Ben Page, chief executive, Ipsos MORI, gave this proesentation to the Local Government Association's annual conference on 26 February 2013

1. The public and public health – what to do?
Ben Page, Chief Executive, Ipsos MORI
LGA Annual Conference
26 Feb 2013

2. A noble goal...what would make you happiest?
%
60
Double
my
50 income Better Health
40
30
20
10
0
15-24 25-34 35-44 45-54 55-64 65-74 75+
Age
Base: 2,015 interviewed face to face in home in GB aged 15 +, 20-25 Sept

3. The public claim to be in good health
Q How is your health in general? Would you say it was...
100 %
90
80
Very good/ good health
76
70
60
50
40
30
20
10
Very bad/ bad health
6
0
Data up to 2002 are unweighted. From 2003 onwards, data have been weighted for non-response
Base: Adults aged 16+ in England (at least 4,500 per wave) Source: Health Survey for England

4. The facts say …..obesity levels
Source: Health Survey for England

5. The facts say - booze consumed
Source: Health Survey for England

6. They are aware of the big health issues
Q Thinking generally, what are the biggest health problems facing people today? What else?
Cancer 34%
Obesity/overeating 30%
Alcohol abuse 16%
Heart disease 16%
Age-related illnesses 16%
Smoking 13%
Diabetes 10%
Unhealthy lifestyle 9%
Stress/pressure 9%
Obesity in children 8%
Dementia 8%
Mental health 8%
Poor diet 7%
Drugs abuse 6%
Lack of exercise 5% All mentions above 2%
Base: 1,004 English adults aged 16+, Dec 2012 Source: Ipsos MORI/DH Perceptions of the NHS Tracker

7. And they say they recognise the importance of lifestyle
Q Looking at this card, which factors, if any, do you think have the biggest impact on your chances of
living a long and healthy life?
Your lifestyle 79%
Your genes 39%
Your social circumstances 35%
NHS 17%
Whether you are male or female 7%
Having a university degree 2%
No answer 1%
Don't know 1%
Base: 1,994 British adults, Aug 2008 Source: Ipsos MORI

8. They claim price is key to helping them be healthier
Q Which of the following would encourage you to lead a healthier lifestyle?
Lower prices for using leisure centres 44%
Lower prices for healthy food 40%
Better sports and leisure facilities 24%
Having more time 23%
Being told to by my doctor for health reasons 17%
Having more healthy food available in local shops 15%
Better access to weight loss services 10%
Better information about how to eat healthily 9%
Better information about how to be more physically active 6%
Having help with my caring responsibilities 4%
Better access to stop smoking services 3%
Advice and support to stop/cut down drinking alcohol 2%
Nothing, I already lead a healthy lifestyle 19%
Base: 4,824 adults, Sept - Dec 2011 Source: Ipsos MORI

9. Meanwhile there are calls for stronger intervention

10. Public support for anti-smoking measures
Q Now thinking about smoking: What, if anything, do you think government should do?
Strongly support/tend to support
Provide information 92%
Incentivise people to stop
smoking
73%
Ban smoking in public places 74%
Ban smoking altogether 45%
Make tobacco companies
invest against smoking
78%
Base: 1,014 UK residents aged 16-64, November 2010 Source: Ipsos Global @dvisor

11. On healthy eating?
Q Now thinking about what people choose to eat: What, if anything, do you think government should do?
Strongly support/tend to support
Provide information about
healthy eating
86%
Provide incentives, such as
health food vouchers
72%
Make unhealthy foods more
expensive 37%
Ban unhealthy foods 33%
Make companies promote
healthy choices
81%
Base: 1,014 UK residents aged 16-64, November 2010 Source: Ipsos Global @dvisor

12. Less open to forceful intervention compared to neighbours
Q Government should introduce laws to ban unhealthy foods
Strongly support/tend to support
China 89%
South Korea 89%
Saudi Arabia 88%
India 87%
Indonesia 87%
Turkey 87%
Russia 86%
Mexico 71%
Japan 70%
Argentina 68%
Italy 65%
Spain 64%
OUTRIGHT BAN
Poland 63%
Hungary 55%
Brazil 53%
Germany 43%
South Africa 42%
Canada 41%
Belgium 39%
France 35%
Sweden 35%
Australia 33%
Great Britain 33%
USA 21%
Base: c.500 - 1,000 residents aged 16-64 (18-64 in the US and Canada) in each country, November 2010 Source: Ipsos Global @dvisor

13. Should the lifestyle we choose affect the care
we receive?

14. Whose responsibility is public health?
Q I am going to read out two statements, one at either end of a scale. Please tell me where your view fits
on this scale.
Agree much more with A Agree much more with B
A B
It is the job of the NHS 5% It is the individual’s
to keep people healthy 25% 27% 39% responsibility to keep
4% themselves healthy
The NHS should be The NHS should give
there to take care of less priority to people
people regardless of 31% 21% 26% 14% 9% who do not take care
why they are ill of their health
Base: 1,646 British adults 15+, April 2010 Source: Ipsos MORI personal responsibility 2010

15. But some willingness to MAKE people take right decisions
Q If the NHS was to face lower levels of spending, which of these, if any, would you be most/ least willing to
accept?
% Most % Least
Requiring patients to change lifestyle before
they are allowed treatment (e.g. give up 53 7
smoking, change diet)
Longer waiting lists 7 12
Charges for visiting your GP
6 35
Some types of treatment not available in 5 16
your area, depending on where you live
Fees for hospital stays 3 19
None of these 17 7
Base: 1,041 British adults aged 16-64, Sept 2009 Source: Ipsos MORI personal responsibility 2010

16. So how will the move of public health into local
govt affect public perceptions?

17. NHS more loved and respected than local government
Q Can you tell me which of the phrases on this card best describes the way you would speak about that
service to other people?
% Critical % Speak highly Net score
-7 (-8 in 2011)
Your local council 28 21
The police in my 19 32 +13
local area
16 54 +38
My local hospital
Local NHS (GPs,
hospitals, ambulance 12 63 +51
service, dentists and
other parts of the NHS)
Base: 828 adults aged 15+ in England , Dec 2009 Source: Ipsos MORI

18. Will local govt as the messenger affect public receptivity?

19. Low awareness of local government’s role
Q I am going to read out a list of services and, for each one, I would like you to tell me whether you
think it is the responsibility of your local London Borough Council or not…
% Yes % No % Not sure/ Don't know
The police service 49 42 8
Your local hospital 45 46 8
Rubbish collection
97 3
and recycling
The Freedom Pass 60 29 11
Base: 1,001 adults aged 18+ in Greater London, April 2008 Source: Ipsos MORI

20. Behind the scenes: what happens next for
public health in local govt?

21. Upheaval ahead though demands remain unchanged
Ongoing
purpose to
Focus on transition protect local
populations and
Normalising to new environment inform
commissioning
A whole systems approach to
business as usual

22. There will be new indicators to measure and track

23. And a new opportunity for collaborative data collection

24. Why it matters...
“Doesn’t bother me, it’s shit
here.”
Blackburn resident
Source: Ipsos MORI

25. Why?

26. How do human beings make choices/decisions ?
Rational
decision Gather pertinent Process pertinent Calculate optimal ‘Rational
-making information information choice decision’
process
Decide Decide without Decide
without all the fully based on
data/using processing faulty cal-
irrelevant the facts culations
Short- data
circuits
of the
‘rational’
process
‘Irrational
decision’

27. Behaviour change is flavour of the month

28. Four levers at your disposal

29. Successful change campaigns use a mix
of informing, enabling, incentivising and enforcing
Inform
Enable
Influence
Incentivise
Enforce
Source: Websites, press search

30. But you can also learn from behavioural science
 People make choices without
Inform going through a full ‘rational’
decision-making process’
 Certain biases pre-dispose
Enable
people to short-cut the
rational decision-making
Influence
process
Incentivise  Using these biases in a
systematic way can make
campaigns significantly more
Enforce likely to succeed

31. Question
What percentage of
African countries
are members of the
United Nations?

32. Evidence – anchoring
Numbers
shown on Mean
“roulette” estimate of
wheel respondents
10 25%
65 45%
Source: Kahneman and Tversky, 1974

33. Example bias – anchoring
People’s estimates
are swayed by data
suggested to them
beforehand, even
when they know the
data is irrelevant or
false.
Source: Daniel Kahneman, Daniel Tversky (1974); McKinsey synthesis

34. Case study – anchoring
Source: 5 a Day campaigns in Argentina, Chile, Germany, Japan, Mexico, Spain, UK, US

35. Case study – anchoring!
Source: 6 a Day campaign in Denmark

36. Example bias – Social norms
People tend to
follow their peer
group – if they
see many people
doing something,
they aim to do it
too.
Source: Bandura, Grusec and Menlove (1967); Milgram et al (1969); Cialdini; McKinsey synthesis

37. Example bias – reciprocity
You are more
likely to obtain a
large
commitment if
you obtain a
small one first.
Source: Festinger, 1957; Cialdini (2006); McKinsey synthesis

38. Behavioural Norms we can use….
Short-circuits of rational
Biases decision-making process
Reciprocity Liking Status quo
Decide without
all the data/using
Consistency Scarcity Endowment irrelevant data
Availability/
Social norms Authority
recency
Decide without
Choice fully processing
Justifiability Anchoring
overload all the facts
Framing/ Hyperbolic
Regret aversion
contrast discounting
Decide
Certainty Probability
Loss aversion based on faulty
preference misassessment
calculations
Mental
Breakpoints False memory
accounting

39. Final case example – the AIDS awareness change in the UK
• Number of diagnoses of gonorrhoea (000s)
70
60
50
40
30
20
10
0
1925 1935 1945 1955 1965 1975 1985 1995 2005
Source: Health Profile of England and Wales

40. Action across multiple fronts to reduce Sexual Infections
BBC programming about AIDS
Inform
Distribution of free condoms
Enable
Influence
“Tombstone” campaign
Incentivise
None
Enforce
Use of numerous biases including Authority,
Liking, Hyperbolic Discounting, Probability
Misassessment and Social norms

41. Social norm: James Bond and the decline in sexual diseases in the 1980s
Average Bond girls per film by actor
Lazenby
3
Connery Moore Brosnan
2
Dalton
1
0
1960 1970 1980 1990 2000
Source: Avert; BBC; www.universalexports.net

42. In conclusion...
•Lots of public support
•Lots of public interest – in principle
•Lots of public confusion – needs great
communications
•Needs measurement – but be careful – need
to understand people’s real motivations
•Over to you....
•Good luck

43. Thank you
Ben.page@ipsos.com