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AUSTRALIA has taken two key approaches to reducing transmission of coronavirus disease 2019 (COVID-19): “policy light”, in which a few, sometimes conflicting, guidelines were delivered around the idea that we use common sense; and the nanny state.
We jumped from the Prime Minister urging us to use our own good judgement and behave rationally, to police patrols and spot-checks, heavy fines and threats of jail sentences (here and here). The imperative to get things under control had become urgent, and the move to legislate, enforce and penalise worked. We’re doing well at containing the spread of the virus and we’re moving back to some kind of normal.
Could we have avoided the authoritarian situation we found ourselves in? Possibly. We could have been more strategic in the way we marketed public adherence to COVID-19 health policy. We could have targeted hard-to-reach groups, such as cynical Australians who thought the early fuss was unwarranted and young Australians who absorbed the messaging that older age groups were most vulnerable. Australians aged 20–29 years comprise the highest number of COVID-19 diagnoses.
Behavioural scientists — and advertisers and marketers — have always understood that humans won’t necessarily make the smartest choices even when they have access to the best information (here and here). Common sense is easily skewed to immediate gratification of personal desires and needs. We’re talented at rationalising why it’s okay to continue doing what we want to do.
There are plenty of examples around personal health. People still smoke and will even spend huge amounts of money for the privilege. We make excuses for skipping exercise and overeating, and then pay diet companies and fitness coaches to work magic. Objectivity can be an illusion cloaked in pre- and post-rationalisation. Sometimes we need to be “nudged” into acting in our own best interests.
Nudging is often employed by governments, using evidence-based insights into human behaviour to market important health messages to consumers. Broadly, nudging influences people towards a preferred choice so that they voluntarily and rapidly make the decision you want them to make. The underlying tactic, put simply, is to trigger the mental shortcuts we use to rationalise our choices (here and here).
These shortcuts are formed around biases that are innate, or that are learned and become entrenched. We’re biased, for example, towards choices that bring us into a community and allow us to fit with social norms. We make decisions based on first and strongest impressions and respond to choices that are prominent in our field of vision or hearing. We value options that are positioned as low risk or that manage the level of risk for us. We are drawn to clear classifications and stereotypes and to anything that confirms us as being informed, intelligent, compassionate and resilient.
Nudging strategies can be seen in the New Zealand government’s actions around COVID-19. Their clearly delineated four-level alert system stamped order on potential chaos, describing the risks the virus posed to the public at each level and specifying the measures the government would take to manage and reduce those risks. The design of the alert hierarchy on the government website is visually eye-catching, simple to access and features prominent motifs around physical distancing, such as references to “bubbles”.
All New Zealand government communication about adherence to the alert system has been steeped in messages of social cohesion and belonging. The government COVID-19 website is called “Unite against COVID-19”. Prime Minister Jacinda Ardern’s dialogue links solidarity phrases, including “our team of five million” and “working together”, with desired actions, such as “going early and hard”. In addition to announcements and press conferences, she has made impromptu social media visits, positioning herself as part of the greater New Zealand family.
This strategic messaging has a long term benefit: it will endure beyond COVID-19 and beyond any current Prime Minister. This won’t be the last pandemic. If a vaccine for the novel coronavirus can be developed, it may only be effective for particular strains of the virus, as occurs with influenza. Even then, a vaccine may only offer effective cover for a proportion of people who are vaccinated, as is the case with the flu vaccine. Strategic nudging now can shape a long term culture of personal and social responsibility for virus management, diminishing the need for coercion in times of viral spread.
As restrictions lift in Australia, our government has released a campaign aimed at preventing a second wave of disease outbreak. Its catch-phrase is: “Stay COVID free — do the 3” (wash hands, stay 1.5 m apart and download the COVIDSafe app). It is yet to be seen whether a memorable rhyme urging rational behaviour can prompt us to act in our own best interests, especially now that we’re basking in liberation from compulsory vigilance.
We’re also moving on from the ethical, legal and social repercussions of our leap into authoritarian control. It is no longer front-of-mind that people were punished for minor infringements, neighbours were reporting each other for breaches and family holidays became subversive activities. The story of the young man who was fined $1000 for sitting on a park bench eating a kebab is a distant blur. Only family and friends will remember that a beloved father’s funeral was interrupted by heavy-handed police. It is forgotten now that at one point, lovers in Victoria were not going to be able to visit each other if they didn’t live together.
Targeted public health messaging informed by behavioural insights early on may have prevented those repercussions and fostered enduring personal and social responsibility for disease transmission. No amount of public policy messaging can achieve 100% compliance but we can bridge the gap between common sense and nanny state. If we want to promote uptake of crucial health policy, especially among hard-to-reach groups, we need to engage behavioural scientists as well as medical scientists.
Dr Klay Lamprell is a health care systems researcher with the Australian Institute of Health Innovation, Macquarie University, and a postdoctoral researcher with the National Health and Medical Research Council Centre of Research Excellence in Implementation Science in Oncology.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
Thank you for a well written and thoughtful article, with many great issues to reflect, navigate and learn.
However, the phrases in the article- ‘young Australians who absorbed the messaging that older age groups were most vulnerable.’ and “Australians aged 20–29 years comprise the highest number of COVID-19 diagnoses.” are not obviously clear.
It could be interpreted as either the “prevalence” of Covid-19, in which case the article is correct, or on the other hand the usual meaning of ‘vulnerable’- being “attacked or harmed” by Covid-19, reflected in mortality rates, or ICU admissions.
The data definitely confirms the issue of older populations being more vulnerable in terms of the mortality rates and serious comorbidity data.
https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/ for New York-
18-44 years – Share of deaths 3.9%
75+ years – Share of deaths 48.7%
https://ourworldindata.org/mortality-risk-covid#case-fatality-rate-of-covid-19-by-age -World data-
20-29 years -0%-0.22%
80+ years -13%-20.2%
“The elderly are at the greatest risk of dying, if infected with this virus.”
Therefore, our future challenges will lie in the area of protecting the older age groups who are most affected in terms of mortality rates.
This is a well written and well thought out article. The question of balance between a “nanny state” and a less regulated state is important – it is vital there be more discussion on this matter. The concept of “nudging” has been brought up in this article, that perhaps if “nudging” had taken place earlier there would be more self imposed compliance and less need for coercive measures such as fines, imprisonment and/or physical force.
Personally I feel “nudging” at a national level from those who feel themselves to have the most informed and authoritative stance, a deeply concerning, manipulative strategy which should be deeply questioned. History shows that official narratives of the day believed to be based on the most authoritative, educated, scientific and/or moral cosmology inevitably become the most undesired narratives of another era. Centuries ago those who proposed the earth was round and that it moved about the sun were seen as heretic, ridiculous and dangerous for their potentially socially undermining alternative thought. The well educated who carried the authoritative views of the day without the capacity to question that narrative, scared of being labeled a heretic called for such alternative thinker to be burnt at the stake. Perhaps the more moderate of the status quo thinkers of that day would have called for greater “nudging” (social engineering) of the populous so any socially subversive heliocentric viewpoints would be neutralized by greater mass consensus of the official view.
We should all be prepared and supported in questioning what we are our own stance – our beliefs. The greatest thinkers are capable of questioning their root summations and world view. In general though such people are seen as somehow just uniformed. The truth is that those capable of independently questioning the official Covid 19 narrative are essential to the well being of the community. Conversely more “nudging” of people into sub conscious acceptance of the official view ( propaganda, social engineering and nudging has been going on a very very long time) along with censorship of people who question the narrative (calling such people dangerous [heretic] ) , can lead our our world into a 1984 scenario. I hope that before well educated people who apparently know best throw themselves paternally into “nudging” and social engineering to avoid needing to use force, they sit a while and question their root assumptions concerning the nature of reality. The true answers I think, are within, within all of us.
I have found that our Australian Government at both State and Federal level have done an incredible job. Not only have they stopped Australia reaching an uncontrolled pandemic with minimal loss of lives they have saved lives. Some people refused to listen to the experts and made the Government go hard to stop the spread of the virus. All the news reports were clear with the messages that were being stated on a daily basis. To be honest I am not sure why this article is just comparing Australia against New Zealand. To get an understanding why hasn’t the writer compared us with all the other Countries. Then you would agree Australia has done an incredible job and saved our Country from a catastrophic pandemic. People have lost there jobs and mental health problems have increased but overall the Government and the citizens of Australia have saved this Country from a much worse outcome. If Australia was hit hard with the virus how do you decide on who lives and who dies. That is what would have happened if we hadn’t flattened the curve. It gave our Country time to plan the much needed equipment and PPE gear for our healthcare workers needed to protect them on the front line. So far we are lucky we haven’t proceeded down that road otherwise our economy would have crumbled. At least we are moving back at a quicker rate than what we would have been if the pandemic had hit us hard. Thank goodness the outcome has saved Australian lives.
Great article Klay. I find myself continuously in the divide between binary thinking that scribes the solution to one extreme or the other rather than identifying that a range of solutions is required. So eloquently phrases as bridging – I may use that in the next discussion I have where I’m presented with a tendency to push towards the boundary conditions.
The single most important message that’s come out of this emergency is that such responses must be centralised on a national basis, to avoid both federal-state and interstate confusion. This is imperative and should involve the use of either an existing overarching national body, or the creation of a new one.
There must be clear guidance on policy and procedure with the avoidance of almost daily change which is confusing to patients, potential patients, and those who deliver healthcare.
The Australian response underscores the importance of seeking and following the advice of the most relevant experts in their relevant fields, even when such advice is predictive rather than based on objective evidence which may not be currently available.