Public health needs to go back to basics, not rely on nudge theory

Poverty of scarcity was a major cause of health inequity in the 19th century.1 Poverty of plenty, which is associated with obesity and unhealthy lifestyle, is the major cause of health inequity in the Western world now.2

Currently, public health relies on nudge theory when trying to persuade people to eat healthily and exercise regularly.3 An approach focused on the individual does not deal with the fundamental structural causes of health inequity. It is not surprising, therefore, that Zhang and colleagues state that “healthy lifestyle promotion alone might not substantially reduce the socioeconomic inequity in health.”4

Public health measures that, historically, made a major impact on population health involved societal level actions. Examples include effective sewage systems, clean running water, workplace safety laws, and smoking bans.5 Public health needs to go back to basics and deal with inequity at a structural level rather than relying on nudge theory to change individual behaviour.