After a harrowing trip to the airport, I finally relaxed at the gate waiting for my flight to be called. My stomach growled as I gazed at the food kiosk across the way. "I should have some lunch before boarding," I thought to myself, "since this flight has no food service." I walked toward the open refrigerator stocked with salads and sandwiches and automatically reached for my favorite sandwich until I saw the rather subtle sign under my choice-622 calories. I pulled my hand back as if it had been burned and moved toward the salads. I selected a small salad with a few strips of roasted chicken on top and a packet of low-fat dressing-285 calories. As I sat eating my salad before takeoff, I realized I had been "nudged."
In their groundbreaking book Nudge: Improving Decisions About Health, Wealth and Happiness, Thaler and Sustein1 advance the argument that the architecture of presenting choices can be structured to match what the evidence indicates would be choices in our best interest. They label this process a nudge, which is defined as "... any aspect of the choice architecture that alters people's behavior in a predictable way without forbidding any options or significantly changing their economic incentives."1(p6) The simple strategy of listing the caloric content on a small sign under the sandwich nudged me toward a healthier choice. Nudges are never mandates or warnings; they are rather easy, inexpensive ways to get us to think before we act and hopefully make the "best" choices.
For those of us who operate on automatic pilot for most of the day, running from patient to patient, from task to task, and from meeting to meeting, well-placed nudges could remind us to wash our hands more frequently, to slow down and breathe deeply from time to time, and to think before grabbing a donut off the pile next to the coffee pot.
There is compelling financial data documenting that individuals are making healthier lifestyle choices; at least they are spending a great deal "out of pocket" on health products and on visits to nonmedical practitioners. A 2007 government survey revealed that US citizens spent $33.9 billion out of pocket over the previous year on complementary and alternative medicine products, materials, and instructional classes and on visits to chiropractors, acupuncturists, massage therapists, and various other complementary and alternative medicine practitioners.2 So what is nudging individuals in this direction? Is it clever marketers who know how to structure the architecture of our choices? Or, is the nation just more interested in health and self-care and improvement as a function of the health care reform debates?
Now that the health care reform legislation has passed, it is likely that we will be increasingly nudged to make choices that promote health and prevent illness. Calories on restaurant menus, free pedometers to incentivize exercise, paybacks for routine screenings such as paps and mammograms are just a few current nudges. Imagine what is to come. The potential of the well-placed nudge can be enormous in creating a healthier society and a healthier you!!
Gloria F. Donnelly, PhD, RN, FAAN
Editor-in-Chief
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