ARTICLE: Trouble comes in threes. Extreme measures produce extreme behavior. Fear and panic are breeding grounds of reactivity. These phrases all seem to be true for today's world. Coronavirus may have reached its peak in some countries, and may be reaching peak in other countries as well, but its side-effects are already rearing their head. Economies are struggling to restart with so much restrictions, governments are still trying to find the right balance in saving lives and livelihoods, and public is finding it difficult to contain their frustration and anger. And nowhere is this trio of safety, economy and equity more on trial than in the United States of America.
Medicines may quell the immediate disease but their side-effects can spur other ailments that become even more problematic. To contain the virus human movement had to be contained. That was the safest solution. However, in doing so, human nature was cornered to a point where it was ready for a rampage given the opportunity. Public policy, governance and governments are key elements of dealing with a crisis. For public policy to be successful the cornerstone on which the effectiveness of the implementation of these policies depends upon is human behavior. That is why all successful public health issues are dependent not just on research of medical sciences but on research of behavioural sciences.
As discovered in the present pandemic, medicine is far behind preventing or finding a cure to this menace. The only way this virus can be contained is by adopting preventive and safety measures. The adoption of these safety measures is all dependent on how public becomes informed and engaged in behavioural change to follow the standard operating procedures. That is why all over the world we are seeing different results of the same policy. While all countries are trying to adopt similar curtailment strategies the results differ. South Korea has succeeded with partial lockdown while India is finding it difficult with total lockdown. Similarly, New Zealand has almost eradicated it while the UK and France are still on the downward trend of the peak.
With similar policies and dissimilar results the aspect of behavioural sciences needs more study and analysis. That is why public health policies are such a tricky element as response of public varies from country to country. The biggest example of this variance was how China effectively dealt with the Wuhan epidemic with a complete lockdown while in many other countries it failed. The policy and strategy were similar but public behavior differed. While Lockdown is the main strategy of the public health policy it has psychological and behavioural consequences. Lockdown word itself has negative connotations. Human beings are born with this instinct of freedom and freedom of choice. Anything enforced creates negative thinking, sometimes even at the risk of its own life.
Human behavior acts and reacts to external stimuli in a varied manner. Science of why and what people do in response to the good or bad happening around them should be an integral part of public health or for that matter any public issue. Behavioral science incorporates insights from psychology about what motivates people to alter their behaviour. Cass Sunstein, a distinguished American scholar at Harvard Law School has advocated the use of Nudge as a strategy of behavior compliance rather than bans or coercion. Sunstein, along with Nobel Prize-winning economist Richard Thaler, pioneered the use of "nudge" as a technical term in their acclaimed 2008 bestseller of the same name. In the book, they suggest that governments could do light-touch interventions to change people's behaviour for the better. Despite this, governments often use mandates, bans and incentives to coerce their citizens - an approach that, according to Sunstein, does not always fully address human behaviour.
Thus what has happened all across the world after prolonged lockdowns are scenes that are difficult to comprehend. Educated, sane people in developed world swarm beaches and parks with little regard to social distancing. In Pakistan, people jammed in shops and streets as if they were out of jails and as if there will be no tomorrow. In all cases whether developed or developing nations, whether educated or illiterate the violation of government rules was flagrant. The explanation lies in behavioural sciences. Whenever a private or public institution blocks choices or interferes with agency, some people will rebel, even if exercising control would not result in material benefits or might produce material harms. What is required is a mixed strategy of inducing voluntary behavioural change:
Communicate and Sell Change - Complete and sudden bans scare people. Yes, in China it worked because the Chinese society is trained to authoritative decrees. Elsewhere the reaction has been mixed. In Europe and the US the communication by leaders was first ridiculing the Chinese actions, the seriousness of the virus and then enforcing similar lockdowns without properly preparing the public. This extreme disdain and extreme curtailment created fear and non-adherence in some parts of the population.
Nudging Rather than Pushing - While government regulations are extremely important for behavior modification in the short run, in the long run it invites rebellion. Sunstein says that New Zealand unlike the UK and Italy went for nudging rather than kicking and that helped voluntary adherence. In the US, the current unrest over the tragic death of George Floyd has become not just an expression of injustice to blacks but an opportunity to evade the lockdown and express their caged frustrations.
Develop Community Influencers - The Local governments and neighborhood volunteers are a long-term replacement for monitoring adherence of SOPs. China used students, the UK has registered volunteers, Pakistan has created Tiger Force. This force should not be using force but relationship marketing in the community to connect, and relate to the community. This should be done in their language, their level and their style to make them understand the importance of practicing new behaviours.
Lockdowns are abnormal and create abnormalities of human behaviour. Dealing with them through normal public policy tools and regulations will not get endurable results. We have seen in countries such as Singapore and Japan that as soon as bans are relaxed people go back to their previous behaviours and the infection rates resurge. What is required is understanding behavioural responses, using pull strategies and interspersing them with sharp and friendly nudges to cover the period till the vaccine becomes available.
(The writer can be reached at [email protected])
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