A NICE future? - BHF National Centre - physical activity + health

A NICE future?
Professor Mike Kelly
Director, Public Health Excellence Centre, National Institute of
Health and Clinical Excellence

NICE published work on Physical
activity
• Four commonly used methods to promote physical
activity (2006) PH2
• Physical Activity and the Environment. PH8
• Physical Activity in children and young people. PH17
• Physical activity in the workplace. PH13

Four commonly used methods to
promote physical activity (2006) PH2
• Partial update now underway.
• Physical activity advice in primary care (publish April
2013)
• Consultation 4 th November till 2 nd December
• Brief advice to promote physical activity
• Local infrastructure and systems that facilitate the
delivery of brief advice

• NICE will reconsider the need to update the
recommendations on exercise referral, following
publication of the health technology assessment (HTA)
review „The clinical and cost effectiveness of exercise
referral schemes: a systematic review
• NICE is developing new guidance on local measures
to promote walking and cycling which will include an
update of the recommendations on pedometers and
walking and cycling schemes.

Timetable
• Physical Activity and the Environment. PH8 review Feb
2014
• Physical Activity in children and young people. PH17
update 2012
• Physical activity in the workplace. PH13 review July
2014

Walking and Cycling
• health impacts of increasing walking and cycling
• wider environmental and economic impacts arising from
promoting walking and cycling as a form of travel (for
instance, a reduction in carbon emissions or
congestion).

Local government public health
briefings
• New audience
• New responsibilities
• New products

The Dual Process system.
• The reflective system.
– Reflective, goal oriented system driven by our values
and intentions requiring cognitive capacity or thinking
space, which is limited.
– Many traditional approaches to health promotion
depend on engaging this system.
– Often based on providing information designed to
alter beliefs and attitudes, motivate people with the
prospect of future benefits, or help them develop self
regulatory skills.
– At best, these approaches have been modestly
effective in changing behaviour.

• The automatic, affective system that requires little or no
cognitive engagement, being driven by immediate
feelings and triggered by our environments.
• This automatic system is the focus of nudge theory.

Dual process model of human
behaviour
Focus of many
“traditional” health
promotion/education
interventions; e.g.
Provision of
information. BUT “at
best, these
approaches have been
modestly effective in
changing behaviour”1
Human actions governed by
Reflective/
deliberative/
rational
processes
Automatic/nonconscious/nondeliberative
processes
Deliberative
behaviours
(acting upon
reflective
process)
Involuntary
cognitions,
emotions and
behaviours
(behavioural
impulses)
“I want to lose
weight – I will eat
healthily.”
Eating healthily – less
high fat foods, more
vegetables, etc
Grab a chocolate bar,
it’s right in front of me.
1: BMJ 2011; 342:d228

Choice Architecture
http://pumabydesign001.wordpress.com/2010/10/07/michael-bloomberg%E2%80%99s-agenda-tonudge-new-yorkers-using-food-stamps/

Changing behaviour through influencing automatic
mechanisms
Human actions governed
by
Reflective/
deliberative/
rational
processes
Automatic/nonconscious/nondeliberative
processes
Non-conscious
activation of
schema
Sensory Information
e.g. situational and
environmental cues
Choice
architecture: “the
environment in which
an individual makes a
decision”2
Involuntary
cognitions,
emotions and
behaviours
(behavioural
impulses)
2: House of Lords Science and Technology Select Committee. 2nd Report of Session 2010–12 .Behaviour Change.
3: Nudge: Improving Decisions about Health, Wealth, and Happiness. Richard Thaler and Cass Sunstein. 2008.

• MARTEAU, T.M., OGILVIE, D., ROLAND, M.,
SUHRCKE, M., KELLY, M.P. (2011) Judging nudging:
can „nudging‟ improve population health? British
Medical Journal.