By Tak Ishikawa, BC BIG
Photograph by Rodrigo Morales, 2015
I used to smoke. In my college years, I would spend afternoons discussing philosophy, math, physics, and psychology with my classmates while drinking coffee and smoking. Fun times! One day, my friend and I decided to quit smoking after a long, intense conversation about how bad it was for our health and how terrible we smelled. “Let’s start tomorrow!” we said with determination. We high-fived and called it a day. The next morning, someone offered me a cigarette during a break between classes. “I am quitting,” I replied…then pulled a cigarette from his pack and lit it.
I obviously didn’t quit then, nor did my friend. But this incident made me wonder why we often do things that undermine our goals, intentions, and well-being. Thus, I became interested in studying this kind of human contradiction: why did I keep smoking despite my desire to quit, or why did the mother in the picture above not wear a bicycle helmet but ensure their child wore one. The pursuit of these questions took me on a journey through a broad range of experiences in the company disparate characters — such as farmers in the Colombian mountains, bankers in the financial district of Bogota, emergency physicians to early childhood educators in Canada. This is a brief account of that journey.
Irrationality and Negotiation
In the early days of behavioural insights (BI), we put a lot of emphasis on the idea of rationality. Thus, a lot of interventions consisted primarily in correcting systematic errors in people’s judgments and decisions so they could be “more rational.” (If this sounds a bit arrogant to you, I agree. It was.) In my work, I developed educational materials and decision aids for small business owners. I had some successes and some failures. One successful project involved forming an agricultural co-op that enabled small farmers to negotiate better prices and conditions with intermediaries. In remote, rural areas of Colombia, small farmers were at the mercy of those who owned a truck; thus, truck owners had an advantage when negotiating prices. The challenge I faced was that some farmers would refuse to join the co-op, even though that meant missing the opportunity to make up to 50% more revenue. Refusal to join had two main causes: old personal grudges between neighbours and sheer envy (“My neighbour has a bigger farm, more produce, so will be getting more money than me”). Our approach was to encourage reluctant farmers to compare how much revenue they would get with the co-op with how much they would make on their own. This small change shifted farmers’ framing of the situation from envy (“My neighbour will make more than me”) to a more beneficial self-focus (“I’ll earn more revenue with the co-op versus on my own”).
Later, I had the chance to work for the United Nations and the Inter-American Development Bank, travelling to remote areas of Colombia and meeting incredibly generous, happy people who also happened to experience extreme poverty, violence, and disenfranchisement. I occasionally worked surrounded by intimidating folks wearing bandanas and carrying automatic weapons. Despite the joys and rewards, I decided to stop this type of work when I saw it would inevitably and literally put me in the crossfire of Colombian armed conflict. Because I am a person who likes contrasts, I decided to join the corporate world in the Colombian capital, Bogota.
Impatience and Pensions
It should go without saying that corporate life was a breeze compared to the rugged existence I had been leading. Applying behavioural insights in my new role, however, was just as interesting and rewarding. One of my most memorable projects was my work in a private pension fund management company. It can be hard to encourage people to invest in their retirement savings because of delayed gratification: people pay into a plan today but receive the benefits several years later. Paying into a pension plan conflicts with people’s tendency to prefer small payoffs in the present over larger payoffs in the future, something we in BI refer to as “present bias”. My task was to train sales staff so they could properly advise prospective clients on their pension plans. One of the strategies that we used was to get people to think about abstract concepts like “health”, “security”, “peace of mind,” before discussing more concrete elements of the pension plan, such as monthly contributions, online payments, or automatic discounts. Thoughts about the distant future involve higher brain functions¹. In contrast, decisions involving the present require lower brain functions, so people’s choices are based on incidental, practical considerations (e.g. “Can I make payments online?”, “Can I withdraw money from my account?”) Unfortunately, since experimentation and evidence were not priorities for corporations in those days, it was hard for me to assess if these early behavioural insights interventions were effective or not. However, anecdotal reports suggest they were useful.
I had the opportunity to apply behavioural insights in many other contexts including market research, conflict resolution, and union management negotiations. From there, I made yet another big change and moved to Vancouver, as soon as the opportunity arose. This change in hometown and home country also included a change in industry.
Health and Nudges
After a few years in Canada, during which I primarily consulted for Colombian companies and government, I decided to pursue a Ph.D. in Experimental Medicine. I worked at the BC Children’s Hospital Research Institute. On one project, I teamed up with landscape architects and early childhood educators to improve physical activity and mental health among children. We made daycare playgrounds more attractive to children by incorporating more plants and more opportunities for unstructured play. We found that while the children’s physical activity did not increase following playground improvements, their mental health improved substantially.
A more recent project sought to improve children’s mental health services in emergency departments of hospitals. We designed an online tool to make it easy for clinicians to assess children in a timely manner and quickly direct them for further evaluation, care, or community referral. The use of this tool at the BC Children’s Hospital’s Emergency Department reduced the median weekly wait time for mental health visits by 40 minutes.
Through my training and experience in the health sciences, I have learned a sobering fact: socioeconomic inequity causes illness. Access to prescription drugs or mental health services, financial distress, marginalization and discrimination, exposure to pollutants, quality of playgrounds, and education are all determinants of health. All of them, invariably, are distributed in such a way that those who struggle financially become even more disadvantaged. Importantly, I learned that policies such as income assistance and affordable childcare can ultimately improve the physical and mental health of children and families. Thus, I began searching for opportunities to work on projects in and out of the purview of my discipline.
Taking a BIG Step
This is how the roads I traversed and the choices I made brought me to BC BIG. I mentioned in my interview that working at BC BIG was my dream job, and I was not exaggerating. BC BIG literally gives me the chance to work across ministries and address the different determinants of health, all from the place where important policy decisions are made — the public service.
In the few months I have worked here, I feel I have found a new abode: a place to pursue my interest in behavioural insights and enjoy myself while working. I welcome the challenges that await me and I am ready to continue learning with renewed energy and new teammates.
By the way, I did quit smoking. I put out the last cigarette of my life the day I boarded the plane that brought me to British Columbia. In other words, moving to this province changed my life. Now, it is time for me to return the favour.
Takuro Ishikawa
Tak is a Senior Behavioural Scientist with the BC Behavioural Insights Group (BC BIG) within the BC Public Service.
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