Evidence-based policy will save us all a headache
While out with friends recently, one of them shared that he has been suffering from such bad migraines recently that he cannot work or relax when they hit. When I returned home, I looked online for information about headaches. Some facts on the World Health Organisation (WHO) website came as a surprise. Taken together, the many forms of headache represent the third largest cause of years lost due to disability. Almost 50 per cent of the global population has experienced some form of headache over the past year, making the health problem a major issue.
The title of a study published in The Journal of Headache Pain in February speaks volumes about how little consideration is given to headaches, despite their impact on people's lives and therefore on the economy. “Migraine is first cause of disability in under-50s: will health politicians now take notice?” the article asked. The study reminded me of a theoretical scenario I discussed during a talk on evidence-informed policy four years ago in Sofia, Bulgaria.
Imagine a presidential candidate finds out that migraines are a major concern for voters. During her campaign, she promises that “fixing migraines” will be a top priority if she is elected. After winning, the new president decides to stick to her promise, doing what a lot of European governments do: creating a committee of the best experts on the topic. The country’s top neurologists, biologists, pharmacologists and health economists are given the mandate to create a solution to headaches that will benefit everyone in the country.
After six months of hard work, the committee proudly hands a report to the minister of health during a highly publicised press conference. The report's recommendations include a revolutionary headache treatment. A bill is quickly voted through parliament for the new treatment to be deployed domestically, making it mandatory for every citizen in the country.
Now here is my question: if you were living in this country, would you agree to take the treatment knowing it has never before been tested? I would not. And you too should refuse.
Luckily, such a scenario is very unlikely because the legal system of most countries requires very rigorous, large-scale, clinical randomised controlled trials (RCTs) to be conducted prior to releasing a medical treatment to the market. The goal of RCTs is to test the efficiency and discover the unintended consequences of newly-developed treatments on a large number of people.
Participants of RCTs are separated at random into two groups: those that take the treatment and those who take a placebo. Most people are very fortunate to benefit from such strict rules as this "testing before implementation" process is the gold standard in health and healthcare. Although very long and costly, RCTs identify issues before a new drug is sold to a large number of people.
But there is something that generally impacts more lives than new medical treatments and is rarely tested before implementation. I’m talking about reforms and new policies. The theoretical scenario I introduced earlier illustrates the way policies are generally created and implemented in many countries. They are informed by expert opinion rather than evidence collected rigorously. I know this too well, having been one of these experts.
There are two main issues with this way of operating. First, new policies are rarely tested before implementation. Second, people deciding on the relevance of a policy are often economists and legal experts. But it is hoped a new policy will change the behaviour of citizens, ideally for the collective good. Yet psychologists, behavioural scientists and neuroscientists are rarely consulted. These basic mistakes too often lead to policy failure.
Fortunately, things have been changing since 2010 when the UK created the first ever governmental behavioural insights unit – better known as the "nudge unit", named after the bestselling book by Richard Thaler and Cass Sunstein.
A "nudge" is a non-prescriptive strategy rooted in behavioural science that can help change for the better how people make decisions and act. The British unit benchmarked how governments should use behavioural insights to improve people’s lives and save taxpayer money. Their field experiments on hundreds of thousands of people have helped improve tax collection, save energy and limit antibiotic prescriptions.
Around the same time, France launched a programme that I led at the prime minister's strategic analysis centre, called neuroscience and public policy, with similar objectives. But while the British were running experiments, proving their theories and saving public money, we were drafting lengthy reports to try to convince the government to allow us to run experiments. I don't feel the need to tell you which strategy was better.
Read more from Olivier Oullier:
A 2016 EU report detailed initiatives in 32 countries that use behavioural evidence to inform policy. The number is still growing, as are strategic and research programmes in academia and the private sector. Last year, Thaler was awarded the Nobel Prize in Economics for “his contribution to behavioural economics”.
Rarely had a Nobel laureate in economics impacted the daily lives of people as he has. Together with Sunstein, who was Barack Obama’s regulatory affairs office administrator, they co-authored the book that drew global attention to the use of behavioural science in policy and beyond.
But their biggest achievement might very well be to have changed the behaviour and beliefs of smart policymakers who embraced behavioural evidence-informed policy. By extension, Thaler’s work has changed the lives of millions of individuals. Not many scientists can claim such an achievement.
And there is even better news. Research published in Psychological Science last year by Wharton professor Katherine Milkman and some of the behavioural economics "all stars" provide hard evidence of the cost effectiveness of relying on behavioural insights.
People change. So do socio-economic contexts. Evidence-informed policies should be the new norm. The next step will be to involve neuroscientific insights and artificial intelligence to this mix – a combination that will save us all lot of headaches.
Professor Olivier Oullier is the president of Emotiv, a neuroscientist and a DJ. He served as global head of strategy in health and healthcare and member of the executive committee of the World Economic Forum
Updated: May 9, 2018 12:44 PM