[The CINet] Individual-Level Solutions Have Led Policy Astray

"So, what do you think?

In their journal paper "The I-Frame and the S-Frame: How Focusing on the Individual-Level Solutions Has Led Behavioral Public Policy Astray" (summary here with links to abstract and full paper), two previously self-described members of the behavioural science academic community change their view.

'An influential line of thinking in behavioral science, to which the two authors have long subscribed, is that many of society’s most pressing problems can be addressed cheaply and effectively at the level of the individual, without modifying the system in which individuals operate. Along with, we suspect, many colleagues in both academic and policy communities, we now believe this was a mistake..'

The reasons for this about-face are based around the following:

'Results from [i-frame: individual-focused] interventions have been disappointingly modest.'

'The fact that corporations have spent billions of dollars promoting i-frame interventions in the belief that such interventions will fail should make behavioral scientists uneasy.'"

...

https://www.comminit.com/global/content/cinet-individual-level-solutions-have-led-policy-astray 

 

I don't want this to sound like "Told you so!" but I'm not surprised, even as the literature and media often wax lyrical about 'synergy', constantly about 'integration' and more recently 'population health'.

I appreciate too that having a (cognitive) model is just the beginning. I really admire the practitioners in The Communication Initiative Network and other groups who grapple with funding, policy, recruitment, communication, change and outcomes around the globe.

As efforts continue across health, social care and education ... never under-estimate the relevance of conceptual tools, especially the power of not just one lever - but at least two:

Hodges' Health Career - Care Domains - Model

See also: I-dentity: How the Individual-Group runs...

Is this a Domain or a Door? Rethink: Behaviour Change

When is a domain really a door to insight, understanding and change?

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - population

Rethink: Behaviour Change - BBC Radio 4	10 children   The  garden is littered with inside doors.  'Line of sight'
Family Intervention Unit.   or Family 'Interference' Unit  Mother, ten children  Several partners Many people in the community  know the family, know the house.	Housing: Eviction notice Housing have to keep calling to the house to replace the doors as they keep being removed. The family is known to the schools, social services, the doctors, the police ...

See also:

'Line of sight'

Sticking with 'nudge' - behaviour and economics ...

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - population

psychological realism cognition

neoclassical model "The most well-known critique of behavioural economics comes from a psychologist, Gerd Gigerenzer of the Max Planck Institute for Human Development. Gigerenzer argues that it is pointless to keep adding frills to a mathematical account of human behaviour that, in the end, has nothing to do with real cognitive processes. ... He [Laibson] concedes that Gigerenzer has a point but adds: 'Gerd's models of heuristic decision-making are great in the specific domains for which they are designed but they are not general models of behaviour.'" "There is a tendency to propose some new theory to explain each new fact. The world doesn't need a thousand different theories to explain a thousand different facts. At some point there needs to be a discipline of trying to explain many facts with one theory." [David K Levine, Is Behavioural Economics Doomed?, 2012]

social proof Source: Financial Times

behavioural  economics "The challenge for behavioural economics is to elaborate on the neoclassical model to deliver psychological realism without collapsing into a mess of special cases. Some say that the most successful special case comes from Harvard's David Laibson. It is a mathematical tweak designed to represent the particular brand of short-termism that leads us to sign up for the gym yet somehow never quite get around to exercising. It's called "hyperbolic discounting", a name that refers to a mathematical curve, and which says much about the way behavioural economists represent human psychology."

Harford, T. (2014) Nudge or fudge? Life&Arts, Financial Times, 22-23 March. pp.1-2.

Clearly indoors, clearing papers ...

HelpForce the Domains for Change in Social Care

There are many lessons to be found - and as governments continue to learn - trip over, in the ongoing COVID-19 pandemic.

The government made a call for volunteers:

https://www.england.nhs.uk/2020/03/your-nhs-needs-you-nhs-call-for-volunteer-army/

 and the public has responded with 750,000 respondents:

https://www.goodsamapp.org/NHS

While of little consequence in the larger world, for me this crisis continues to reveal how the axes of Hodges' model encompass far more than their respective labels might indicate.

Taking the vertical axis:  INDIVIDUAL to GROUP (population) nations have had to resort to law to direct, instruct, force their citizens to stay at home.

Health policy, public health and economics specialists have long sought a means to influence people's behaviour. Nudge theory has joined the basic motivators of carrot and stick.

In the UK the call for volunteers has a long history.

Tom Hughes-Hallet, Your NHS Needs You, The Sunday Times, 26 August 2018, p.22.

HelpForce

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - population

An individual's behaviour ...

... and the impact of the same.

THE BIG SOCIETY

"The Big Society was a political ideology developed in the early 21st century. The idea proposed "integrating the free market with a theory of social solidarity based on hierarchy and voluntarism". Conceptually it "draws on a mix of conservative communitarianism and libertarian paternalism". Its roots "can be traced back to the 1990s, and to early attempts to develop a non-Thatcherite, or post-Thatcherite, brand of UK conservatism" such as David Willetts' Civic Conservatism and the revival of Red Toryism. Some commentators have seen the Big Society as invoking Edmund Burke's idea of civil society, putting it into the sphere of one-nation conservatism.   The term Big Society was originated by Steve Hilton, director of strategy for the Conservative Party, and the idea became particularly associated with the party's leader David Cameron who was a strong advocate for it. The idea formed the flagship policy of the 2010 UK Conservative Party general election manifesto and was part of the subsequent legislative programme of the Conservative–Liberal Democrat coalition agreement. The stated aim was to create a climate that empowered local people and communities, building a "big society" that would take power away from politicians and give it to people." WikiPedia

Clearly, there is a macro form of nudge and hopefully this will result in social care being given the attention (funding) it desperately needs, recognising the value and values inherent in the sector.

Also in the Sunday Times article 'The NHS in numbers':
9m - Increase in UK population of pensioners in next 40 years

1942 - When William Beveridge's blueprint for postwar welfare state was published

10,000 - Volunteers supporting 4,000 staff at Marie Curie cancer care charity.

Tom Hughes-Hallet, Your NHS Needs You, The Sunday Times, 26 August 2018, p.22.


https://en.wikipedia.org/wiki/Big_Society

Recipe II: Holistic care - Care pebble overhere!

...

WouldBeUser: Well there's no shortage of pebbles, the referrals come thick and fast.

ActualUser: That's why reflecting on that particular pebble is important, turning it - them, their situation over. Asking yourself is there anything I and the team have missed?

WouldBeUser: OK, the beach is still full of them!

ActualUser: Is it the pebble you are trying to see?

WouldBeUser: Ah, of course! Individualised care?

ActualUser: That's right. Nursing, health, social care and in fact good governance everywhere is about seeing the person. Sometimes it isn't easy; but if you pick that person out then you can count the rewards as you would the pebbles on the beach ...

Original image sources - see Recipe I

Recipe: Holistic care - Care pebble turnover*

WouldBeUser: How can you sum up use of the health career - care domains - model?

ActualUser: Well it's a bit like you are picking and throwing some pebbles on the care plan or game board.

WouldBeUser: What - as simple as that!

ActualUser: Yes, but - NEVER underestimate the value of turning each of those pebbles over and reflecting, sharing...

*Also great for a game of nudge - nudge.

Original image sources:

http://imagecache.artistrising.com/artwork/lrg//4/417/7CV9000A.jpg
http://www.crglass.ca/images/dark%20green%20pebbles.jpg
http://www.crglass.ca/images/dark%20blue%20pebbles.jpg
http://www.crglass.ca/images/red%20pebbles.jpg