Changing Behaviour in a time of plague. Be careful what you wish for…

When I discovered last week that my favourite Chinese restaurant was open for take-aways and delivering locally, I telephoned but found I was out of range so I ordered to collect. Bad boy, my wife admonished, I was making an unnecessary and selfish journey and this was not allowed. Suitably censured I agreed to stay home and to satisfy my desire for spicy food I located at the back of a cupboard an out-of-date Vesta curry bought years ago possibly for just such a crisis.

Myself aside, we are mostly obeying government rules on staying home and social distancing and this should not really be surprising. What is a surprise is that those experts advising government on public behaviour in this pandemic seem less confident about our level of compliance. The SAGE subcommittee on behaviour worried early on and before the lockdown that a modern Western liberal population would have great difficulty sticking with such restrictive rules. This perhaps was a factor in the lateness of the UK lockdown and which potentially may have cost many lives especially in regions such as London where community transfer of the virus was already very active. In reality the public had locked down a week before the government told it to do so. Public behaviour was ahead of the experts.

The SAGE behavioural subcommittee in formulating its advice, I suspect, was too highly influenced by Nudge Theory. Nudge Theory was devised by US behavioural economists and was so politically influential ten years ago David Cameron, then PM, set up a Nudge Unit within No 10 Downing Street which is I believe still there. This Behavioral Unit exists to ensure the public does what the government wants it to do without the use of coercion or punitive laws and is based on; boundaries, social norms, beliefs and values. When, having failed to pay tax on time and you get a letter from HMRC telling you 97% of people do, or when you stand at a urinal in Charles De Gaul Airport and note an intimidating fly tattooed onto the enamel near the sink hole, you are witnessing Nudge Theory in action.

As pampered spoilt brats it was felt most of the UK could not be locked down for more than a short time. This advice missed a key point not accommodated for in behavioural economic theory. When an individual perceives a risk, believes it to be true and understands it is acutely detrimental to their wellbeing, they change behaviour immediately without much need for persuasion. For many that change can be permanent.

Edwina Currie when UK Minister of Agriculture almost destroyed the egg industry when she glibly commented that most of UK hens were infected with Salmonella typhi. Over the following days farmers were forced to dump eggs as supermarket and catering businesses could not sell them on. This behaviour was in complete contrast to the impact of a Department of Health campaign, running for two years before Edwina’s comments, and trying to reduce egg consumption to two eggs weekly as egg consumption was linked to increased risk of heart disease. This latter advice has since been modified off course. The difference in behaviour responses? For salmonella; it was known, serious, acute, likely to happen now whereas the risk of a heart attack 20 years from now that might not happen at all was not strong enough to persuade. Nudge theory does not accommodate the significant difference in these public behavioural responses and therefore underestimates how the public behaves and obeys the rules in a time of pandemic.

Off course there will be those, like me, who are less compliant but you only need 60% of the population to stay home, practice social distancing and wash their hands to bring the R value, the virus spreadability, down from the estimated natural 2.5 where we get exponential growth in cases to less than 1. It is about 0.5 in N. Ireland at the moment.

My point here is that it will be more difficult than we think to get us back to normality. We have behaved so well and government has been using all the known persuasion techniques advised by the behavioural committee; daily briefings on Covid-19 deaths, TV interviews with grieving relatives, clapping the Health Service on Thursdays and making Captain Tom is a national hero, that many will continue to behave like this into the future.

As we attempt to get our lives back to a new normal that will allow our society, our economy and our health services to do what they must to support our wellbeing and make us prosper we will find it very difficult to undo the behaviours we have so successfully inculcated in a large percentage of the population. Yesterday I saw a gross act of racism from a normally mild octogenarian on a foreign neighbour. Last week I had to plead with two very sick people one with angina and one with respiratory disease to go to hospital and if they hadn’t the outcome would have been very serious. They had been so frightened they would literally rather die than go to hospital.

Government is committed to “keeping the foot on the pedal” but I am not so sure this is still necessary. On the contrary we will need to coax that part of our population we have so aggressively frightened, back to a confident sense of normality. The consequences for not doing so is an increased death rate from good old-fashioned diseases the ones that normally killed us before Covid-19 appeared and which will be killing us in much greater numbers than Covid-19 if we fail to manage them. Such has been our obsession with Covid-19, mostly justified I admit, we’ll need reminded that; cancer, heart disease, lung disease and mental health carry a much bigger scythe.

Photo by Lockie is licensed under CC BY-NC-SA

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