Behavioural science and public health – keeping ahead of change

'You say you want a revolution / Well, you know / We all wanna change the world'. So sang John Lennon, who gives his name to the building that hosted this excellent one-day conference, with delegates discussing how the behavioural and social sciences can help individuals, local and national governments respond constructively to change, and to harness it for public good.

I arrived just as Professor Mark Bellis, Director of Research and Innovation at Liverpool John Moores University, was highlighting the different approaches which emerge when you start combining different sciences (including shopping trolleys that detect arrhythmia). This led nicely into the opening keynote, from Linda Bauld, Professor of Public Health at the University of Edinburgh and Chief Social Policy Adviser to the Scottish Government. She talked about the creation of Behavioural Research UK, a consortium seeking to harness, connect and extend the UK's capacity and capability in interdisciplinary behavioural research. A key theme of the day was not just conducting this research, but getting it out into policy and practice, understanding and fostering change within multiple complex systems.

A first step in that was a cross-sector, nationwide survey – leading to an interactive map – of which organisations are doing what behavioural research. The majority were working in health and the environment, with Bauld saying 'and my goodness, did they tell us we need more research in those areas'. There was less on, for example, crime and policing, and Bauld pointed to opportunities to add value in terms of training in cutting edge methods, the provision of more examples and case studies, and an 'ask an expert' service. 

Turning to mis- and dis-information, Bauld said that working with the psychologist Stephen Reicher during the pandemic made them realise it had become a 'particularly acute issue'. It spreads faster and further than messaging from public bodies; there is evidence of widespread public concern over it; we're seeing the removal of fact checkers, changes to machine learning algorithms and the expansion of deep fakes; and the imminent Online Safety Act is not readily applicable to the problem. 'We can't compete,' Bauld admitted, 'but we have to try, in the best evidenced way we can'. This response needs to at all levels – informational, individual, interpersonal, institutional. There's a place for 'prebunking' as well as debunking, and education is key – particularly with the younger generation, with Bauld presenting worrying results around their trust in such information staples as books.

Complex like clouds

Next up, independent behavioural insights advisor Steven Johnson admitted 'It's tough out there'. 'Behaviour change is a really difficult business to be in', he said, with inherently challenging phenomena of interest, in intractable contexts, and constant voices from inside and outside the discipline questioning the impact of what behavioural scientists do. And that's before you add in the replication crisis – 'human behaviour doesn't replicate', Johnson said: 'It's just not how human behaviour works.' People, he argued, aren't like clockwork – predictable with enough information, breaking in identifiable ways. They don't tick, they move like clouds. Their 'Big C Complexity' demands coordinated systems of intervention which work across multiple levels; or, in the example of his work helping off-shore workers live healthier lives, creating a system small enough to understand and change the dynamics.

Other case studies of Johnson's looked to move from population averages, through segmentation, to 'hyper-personalisation'. In an area such as ensuring people attend medical appointments, 'every member of the population has some bundle of variables that makes this more or less likely'. And so the 'holy grail' is intervention at a personalised level, automated in operational systems, and even creating a self-learning, virtuous circle. 

Unfortunately, as Johnson admitted, there is 'very rarely the tech, data and time to get that far into the weeds'. So, he said, we often need to look to the foundations that motivate human behaviour – our identity, goals, morals, purposes. Evoking Shalom Schwartz's universal value orientations, Johnson presented data in the form of a Bayesian network, showing, for example, that buying an electric car is not as strongly associated with concern for nature as you might expect. Instead, it taps into our need for hedonism and stimulation, and this needs to be considered in any messaging looking to change purchasing behaviour. 'It's about tapping the deeper currents', Johnson concluded.

Public health works

It was the turn of the Sheffield Director of Public Health straight after lunch, and there's no chance of a post-prandial dip when Greg Fell's in full flow. 'I'm not known for pulling punches,' he warned, 'and so I won't here'. Fell has a positive message – 'Public health works' – along with a realism around the scale of the challenge, when 'everything is in… it's just a question of how far upstream you go.' He settled on his 'four biggest risks to health': neoliberal economic ideology, commercial actors influencing policy, public sector finances, and the hegemony of medicine.

Watching Fell speak always reminds me of that quote that everything is political… especially the stuff they tell you is not political, that's particularly political. The key, he says, is to not be party-political. That must be a challenge, though, when 'lifestyle drift is everywhere. Think why.' Words matter, Fell says, but framing matters more. It shapes what policies are favoured. So we need to learn about devious framing, and 'Dark PR', and 'sludges'. 'Get good at flipping arguments', he advised: 'we are often quite paternalistic in our approach, when instead we need to be talking about freedom.'

Again, complexity in understanding and responding to change was to the fore. An issue such as active travel and bike use can't be solved through infrastructure alone: it requires a human and community centred approach. Talk about the 'co benefits' of policies, and focus on 'multiple reinforcing approaches to engage in a political system'. 'You have a lot of skill and insight to add. Get involved at the scoping phase, and be pushy about it.' 

The art of the possible

Elsewhere at the conference, I caught presentations from Dr Julie Van de Vyer (Magpie) and Lou Hallworth (Hertfordshire County Council), Hannah Frome (Brunel University), Andrew Harrison (Groundworks Ltd) and Jun Nakagawa and Harsha Baheti (Camden Council), all of which pointed to the impact of the cost of living crisis on behaviour change work. Covering air pollution, food insecurity, energy use and youth vaping respectively, each talk showed the need for research and practice to be agile in response to people's shifting goals. 'People have complex lives with complex problems,' Harrison said, 'and we have to remember we often start as strangers in someone's home.' For his project, that meant developing tangible resources to leave behind for people to digest over time. 

Dr Paul Chadwick, CEO of BSPHN, described this as 'The art of what is possible under very extreme constraints', and during the concluding workshop he returned to his key concern of 'how to build capacity'. Talking of his work with Susan Michie and her ever-present COM-B model / behaviour change wheel – seriously, what must it be like being Susan Michie at a health psychology / public health conference? I think of that scene in Being John Malkovich – Chadwick said that people often have the motivation to change behaviour, but there are significant capability and opportunity barriers. It's useful, he said, to 'create manualised programmes with behaviour change baked in'; although Professor Angel Chater cautioned against diluting our strengths and value. 'We would never expect a new drug to be developed in a day, so why do people think behaviour change can be quick, easy and cheap?'

To the future

I chaired a discussion, featuring the three keynote speakers and Chair of BSPHN Trustees Professor Jim McManus. Keen to explore whether we are even keeping up with change, let alone 'ahead' of it, I asked the panel to reflect on how accurate their own horizon-scanning for the last decade had been, and what that suggested for the coming one. Johnson referred to the emergence of AI, and how its generative side in particular is 'a little bit like the Wild West at the moment'. He hoped it might supply new ways to understand new needs in health inequity. Bauld referred to the huge amounts of adaptation and technological shift seen during the pandemic, and her concerns around younger male populations in particular – 'the data is so stark'. understanding of behavioural research. Fell looked back on his own years of 'allowing and facilitating an individualised and medicalised model… I got it wildly wrong,' he said, warning delegates of the 'coming storm' and urging them to 'put your energy and effort into shaping a different narrative, and understanding the skilful and wilful use of PR to shape the policy environment'. McManus agreed on the clear need to move beyond an individual focus, adding that he would 'put the value of community back into that.'

Returning home from a day where the sheer scale of the tasks at hand could end up feeling overwhelming, I had Greg Fell's words in my ears: 'We have made great progress on many things, in partnership with others. Your ability to use your skills to shape behaviour matters. But individual responsibility is a hopeless framework for health. Think beyond the bit of the system you might be exploring in detail. Think about the whole of the system.'