The Lancet on nudging and nagging vs. environmental change

I’m getting caught up on my journal reading and just ran across an editorial from The Lancet, January 21.  It takes on the UK government’s “personal responsibility” approach to health promotion based on the idea that

gently ‘nudging’ people to change their unhealthy behaviours was the key to public health.

Even the UK government has to admit that the nudge approach isn’t working.  Now it is telling physicians in the National Health Service (NHS) to nag:

use every contact with patients and the public to help them maintain and improve their physical and mental health and wellbeing.

The Lancet asks:

Is this a realistic, sensible, and effective recommendation? We would say not.

Effective, evidenced-based public health measures do not include nudging people into healthy behaviours or getting NHS staff to lecture patients on healthy lifestyles.

They include measures such as raising taxes on cigarettes, alcohol, fatty foods, and sugary drinks, reducing junk food and drink advertising to children, and restricting hours on sale of alcoholic drinks….Focusing on other approaches is foolish.

The nudge and nag approaches need one thing: the firm elbow.