Behaviour Change as part of a public health strategy
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Presentation at the Local Government Association Behaviour Change Conference on 15th October 2013
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Behaviour Change as part of a public health strategy
- 1. www.hertsdirect.org 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
- 2. www.hertsdirect.org Before we start I 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
- 3. www.hertsdirect.org 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
- 4. www.hertsdirect.org How do I make sense of all this noise? I must do something, but what?
- 5. www.hertsdirect.org The Nuffield Ladder...pros and cons
- 6. www.hertsdirect.org 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
- 7. www.hertsdirect.org 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
- 8. www.hertsdirect.org 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)
- 10. www.hertsdirect.org First get your strategy sorted OUR 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) The Public Health Outcomes Framework (the national PHOF will Help us measure Our success) WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUT POPULATION (our strategic priorities: what we achieve for our County) Priority 1: Our Populatio n lives Longer, H ealthier 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, biolo gical, radiologic al 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
- 11. www.hertsdirect.org So first get your strategy sorted OUR PURPOSE to 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) The Public Health Outcomes Framework (the national PHOF will Help us measure Our success) WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUT POPULATION (our strategic priorities: what we achieve for our County) Priority 1: Our Populatio n lives Longer, H ealthier 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, biolo gical, radiologic al and environmental) Building Blocks For the Public Health Family Strong Leadership Capable, Skille d 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
- 12. www.hertsdirect.org 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
- 13. www.hertsdirect.org Six Levels Example - Tobacco Levels 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 displays Structural – policy changes such as workplace health, school health policies Workplace policies Tobacco control partnerships
- 14. www.hertsdirect.org Social Marketing and Behavioural Economics have a place
- 16. www.hertsdirect.org 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
- 17. www.hertsdirect.org 2nd Line – Behaviour Change 3rd Line - Activity 4th Line – Specialist1st Line – Brief Intervention Opportunistic brief advice by GP, pharmacist or practice nurse 1.Identify health issue of concern (and follow appropriate pathway for that, e.g. obesity) 2.Assess motivation to change 3.If motivated, refer on 4.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, m ain 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, healt hy 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)
- 18. www.hertsdirect.org 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
- 19. www.hertsdirect.org 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
- 20. www.hertsdirect.org Thank you...lets’ hope it works! Jim.mcmanus@hertfordshire.gov.uk