• by Jacob Braude , August 17, 2012

As the blitz of new data about ballooning healthcare costs continues to intensify (in March, The Annals of Family Medicine published this paper projecting that health costs will equal half of the average paycheck by 2021), the banging of the behavior-change drum grows ever louder. Hospitals, health insurance companies, employers and national and local government -- all are focusing their efforts on behavior change to stem the tide. The thinking is seductively simple: three of the top five killers in this country are the direct result of bad diet and no exercise. If we just get people to change their behaviors, we can solve this oncoming crisis before it devastates our economy.

It’s not so simple. Creating a sustained shift in human behavior is very difficult. To succeed, we all need to get smarter about how our brains work, and where these behaviors really come from. 

It starts with the myth that you have one brain. You don’t. From a behavioral perspective, you have two brains – conscious and unconscious – each with a very different approach to making choices and taking action. When your conscious brain makes a decision, it’s like a session of Congress: endless debate, weighing the pros and cons, playing out possible scenarios and calculating the consequences. When your unconscious makes a decision, it’s as simple as a gun going off: the hammer hits the bullet casing, ignites the gunpowder, and hurls the metal bullet out into the world. 

There’s good and bad to both. Conscious choices are systematic and give you the opportunity to take the long view, which is the kind of thinking you need when you are trying to start eating right and getting your exercise. However, conscious choices are also painfully slow and use up a lot of your brain’s energy. Unconscious choices, on the other hand, are super fast and cheap (bullets don’t think – they just do), but they are also based on what’s happening to you right now, which can land you in hot water (think: being hung over in a meeting because the night before that one last drink seemed like a really good idea). 

These two different behavioral systems are at the heart of the health challenges we face. Basic economic principle tells us that any system that has to decide between slow and costly or fast and cheap is going to outsource as much work as possible to fast and cheap (see manufacturing, United States, late 20^th century), which is exactly what happens in your brain. Scientists now estimate that 85% or more of the work your brain does is unconscious – including up to 45% of your choices. For routine behaviors like eating and exercise, this means there’s a lot more bullet and a lot less debate behind what you do. 

Now for the good news: this outsourcing model can be used to help rather than hurt. But to do it, we have to shift our mindset away from convincing the conscious brain and start thinking about hacking the unconscious system. There are hundreds – maybe thousands – of these little behavioral programs running amok in your unconscious, and they tend to be triggered by some element of your physical experience. It could be something in your environment, some action your friend took or some sensory feedback from your body. This presents a lot of opportunities to proactively trigger a positive behavior. Here are three ideas to get you started:

1. Redesign the Environment: Our physical experiences with the environment are constantly triggering behavioral programs. One elegant example I’ve always loved is the piano stairs that DDB and Volkswagen installed in a subway station in the capital of Sweden. The stairs were right next to an escalator. Prior to the piano, most people opted for the escalator, while afterwards two-thirds more folks decided to hoof it. Another example is the hospital chair designed by Michael Graves Design Group that reworked the handles of the typical hospital chair to automatically trigger the right behavior for standing up when recovering from a procedure.

2. Make the Behavior Socially Obvious: Our unconscious behaviors are enormously influenced by the social graph. What the people around you do is so impactful that recent research revealed that just having friends who are obese makes you 57% more likely to be obese yourself. Social technologies are opening up an exciting opportunity to use these natural behavioral triggers for good. It can be as simple as automated RunKeeper alerts that inspire your friends to get in a jog before dinner. Or it can be more involved, like Massive Health’s new app “The Eatery,” which lets the social web vote on everything you eat. It’s amazing how that delicious cheeseburger loses its appeal when a few people give it the thumbs down.

3. Add to the Body’s Built-In Alarm System: If you’ve ever jerked your hand away from a hot surface – even before you realized you were being burned – then you have used your body’s built-in alarm system. Your nervous system protects you by triggering these super-fast unconscious behaviors. The problem is that evolution hasn’t kept up with what threatens us these days: heart disease, diabetes and cancer. We now know, for instance, that it takes at least 20 minutes before your stomach tells your brain that you are full. Imagine slicing your hand open with a kitchen knife, and 20 minutes later your brain learns about the accident. You wouldn’t last very long. If you knew right away when you’d had enough of that burrito, the chances of you overeating would plummet.

Technological feedback loops promise to let us use this hardline between nerves and unconscious behaviors to our benefit. There are several products already on the market, and more were introduced at CES this year. One I particularly like (conceptually – technologically, they’ve had a pretty rough go of it) is the UP from Jawbone. It is a bracelet you wear that monitors your movements and provides real-time feedback through vibrations. One simple feedback loop it adds to your body: you can set it to vibrate if you’ve been sitting around for 20 minutes, which, according to this research, can literally save your life. A future enhancement I’d like to see added is the ability to measure the time between bites and vibrate if you’re scarfing your food down too fast. The slower you eat, the more time for your stomach to get through to your brain that you’ve had enough. 

The burgeoning behavior change market holds enormous opportunities. It remains to be seen whether the new landscape will come to be dominated by current healthcare giants who have remade themselves as behavior change experts, or if they will be supplanted with an innovative group of new enterprises. Whatever the future holds, our success will be built on new abilities to hack the outsourcing model that is driving these behaviors. I, for one, am excited to see where these new insights will take us.