Should governments regulate lifestyle by developing a lifestyle policy, affecting tobacco, alcohol and diets? Should they be allowed to change individual behavior to attain legitimate public health goals, such as higher life expectancy and improved public health?
The European Union has recently recognized the growing impact of NCDs, including cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, on the EU's economy and the well-being of its citizens and has consequently started to develop policies intended to tackle the four main factors to which they are linked. Nevertheless, if common themes emerge between the different EU policies intended to promote healthier lifestyles, no attempt has yet been made to systematize them.
24. NCDs, like heart attacks and
strokes, cancers, diabetes and
chronic respiratory disease account
for over 63% of deaths in the world
today
- 80% in low and middle-income countries -
25. Global burden of mortality, morbidity
and disability attributable to NCDs has
rapidly increased
also in developing countries
(‘double burden’)
30. ‘regulatory mix’
Evidence-based, cost-effective, population wide and
multisectorial intervention
through ‘the implementation of international
agreements and strategies, and education, legislative,
regulation and fiscal measures’
(great faith in the power of law)
31. addressees
Governments and ‘all relevant
stakeholders’, including individuals,
families and communities, NGOs, civil
society, academia, and – where
appropriate – the private sector
32. Regardless of the moral, philosophical and social
reservation you might have
36. The EU is gradually stepping
in into the regulation of
‘lifestyle risks’
37. Risk factors in the EU
• EU Tobacco:
– Largest risk factor
– 650.000 deaths per year (out of 6 million www)
– Tobacco prevalence around 29%
– Costs: 125 billion – 1.3 EU GDP
38. Percentage of daily smokers (males) aged 15+ in the EU-27
Source: WHO-HFA, 2007
38
58. A way out…
While the EU approach to tobacco
products remains based on regulation,
self-regulation characterises the
EU emerging policy vis-à-vis obesity
prevention and alcohol
59.
60. Alcohol & Health Forum
multi-stakeholder, partnership approach leading to
committments:
- by companies
- by governments and other stakeholders
67. Contested
• Fear of regulation self-regulation
• Some, not all companies
• Weak enforcement record
• Coverage of committments (TV not
internet: adgames/mobiles): loopholes
• Credibility of committment by
industry – inherent conflict?
– Article 5.3 FCTC
73. US new packs (22.09.2012)
U.S. District Judge Richard Leon ruled that the requirement ran afoul of the First Amendment's
free speech protections and blocked the requirement. The government appealed.
82. design
How to realistically expect that regulation may
require people to, or not to eat, certain foods
and to do exercise
83. role of the industry
What should it be the role of the industry?
84. At a time in which international community
legitimised regulatory action vis-à-vis lifestyle
choices, some countries are experimenting new
forms of interventions
88. By changing the environment in which the
choice is made, a nudge-inspired policy steers
people - who are placed in this environment -
towards making positive decisions while
preserving individual choice.
117. Binge drinking
• Need to correct the false perception of how
much students’ peers drink, how?
• By making it less salient:
Communication campaign of accurate drinking
levels to all university students in Wales
121. Nudging
• Its intervention does not restrict choice
• It must be in the interest of the nudgee
• It involves a change in ‘choice architecture’
• It implies strategic use of some patterns of
human irrationality
• The action it triggers does not stem from a
fully autonomous choice (especially about the
context)
123. Paternalism Nudge
• Reduce the options set by • Changes the environment in
legislating against risky which the choice is made to
behaviour make risky behaviour less likely
• Rests on the assumption that
• Rests on the assumption that people conditioned by
people behave rationally environment
• Top-down: requires bureaucratic • Bottom-up: less funding
oversight
• Exaggerates the prevalence of • Play down the reality and depicts
risky behaviour abstention as the social norm
• Evidence-based (real) • Evidence-based (laboratory-
setting)
• Adversial to the industry • Cooperative with the industry
125. • New paternalism
• Intrusiveness: a threat to liberty!
• Ineffective/lack of evidence
• Non transparent
• Ethical unacceptable
• Unintended side effects:
– Infantilization
– Hindrance to moral development
• Corruptibility
127. 3 main conclusions
• Mixed results:
– Nudges are less effective when used in isolation:
call for their integration with traditional forms
– Being controversial need to be evidence-based
– Overall less effective than behavioural marketing