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The field of behavioral economics has brought attention to promising ways of motivating people to make better life choices. Many behavioral economic-inspired interventions are relatively hands off -- they nudge people to make wiser decisions without in any way restricting their choices. The idea of nudges was made justifiably popular by Cass Sunstein and Dick Thaler in their best-selling book and has inspired governments around the world to create nudge units.
I’m a huge fan of nudging. But I also don’t think that, when it comes to shaping people's behavior, we should limit ourselves to nudges.
What?!? I want to coerce people? I’m a paternalist? I favor shoves over nudges? No, no, and no. It is a serious mistake to think that the alternative to a nudge is a shove. As Meredith Rosenthal and I wrote about in The New England Journal of Medicine, behavioral interventions come on a continuum. Say we are trying to get physicians to prescribe fewer unnecessary antibiotics. We could try a nudge -- maybe give them feedback on their prescribing rates compared to peers; maybe a poster on the wall of their clinic reminding them of the importance of antibiotic restraint. Or we could shove them -- threaten to suspend their medical licenses if they prescribe too many unnecessary antibiotics in a calendar year. But we could also turn to a whole range of interventions that reside on the continuum between a nudge and a shove.
This range of interventions is sometimes depicted in the Nuffield ladder, which at the bottom lists the least restrictive interventions -- providing information -- ascending upwards to the most restrictive - such as eliminating choice:
This picture is great at reminding us that interventions reside on a continuum. But it still lacks important nuance. For example, it lists incentives around the middle of the ladder. But incentives themselves come on a continuum. We could base 1% of a physician’s salary on how often they overprescribe antibiotics, or 5%, or 25%. In other words, financial incentives themselves range from nudges to shoves.
That’s why Rosenthal and I modified the Nuffield ladder, to depict the continuum varying not only from bottom to top, but also from left to right. Here’s our ladder:
As the picture illustrates, methods of influence not only increase from bottom to top but also from left to right. Monetary incentives stand in the middle of the ladder, height-wise, because they are, in general, more hands-on than mere information nudges. But monetary incentives range from pretty hands-off to quite heavy handed, represented by the shading progressing from green to red as we move left to right.
Why is it important to recognize this more nuanced, multi-dimensional take on nudging? Because we cannot rely solely on nudges to promote publicly important behaviors. And we should not mistakenly conclude that anything more than a nudge is, thus, a shove.
As I see it, some behaviors should only be addressed by gentle nudges. When behaviors cause only mild harms to the people who engage in those behaviors, it’s hard to justify more than a nudge. However, when behaviors cause greater harms that spill beyond the people engaging in the behaviors--think of all the people harmed by inappropriate antibiotics, or the worldwide damage created by carbon emissions--we should be prepared to go beyond nudges if nudges don’t yield the amount of change we need.
More importantly, it’s nice to know that when we do go beyond nudges, we don’t necessarily have to resort to shoves.
