Eight Innovative Ideas to Influence Health Behavior

The majority of my work in the Department of Research and Evaluation at the Robert Wood Johnson Foundation has been predicated on the long-held assumption that if you show people convincingly that doing one thing will create the outcome they desire, you can inspire behavior change. The problem is that when it comes to health, we consistently observe individuals acting in ways guaranteed to produce poor outcomes.

The observation of seemingly “irrational” behavior by economists, psychologists and others led to the development of the field of behavioral economics, which has, in recent years, produced insight to explain some of the perplexing health behaviors we observe in a way that the classical economic theories I learned in graduate school cannot. The Robert Wood Johnson Foundation believes these emerging insights have breakthrough potential to help people make better choices for their health. That’s why I’m excited to announce that the Pioneer Portfolio and Donaghue Foundation are now supporting a group of innovative researchers who are testing simple interventions that may have widespread impact on complex problems.

Last fall we asked behavioral economists, choice theorists, and others studying habit formation or physiological mechanisms to submit new ideas to help people make the “right” decisions for their health. After narrowing the field for our Applying Behavioral Economics to Perplexing Health and Health Care Challenges solicitation from an initial 330 responses to 25 finalists, we’ve selected the following eight grantees:

• Anne Thorndike, Massachusetts General Hospital, Feedback, incentives and point-of-purchase interventions to engage employees in healthy eating behaviors
• Elizabeth Merrick and Dominic Hodgkin, Brandeis University, Using novel patient financial incentives to improve uptake of routine mammography
• Ellen Magenheim and David Huffman, Swarthmore College, Fighting viruses with viral marketing? Using online social endorsements to enhance incentives to sign up for flu vaccinations
• Gretchen Chapman and Elliot Coups, Rutgers University and University of Medicine and Dentistry New Jersey, Walking with prospect theory
• Judd Kessler, Eric Zwick and Dmitry Taubinsky, University of Pennsylvania and Harvard University, Using behavioral economics to promote medication adherence and habit formation
• Justin Sydnor, Heather Royer and Mark Stehr, University of Wisconsin, University of California and Drexel University, Improving the structure of financial incentives for exercise: insights from behavioral economics
• Karen Glanz and Jason Karlawish, University of Pennsylvania, Social goals and individual incentives to promote walking in older adults
• Paul Resnick and Caroline Richardson, University of Michigan, Impacts of public announcements of goals and outcomes on goal completion

Typically, the phrase “pioneering ideas” brings to mind cutting edge technology, and the most advanced science. What’s pioneering about these new grantees is that they recognize how small, low-cost ideas that are easy to implement can create a big change.

We are looking forward to working with the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute and seeing how these ideas pan out over the next 18 months. We embrace the risk that some of these great ideas will fail to produce lasting change. Stay tuned, because next year we’ll convene each research team to share their findings—expected and unexpected—and to look for ways to spread the best ideas to those who most need a breakthrough solution.

Comments

[Barry Cohen]

It's great to see research looking for "breakthrough potential". Are you open to really really really really "pioneering" ideas? I've got just one...

Background. I've alway been curious to find out why we publicize and shoot for a cholesterol of under 200, knowing that 35% of heart attacks and strokes occur under 200. The 200 number appears everywhere (American Heart Association, etc.)as either "desireable" or "optimal". The 200 number is killing us. And, interestingly enough, if we keep it there, we'll always be fighting for a cure.

After 2 years of questions to our heart/health institutions, I finally learned the truth of where the 200 came from...that Dr. Castelli, former director of the Framingham Institute (where MOST of the heart/stroke risk work has been done), was involved in the research that yielded the 200 number and that the 200 number was taken out of context (you can read or listen to his Feb. 2011 interview). We've been living (or dying) with it ever since.

The real number to prevent heart attacks and strokes is under 140. Societies with populations that eat diets that yield numbers below 140 don't have heart disease.

But, with the 200 number, so many people approach or just get under 200 and feel a sense of safety. They're NOT. The 200 number is killing us.

Here's the question...what if everybody knew that under 140 was the truly safe number? How easy would it be to spread the word? The next question people would ask is "how can I get there"? Obviously, dietary changes would be necessary. I belive the simple act of telling the truth on one (1) single health fact could change diets overnight...and the health of a society. You can read or listen to the interview here: http://www.prescription2000.com/Interview-Transcripts/2011-02-18-william-castelli-heart-disease-lipids-transcript.html

The common knowledge that 200 isn't safe and that under 140 is...would be a so-called game changer, diet changer, society changer. We are a numbers-driven, competitive, goal-oriented people. What if the goal was moved?

I don't have a bunch of initials next to my name, but I've been in the health field for over 25 years. At 52, I'm too old to give up my businesses, financial security, wife and 4 kids to get the initials behind my name...but I am educated and "get" our biggest health issues and potential solutions.

Much of what you're researching today, I've already pioneered in practice. It's a little frustrating watching money spent and time lost to demonstrate, in writing, whether something works or doesn't.

I hope you'll seek for yourself the truth in my 200/140 argument. Many are vested in NOT having us get healthier. The 200 guarantees it. Others say that the 140 number is unrealistic. I say, tell the truth and let people respond for themselves.

You can read more about my background on the blog at "Behind General Healthy". Maybe, someday, we'll even speak. That would be great.

I'd be excited to hear your thoughts.

Sincerely,

Barry "General Healthy" Cohen

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