The public and public health – what to do? Ben Page, Chief Executive, Ipsos MORI

LGA Annual Conference 26 Feb 2013

A noble goal...what would make you happiest?

0

10

20

30

40

50

60

15-24 25-34 35-44 45-54 55-64 65-74 75+Age

%

Double my

income Better Health

Base: 2,015 interviewed face to face in home in GB aged 15 +, 20-25 Sept

76

6 0

10

20

30

40

50

60

70

80

90

100

Q How is your health in general? Would you say it was...

The public claim to be in good health

Base: Adults aged 16+ in England (at least 4,500 per wave) Source: Health Survey for England

%

Very good/ good health

Very bad/ bad health

Data up to 2002 are unweighted. From 2003 onwards, data have been weighted for non-response

The facts say …..obesity levels

Source: Health Survey for England

The facts say - booze consumed

Source: Health Survey for England

34% 30%

16% 16% 16%

13% 10% 9% 9% 8% 8% 8% 7% 6% 5%

Cancer Obesity/overeating

Alcohol abuse Heart disease

Age-related illnesses Smoking Diabetes

Unhealthy lifestyle Stress/pressure

Obesity in children Dementia

Mental health Poor diet

Drugs abuse Lack of exercise

Q Thinking generally, what are the biggest health problems facing people today? What else?

They are aware of the big health issues

Source: Ipsos MORI/DH Perceptions of the NHS Tracker Base: 1,004 English adults aged 16+, Dec 2012

All mentions above 2%

79%

39%

35%

17%

7%

2%

1%

1%

Your lifestyle

Your genes

Your social circumstances

NHS

Whether you are male or female

Having a university degree

No answer

Don't know

And they say they recognise the importance of lifestyle

Q Looking at this card, which factors, if any, do you think have the biggest impact on your chances of living a long and healthy life?

Base: 1,994 British adults, Aug 2008 Source: Ipsos MORI

44% 40%

24% 23%

17% 15%

10% 9%

6% 4% 3% 2%

19%

Q Which of the following would encourage you to lead a healthier lifestyle?

Lower prices for using leisure centres

Lower prices for healthy food Better sports and leisure facilities

Having more time

Being told to by my doctor for health reasons Having more healthy food available in local shops

Better access to weight loss services Better information about how to eat healthily

Better information about how to be more physically active

Having help with my caring responsibilities Better access to stop smoking services

Advice and support to stop/cut down drinking alcohol

Base: 4,824 adults, Sept - Dec 2011

They claim price is key to helping them be healthier

Nothing, I already lead a healthy lifestyle

Source: Ipsos MORI

Meanwhile there are calls for stronger intervention

Q Now thinking about smoking: What, if anything, do you think government should do?

Public support for anti-smoking measures

Base: 1,014 UK residents aged 16-64, November 2010 Source: Ipsos Global @dvisor

92%

73%

74%

45%

78%

Strongly support/tend to support

Provide information

Incentivise people to stop smoking

Make tobacco companies invest against smoking

Ban smoking in public places

Ban smoking altogether

Q Now thinking about what people choose to eat: What, if anything, do you think government should do?

On healthy eating?

Base: 1,014 UK residents aged 16-64, November 2010 Source: Ipsos Global @dvisor

86%

72%

37%

33%

81%

Strongly support/tend to support

Provide information about healthy eating

Provide incentives, such as health food vouchers

Make companies promote healthy choices

Make unhealthy foods more expensive

Ban unhealthy foods

Q Government should introduce laws to ban unhealthy foods

Less open to forceful intervention compared to neighbours

Base: c.500 - 1,000 residents aged 16-64 (18-64 in the US and Canada) in each country, November 2010 Source: Ipsos Global @dvisor

89% 89%

88% 87% 87% 87%

86% 71%

70% 68%

65% 64%

63% 55%

53% 43%

42% 41%

39% 35% 35%

33% 33%

21%

China South Korea Saudi Arabia

India Indonesia

Turkey Russia Mexico Japan

Argentina Italy

Spain Poland

Hungary Brazil

Germany South Africa

Canada Belgium France

Sweden Australia

Great Britain USA

Strongly support/tend to support

OU

TRIG

HT

BA

N

Should the lifestyle we choose affect the care we receive?

5%

31%

4%

21%

25%

26%

27%

14%

39%

9%

Whose responsibility is public health?

Base: 1,646 British adults 15+, April 2010 Source: Ipsos MORI personal responsibility 2010

It is the job of the NHS to keep people healthy

It is the individual’s responsibility to keep themselves healthy

The NHS should give less priority to people who do not take care of their health

The NHS should be there to take care of people regardless of

why they are ill

Q I am going to read out two statements, one at either end of a scale. Please tell me where your view fits on this scale.

Agree much more with A Agree much more with B

A B

53

7

6

5

3

17

7

12

35

16

19

7

Longer waiting lists

Charges for visiting your GP

Some types of treatment not available in your area, depending on where you live

Fees for hospital stays

Requiring patients to change lifestyle before they are allowed treatment (e.g. give up

smoking, change diet)

% Most % Least

Q If the NHS was to face lower levels of spending, which of these, if any, would you be most/ least willing to accept?

Base: 1,041 British adults aged 16-64, Sept 2009

None of these

But some willingness to MAKE people take right decisions

Source: Ipsos MORI personal responsibility 2010

So how will the move of public health into local govt affect public perceptions?

NHS more loved and respected than local government

Q Can you tell me which of the phrases on this card best describes the way you would speak about that service to other people?

63

54

32

21

12

16

19

28

% Critical % Speak highly

Your local council

The police in my local area

My local hospital

Local NHS (GPs, hospitals, ambulance service, dentists and

other parts of the NHS)

Net score

-7 (-8 in 2011)

+13

+38

Base: 828 adults aged 15+ in England , Dec 2009

+51

Source: Ipsos MORI

Will local govt as the messenger affect public receptivity?

Low awareness of local government’s role

Base: 1,001 adults aged 18+ in Greater London, April 2008

Q I am going to read out a list of services and, for each one, I would like you to tell me whether you think it is the responsibility of your local London Borough Council or not…

49

45

97

60

42

46

3

29

8

8

11

The police service

Your local hospital

Rubbish collection and recycling

The Freedom Pass

% Yes % No % Not sure/ Don't know

Source: Ipsos MORI

Behind the scenes: what happens next for public health in local govt?

Upheaval ahead though demands remain unchanged

Focus on transition Normalising to new environment A whole systems approach to business as usual

Ongoing purpose to protect local populations and inform commissioning

There will be new indicators to measure and track

And a new opportunity for collaborative data collection

Why it matters...

“Doesn’t bother me, it’s shit here.”

Blackburn resident

Source: Ipsos MORI

Why?

How do human beings make choices/decisions ?

Gather pertinent information

Process pertinent information

Calculate optimal choice

Rational decision-making process

‘Rational decision’

Decide based on faulty cal-culations

Decide without fully

processing the facts

‘Irrational decision’

Short- circuits

of the ‘rational’ process

Decide without all the

data/using irrelevant

data

Behaviour change is flavour of the month

Four levers at your disposal

Successful change campaigns use a mix of informing, enabling, incentivising and enforcing

Source: Websites, press search

Influence

Incentivise

Inform

Enable

Enforce

But you can also learn from behavioural science

Influence

Incentivise

Inform

Enable

Enforce

People make choices without going through a full ‘rational’

decision-making process’

Certain biases pre-dispose people to short-cut the

rational decision-making process

Using these biases in a systematic way can make

campaigns significantly more likely to succeed

Question

What percentage of

African countries

are members of the

United Nations?

Evidence – anchoring

Source: Kahneman and Tversky, 1974

Numbers shown on “roulette”

wheel

Mean estimate of

respondents

10

65

25%

45%

Example bias – anchoring

People’s estimates are swayed by data suggested to them beforehand, even

when they know the data is irrelevant or

false.

Source: Daniel Kahneman, Daniel Tversky (1974); McKinsey synthesis

Case study – anchoring

Source: 5 a Day campaigns in Argentina, Chile, Germany, Japan, Mexico, Spain, UK, US

Case study – anchoring!

Source: 6 a Day campaign in Denmark

Example bias – Social norms

Source: Bandura, Grusec and Menlove (1967); Milgram et al (1969); Cialdini; McKinsey synthesis

People tend to follow their peer

group – if they see many people doing something, they aim to do it

too.

You are more likely to obtain a

large commitment if

you obtain a small one first.

Example bias – reciprocity

Source: Festinger, 1957; Cialdini (2006); McKinsey synthesis

Behavioural Norms we can use….

Decide without all the data/using

irrelevant data

Decide without fully processing all the facts

Decide based on faulty

calculations

Short-circuits of rational decision-making process

Reciprocity Liking

Consistency Scarcity Endowment

Social norms Authority

Status quo

Availability/ recency

Choice overload Justifiability Anchoring

Breakpoints

Certainty preference Loss aversion Probability

misassessment

Regret aversion Framing/ contrast

Hyperbolic discounting

Mental accounting

Biases

False memory

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1925 1935 1945 1955 1965 1975 1985 1995 2005

Final case example – the AIDS awareness change in the UK

Source: Health Profile of England and Wales

• Number of diagnoses of gonorrhoea (000s)

Action across multiple fronts to reduce Sexual Infections

Influence

Incentivise

Inform

Enable

Enforce

BBC programming about AIDS

Distribution of free condoms

“Tombstone” campaign

Use of numerous biases including Authority, Liking, Hyperbolic Discounting, Probability

Misassessment and Social norms

None

Social norm: James Bond and the decline in sexual diseases in the 1980s

Source: Avert; BBC; www.universalexports.net

0

1

2

3

Average Bond girls per film by actor

Connery

Lazenby

Moore

Dalton

Brosnan

1960 1970 1980 1990 2000

In conclusion...

•Lots of public support •Lots of public interest – in principle •Lots of public confusion – needs great communications

•Needs measurement – but be careful – need to understand people’s real motivations

•Over to you.... •Good luck

Thank you Ben.page@ipsos.com