them to do?”

Daniel Kahneman, a social psychologist, and the most recent Economics Nobel Laureate, Richard Thaler, laid the groundworks for the field of behavioural economics. Behavioural economists view the person as one with limited self-control and many decision biases. How do these biases affect our dietary choices? Are there possible nudges away from them in the spirit of the latter question posed by Lewin?

Human beings tend to take the path of least resistance when it comes to smaller or more frequent decisions. We might automatically decide based on previous choices, or default to the first option presented. There is an opportunity to disrupt the decisions based on previous choices at the point of decision-making. This is already common in Singapore, with the healthier choice symbol and posters at point-of-selection and purchases. However, more can be done about the default options being presented to consumers. A prudent approach would be to encourage food and drinks stalls to prompt buyers on a default option, for example, of “kopi-O kosong” (black coffee without sugar) instead of the sugar-laden version.

Many of us have faced the situation of indecisiveness when deciding on what to eat, making a choice based on a whim, and then regretting the choice of our meals later. Too many options can cause us to have difficulty processing which are the more important criteria — smaller portions, less sugar, and other healthier choices. Since limiting options might be considered against the spirit of nudging, healthier food options can be placed ahead of unhealthy choices in a menu. Stalls offering healthier food choices can be positioned near the front of food places. This can be applied to the placement of healthy food items in the supermarket as well.

A common suggestion to aid dietary choices is for more caloric information to be displayed in menus and labels. This may be detrimental to making informed choices due to information overload. A better nudge would be to simplify how the caloric information is being displayed, either through graphics or colour codes.

People are more likely to better weigh the costs and benefits that are presently ahead of them instead of long-term consequences. Since satiating hunger and cravings return a huge immediate benefit to us, this present-biasness can cause us to succumb to unhealthy food choices. Campaigns against diabetes may focus too much on getting people to realise the long-term consequences of their dietary habits. However, since we are already inherently biased against the long-term, it might be worth educating the public on the short-term consequences, such as overspending or fatigue, of their actions as well. Again, strategically placed reminders at points-of-purchase might do the trick.

Having read through the nudges that are suggested in this article, you will not be wrong in thinking that they are rather simplistic solutions to a complex health issue. Simplicity is a boon when it comes to the cost of implementing these nudges. This makes it easier for policymakers to carry out multiple experiments or trials to determine which nudges are the most effective in Singapore. During such trials, the features in the nudges, such as the graphical caloric information mentioned earlier, can also be iteratively adjusted for effectiveness. Small incremental changes in a complex dynamic issue can have big effects.

There might also be a lingering doubt in your mind that there is something quite stealthy about these nudges. Indeed, some of these behavioural insights have long been used, successfully, by companies to sell their products. Policymakers and society need to have a consensus on the acceptability of these nudges. Otherwise, a negative awareness of these nudges might dilute their effectiveness. Finally, given the immensity and seriousness of the diabetes health issue in Singapore, incremental nudges may not be an optimal, or the only, solution. Policymakers can draw on different instruments like a blanket tool such as a sugar tax, conventional public health education, and nudges to address the poor dietary habits.

Zach Lee is a research associate at the School of Social Sciences, Nanyang Technological University. The author acknowledges the feedback from the many commentators on his previous article in the making of this one.

Reference:

Kahneman, D. (2010). The Human Agent, Behavioral Changes and Policy Implications. Obesity Prevention (First edit). Elsevier Inc. http://doi.org/10.1016/B978-0-12-374387-9.00033-7

Dubé, L. (2010). Libertarian Paternalism: Nudging Individuals toward Obesity Prevention. Obesity Prevention (First edit). Elsevier Inc. http://doi.org/10.1016/B978-0-12-374387-9.00035-0