Glass of wine

It seems at once the simplest and most complex of health problems: by eating healthily, not smoking, being more active and cutting down on alcohol, we can live longer, healthier lives. Why, then, do so many of us ignore this advice?

The remit of Cambridge’s Behaviour and Health Research Unit (BHRU), launched just over a year ago in April 2011 and funded by the Department of Health’s Policy Research Programme, is to develop and evaluate ways of changing behaviour at a population level to improve health and reduce health inequalities. Something that, so far, many countries have tried to do, but with limited success.

The Unit brings together a team of experts from the University of Cambridge, two Medical Research Council units in Cambridge (Epidemiology and Human Nutrition Research), RAND Europe and the University of East Anglia. As well as researchers from the Clinical School, the Unit includes David Spiegelhalter, Winton Professor of Public Understanding of Risk at the Centre for Mathematical Sciences. The range of disciplines covered includes behavioural science, neuroscience, anthropology, economics and epidemiology.

This disciplinary mix is what marks out the new Unit, explained its Director and Honorary Professor of Behaviour and Health, Theresa Marteau. “It’s a range of disciplines, some of which have been addressing similar problems but from different perspectives, for example bringing in neuroscience as well as epidemiology and behavioural science to understand the behaviour that contributes to population health and ill-health.”

Insights from behavioural and neuroscience into the basis of everyday behaviour will be particularly important. “We will focus on two key systems. The first is the reflective, goal-directed system driven by values and intentions. We want to lose weight, we intend to eat less. The second system is the more automatic system that is driven by immediate feelings and habits. These two systems operate sometimes synergistically as well as antagonistically in shaping our behaviour,” she said.

So, despite intending to eat less, we find we have bought the chocolate bar at the checkout. “As neuroscience increasingly reveals how our behaviour is governed by unconscious processes, we understand better how advertisers and retailers shape our behaviour, unfortunately often to the detriment of our health. The trick is to see how we can capitalise on this understanding to develop more effective interventions that cue healthier behaviours.”

Focusing on four key behaviours – diet, physical activity, smoking and alcohol consumption – the Unit’s research programme has two overlapping strands, primary research and synthesis of existing evidence.

According to Professor Marteau: “It’s good science to start with what we know, based on rigorous evidence synthesis, and design new studies that contribute to the existing evidence base.” One of the Unit’s new primary research studies involves studying online food purchasing using a virtual, online supermarket. Using this, researchers will be able to vary the way purchasing decisions are presented to thousands of ‘shoppers’, as well as altering how foods are presented. “The virtual online supermarket provides the opportunity to run a large number of experiments in which we can change different features in a systematic way to identify the most promising interventions to take forward in real-life experiments,” she explained.

How, for example, do our brains deal with a chocolate bar that looks very inviting but carries a nutritional label warning us about its calorie count? And does a web site adorned with fruit and vegetables prime people to buy more of this type of food? The virtual online supermarket goes to the heart of what researchers in the field call ‘choice architecture’ (i.e. the way that options or choices are presented to influence the decisions that are made) and how consumers might be ‘nudged’ into making healthier choices.

To be useful to policy makers, interventions need to be acceptable as well as effective, so another strand of research at BHRU is examining the public and political acceptability of interventions, something particularly relevant to alcohol.

According to Professor Marteau: “The majority of smokers want to quit and the majority of those who are overweight want not to be so. By contrast, most people in the UK don’t want to reduce how much alcohol they consume. In part reflecting this, only half the population favours any kind of pricing policy to reduce alcohol consumption. This raises questions about the basis upon which such judgments are based. What happens if the evidence about the effectiveness of alcohol policies is presented not in terms of health but, for example, in terms of road accidents or violence? Does this alter how acceptable people find policies that at first glance they reject? How sensitive are people’s judgments to the weight of evidence including its uncertainty? Exploring these questions using experiments grounded in qualitative work could shed light on the complex relationship between science and policy in health and other areas of public policy.”

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