behaviour change as part of a public health strategy
DESCRIPTION
Presentation at the Local Government Association Behaviour Change Conference on 15th October 2013TRANSCRIPT
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Noise, Nudge and Niggles in the Night...Putting Behaviour Change in context in a local Public Health strategy
LGA Behaviour Change Conference,15 Oct 2013
Jim McManus, FFPH, CPsychol, CSci, AFBPsS
Director of Public Health
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Before we startI am biased...we all are
• I am passionate about finding social science based solutions as part of an integrated public health strategy
• Behaviour change focusing solely on the individual is an impoverished neo-modern answer to a problem that isn’t that simple...real life isn’t structured round individuals
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The Noise....you’ve lost me...
• Epidemiology – behaviour as a major factor• Health Psychology – what’s that?• Social and Organizational Psychology – Que?• Positive Psychology – What?• Marketing – Like, you mean, adverts?• Behavioural Economics ...that’s nudge, right?
The reality is you need elements of all of these in a good strategy, and you need to know when to use them
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How do I make sense of all this noise?
I must do something, but what?
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The Nuffield Ladder...pros and cons
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Problem
• Just as prescribing individual counselling for stress can be a way of blaming the person when the ORGANIZATION needs to change, so focusing on changing behaviour and individual agency when the problem is STRUCTURAL is not a satisfactory solution
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Some Key Points
• Behaviour change strategems are part of, not a replacement for whole system public action
• They are not a magic bullet• Sometimes legislation and structural
solutions are more effective and better buys• You need more than one behavioural change
strategy• Behavioural change strategems work best when
balanced
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Systems thinking – our health occurs in a system. So must behaviour change.
The wider determinants of Health and Local Government functions (Must adopt a Lifecourse approach!)
The Lives people lead and whether LA functions help or hinder healthy lifestyles (policy, service quality, access, behavioural economics, behavioural sciences)
The services people access such as primary care (high quality, easy access, good follow up, behavioural and lifestyle pathways wrap around)
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Influences on behaviour
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First get your strategy sortedOUR PURPOSE
to work together to improve the health and wellbeing of the people of Hertfordshire, based on best practice and
best evidence
Priority 5: We understand what’s needed and we do what works
Priority 6: We make public health everybody’s business and work together
HOW WE WILL WORK TOGETHER(our strategic priorities: how we do it for
our County)
ThePublicHealthOutcomesFramework(the nationalPHOF willHelp us measureOur success)
WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUT POPULATION
(our strategic priorities: what we achieve for our County)
Priority 1: Our Population lives Longer, Healthier Lives
Priority 2: Our Population Starts Life Healthy and Stays Healthy
Priority 3: We narrow the gap in life expectancy and health between most and least healthy
Priority 4: We protect our communities from harm (chemical, biological, radiological and environmental)
Building Blocks
Making better use of behavioural sciences at individual, interpersonal, community and service levels
Behavioural sciences are a building block of any good Public Health Strategy...see next slide
OUR VISION:A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy and happy lives. We compare well with England and every area in Hertfordshire compares well
against Hertfordshire
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So first get your strategy sorted
OUR PURPOSEto work together to improve the health and wellbeing of the people of Hertfordshire, based on best practice and
best evidence
OUR VISION:A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy and happy lives. We compare well with England and every area in Hertfordshire compares well
against Hertfordshire
Priority 5: We understand what’s needed and we do what works
Priority 6: We make public health everybody’s business and work together
HOW WE WILL WORK TOGETHER(our strategic priorities: how we do it for
our County)
ThePublicHealthOutcomesFramework(the nationalPHOF willHelp us measureOur success)
WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUT POPULATION
(our strategic priorities: what we achieve for our County)
Priority 1: Our Population lives Longer, Healthier Lives
Priority 2: Our Population Starts Life Healthy and Stays Healthy
Priority 3: We narrow the gap in life expectancy and health between most and least healthy
Priority 4: We protect our communities from harm (chemical, biological, radiological and environmental)
BuildingBlocks For the Public Health Family
Strong Leadership
Capable, Skilled People
Co-production with citizens
Effective Partnerships
Evidence and Knowledge Driven
Plan and Deliver for Localism
Whole System Approaches
Making better use of behavioural sciences at individual, interpersonal, community and service levels
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Behavioural solutions work only as part of a sensible public health architecture
• Seek to incoporate behavioural sciences as a normal part of your strategy, based on competence and fitness for use only
• Think through which problem requires what level of action
Levels of Public Health Action
• Social
• Environmental
• Biological
• Behavioural
• Legislative
• Structural
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Six Levels Example - TobaccoLevels Application to Tobacco
Social – changing social norms about health, e.g. acceptability of binge drinking, acceptability of taking smoking breaks
Behavioural economics, social marketing Young people
Biological – immunisation, vaccinations, treatments
Nicotine replacement therapy and cognitive tools for cravings
Environmental – encouraging green transport, reducing pollution, changing the public realm
Environmental cues, display legislation
Smokefree playgrounds
Behavioural – helping individuals to stop smoking
Individual and group behavioural change and support
Legislative – the smoking ban, legislation on alcohol sales
The ban on smoking
Legislation on displaysStructural – policy changes such as workplace
health, school health policiesWorkplace policies
Tobacco control partnerships
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Social Marketing and Behavioural Economics have a place
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The StepJockey story
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Behaviour Change in the Hertfordshire Strategy
1. Behavioural Economics
2. Health Psychology
3. Behavioural Psych
4. Developmental Psychology
5. Social and Organizational Psychology
6. Positive Psychology
7. Marketing
1. StepJockey, checkouts
2. CVD Prevention, Patient- Clinician Consultation
3. Do Something Different
4. My Baby’s Brain
5. Prosocial behaviour- countryside walks
6. Resilience/Bullying/how to be a carer
7. Stoptober
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2nd Line – Behaviour Change 3rd Line - Activity 4th Line – Specialist1st Line – Brief Intervention
Opportunistic brief advice by GP, pharmacist or practice nurse1.Identify health issue of concern (and follow appropriate pathway for that, e.g. obesity)2.Assess motivation to change3.If motivated, refer on4.If not motivated,
1.Raise awareness of risks.2.Offer written information on healthy eating and physical activity. 3.Raise again in 3 months.4.Offer information prescription
Smoking is primary, main or only goal
If fall into 1st or subsequent line category of advice within Obesity Care Pathway refer to Lifestyle Programme, provided there are no contraindications
Discuss primary or main goal then refer appropriately For patients with co-
morbidites
Patients who are diabetic or have coronary heart disease or a history of heart problems must have referral from appropriate primary care team or secondary care to participate in programme.Behaviour change programme to be developed in partnership with specialist services
Refer to smoking cessation service
Weight loss, healthy living or CVD risk is main or primary goal
Refer to lifestyle service
Patients with highly complex psychological or emotional issues (e.g. depression or eating disorder.)If not already in contact with such services, refer to IAPT programme psychology or primary care mental health team
Towards a Health Behaviour Change Care Pathway (Version 1.0, September 2013)
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The components of the Hertfordshire Approach to Behavioural Sciences
• Within a strategy, based on strategic fit• 6 levels of public health• Specialist Skills building generalist skills...• Pathways• Positive Psychology as the fundamental lens
into behaviour change• Behavioural science kick start unit
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Organizational Psychology – the Six Steps to being a Public Health Organization (behaviour change works at organizational and individual level)
1. Leadership commited to Public Health
2. Understand Public Health Challenges
3. Identify what each can do
4. Identify what Public Health Tools and Skills we can use
5. Consider every area of the business systematically
6. Make us an example of healthy employer and service provider – do becomes behaviour becomes culture
