The White House Office of Science and Technology Policy has created something called the Social and Behavioral Science Team. It is intended to draw upon these fields in order to make government policies more effective and efficient.
The approach is discussed in a New York Times article by a professor at the University of Chicago who has advised the Obama administration and who also advised the villainous David Cameron administration in Great Britain. Fox and other right-wing media were sent into a fit with fears of Obama brainwashing.
It’s nothing of the kind—which doesn’t mean that the Team’s work is benign. I’ll tell you why. The Times article mentions three issues that are receiving the Team’s attention.
At 3 years of age, poor children have a significantly smaller vocabulary than well-off children. Much of this is attributed to how caregivers and parents speak to and read to their children. Coaching and new technologies are cited that could improve the performance of parents and caregivers.
A second category concerns domestic violence and the effectiveness of domestic violence hotlines. Women who call are too often left on hold, the call is dropped, and help is not received. Improved call handling methods and technologies are cited—for example, communicating wait times—so that callers are kept on the line until they can get the help they need.
The final category concerns the failure of patients to follow a course of treatment, such as taking medications at the prescribed times during the day or getting to appointments. Changing medication design (for example, from three-times daily to once) and information technologies for “mental crutches” are cited as ways to make compliance easier.
Although only the last is called a health issue, I believe that all three are health issues—and serious ones. It’s disappointing that the solutions offered ignore the obvious political economy of each of these problems.
Yes, enabling parents to improve children’s language skills is desirable. But that’s not the problem. The problem is they’re poor. Providing those families with economic security will do far more than coaching parents to read to their children.
Yes, having better communication techniques for victim’s of domestic violence is a good thing. But eliminating the economic insecurity that is the soup from which domestic violence bubbles up is going to be far more effective than telling callers how long she has to wait before she can talk to someone. And for that matter, why not spend money making sure that no one ever needs to be put on hold?
Yes, some people have trouble following a doctor’s orders. How often is the problem not three pills versus one but choosing between the pill and the meal with which you’re supposed to take it? Oddly, the article opens this section by citing a study that showed better compliance when the co-payment for a treatment was eliminated. After concluding “for some highly effective treatments, there should be no co-payment at all,” the article pats the idea on the head and moves on to redesigning pills. Why not eliminate all co-payments altogether?
Characteristic of the Obama Administration’s disappointing performance in general, the work of the Social and Behavioral Science Team will nibble at the edges of serious problems.
The ideas are not necessarily bad ones—for what they are. They come from an academic literature on what’s called nudging—which means making small environmental changes that have a significant effect on our health and well being. An example that sticks in my head concerns organ donorship.
Both the US and France manage organ donation through their driver license system. Your driver license designates you as a donor or not. You choose when you get your license and can have it changed at any time. But there’s a big difference between the US and France. The percent of people who are donors in the US is very low while in France it’s very high.
The difference has nothing to do with altruism, but with how the question is asked. In the US, you are asked to opt in—that is, you have to check the box to be a donor. In France, you are asked to opt out—that is, you’re a donor unless you check the box.
You might think it’s too bad that the US has such a system, one that prevents a noble, life-saving act. However, the organ donation system is less than a noble undertaking and there is some evidence that many donations are made before the donor has joined the choir invisible—both from the haste of the “extraction team” and the questionable parameters used to decide when someone is dead.
What I’m saying is that making a policy work better using nudges is a smart thing, but we should make sure we’re signed for the policy and understand the de facto effect of the policy.
It seems to be a de facto policy that children should live in poverty.
It seems to be a de facto policy that women should live in fear of domestic violence.
It seems to be a de facto policy that medical care should require financial sacrifice.
It’s those de facto policies that the Social and Behavioral Science Team is nibbling at in the name of efficiency, producing band-aids at best.