Healthy lifestyles: Is a hug, shove, nudge or smack best?

Obese child Obesity rates have been rising

With all the controversy over the government's NHS reforms, it is easy to forget the system is changing in terms of tackling unhealthy lifestyles too.

From 1 April, alongside the creation of a whole new structure in the health service, local government will be given responsibility for public health.

That means from encouraging people to give up smoking to drinking and eating less, it will be the job of councils to help us alter our unhealthy habits.

The move marks a return of public health to the local government fold - nearly 40 years after it was taken away.

In the meantime, the nation has got more obese and alcohol consumption has soared.

So what should councils do?

Ben Page, chief executive of the polling group Ipsos Mori, has perhaps put it most succinctly.

He says because of local government's power over everything from schools and planning to leisure services and green spaces it has a "great opportunity" to influence behaviour.

But councils have a choice over how they can go about this, he says. They can either hug, smack, nudge or shove.

Free leisure

But what exactly does he mean?

A look at what is happening already provides some clues.

While the NHS has been formally responsible for public health since 1974, the past decade has seen councils working increasingly closely with their NHS cousins.

It has resulted in some pretty interesting schemes.

Influencing lifestyle

  • Hug - Covers a range of incentives - although not usually hard cash. Instead, the focus has been on providing vouchers or giving discounts. Already used to discourage things such as drug use and smoking.
  • Nudge - Based on the idea of changing behaviour without using compulsion. Can include enticing people to take up activities or using subliminal marketing. For example, stressing social norms can encourage people to change behaviour because they want to be alike.
  • Shove - More deliberate than a nudge. For example, some council planning departments have been restricting takeaways and fast food restaurants near schools.
  • Smack - The most draconian of all the measures: banning something. Most famously used by central government when it introduced the smoking ban.

Several areas have used financial incentives to get people to give up smoking - particularly among pregnant women and new mothers.

In exchange for quitting, they have received vouchers which they can then use to pay for nappies or other baby products.

That, of course, constitutes a hug.

Meanwhile, nudging, for which the government itself has been a strong advocate, involves more subtle approaches.

In some areas, councils have started providing free entry to leisure services at certain times.

But sometimes it involves smaller steps. For example, trading standards officers have been working with fish and chip shops in north-east England to get them to use salt shakers with fewer holes.

Reducing them from 17 to five can cut salt consumption by three quarters.

At the other end of the spectrum are the more draconian shoves or smacks.

These can involve closing down takeaways near schools (a shove) or a ban on smoking near playgrounds (a smack).

Dr Janet Atherton, president of the Association of Directors of Public Health, says "there's probably a place for all four".

To help kick-start the process, the government has provided councils with a ring-fenced budget of nearly £3bn to spend on public health initiatives.

This has caused some grumbling within local government, which is seeing the rest of its budget slashed, while others argue it is not enough to make a difference.

But many are still hopeful.

Research has shown that at any one time the NHS is only directly affecting the lives of one in five people.

But Blackburn's public health director, Dominic Harrison, says public health is different as it has a "much bigger impact".

He even says councils should challenge themselves to create a new perception of themselves.

He points out that what is done in the next few years could become as important in the public consciousness as hospitals - which, he says, symbolise our "willingness to care for each other".

If that happens, perhaps there will be marches to save a local council rather than the A&E department in the future.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 111.

    Local Government is the most corrupt, incompetent and wasteful level of government there is. Cameron's policy of giving more power to council jobsworths and busybodies is the stupidest thing he has done – he should be reducing their power.

    As for council inspectors, touring fish shops to ensure the saltshaker has the statuary number of holes – they don’t even do that North Korea.

  • rate this

    Comment number 110.

    This is another scam of the Government unloading a national problem to local councils, and another for councils to have another excuss to spend more while they are complaining on not enough funds to provide existing services and aiming to raise council tax. Unresponsible Government and binge spending councils combined, what chance we have as the public to be healthy and happy?

  • rate this

    Comment number 109.

    Curiousman - for me, both options are unhealthy. In fact my BG levels would come down faster from the chocolate than they would from the bananas, but until this problem is recognised, people can do what they like, it will not change the obesity crisis.

  • rate this

    Comment number 108.

    What do we employ councils for?

    To provide local services, that's what! Most don't even do that very well, and certainly are not very accountable: it is hard to find out how priorities are set, let alone direct them in how we want them to be.

    If I want advice on health, I see a medical professional - not a council employee.

  • rate this

    Comment number 107.

    Look to America, where insured people are turned down for treatment as they class it 'experimental'. And I would bet you if I got insurance now it would be sky high costs because I had cancer.
    Insurance companies will do anything not to pay. I suggest watch Michael moore's Sicko. A very good documentary about health insurance


Comments 5 of 111



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