The effects of a tailored health warning on socio-economic behaviours and health outcomes

A number of common and long-term health conditions such as diabetes and high blood pressure display no signs even at advanced stages and so people may carry the disease without being aware of it. In fact, evidence shows that this is a common occurrence across the developed and developing world. Medical guidance indicates that if people were aware of their clinical status, then they would be able to mitigate the long-term effects of diseases on their health by making lifestyle changes through the use of medication and making changes in health behaviours (e.g. exercise, fruit-veg consumption, salt consumption). People may also be able to mitigate the effects of the disease on their wellbeing by modifying non-health behaviours (labour market choices, retirement planning, spending, financial planning). In the face of this growing public health problem, a number of organisations have enacted campaigns that promote health checks (e.g. NHS health check, Diabetes UK and the British Heart Foundation offer health diagnostic checks for heart disease, stroke, diabetes, kidney disease, hypertension and cholesterol concentration) so that individuals diagnosed with a condition can make lifestyle choices at an early stage. One dimension underpinning these campaigns is a belief that if individuals knew they had the condition then they would act differently but currently there is little evidence to say whether or not people do change their lifestyles in response to receiving personalised health information. Wide-spread health checks place a large strain on the public purse (estimated annual cost of NHS health checks is £320m) and so it is important to know whether such interventions are likely to bring savings through the improved wellbeing of the nation. In this project we will make a step towards filling this evidence gap by providing causal evidence on the extent to which individuals change their health and other socio-economic behaviours in response to receiving personalised health information.

Relatedly, there is evidence to suggest that health information campaigns that target at risk groups of the population, such as a Food Standards Agency campaign to reduce salt consumption, have been unsuccessful. One reason that these campaigns may not work is if individuals believe that the group level information does not apply to them as they are "healthier-than-average" (such better than average effects have been shown in other areas, for example, where one study found that 93% US drivers think they are better drivers than the median). The evidence that we will provide in this project will be useful in understanding whether information campaigns that deliver personalised information (and not population level health information) are better at getting people to change their behaviours.

The condition we consider is high blood pressure which is a global public health issue. Lowering blood pressure through medication and lifestyle choices is feasible and significantly reduces the risk of death due to heart disease and stroke (leading causes of death in the UK and worldwide) and the development of other debilitating conditions. But often people are unaware that they are afflicted with hypertension and it has been called a 'Silent Killer'. We first provide evidence that would help with the targeting of health campaigns on the extent to which low income households maybe more likely to have high blood pressure (clinically diagnosed) but less likely to know it. We then go on to present evidence from a personalised information treatment that gave respondents of the Understanding Society Survey a blood pressure reading from a trained nurse. We make innovative use of two novel features of this data: that it contains clinically measured indicators of health linked to a rich set of socio-economic variables; and perhaps more unusually that it provides us with subsamples of individuals that have and have not been given personalised health information.

Public Sector: The findings will be of interest to the Department of Health (as well as other departments and organisations such as NICE, the Department of Work and Pensions and HM Treasury). In particular, the NHS introduced a Health Check for those aged between 40 and 74; our results will be useful on the general principle of the efficacy of tailored health information. There is the potential of direct cost saving to the NHS and Public Health England. If health information provision is effective this suggests the health checks should be increased and promoted more. If information provision is ineffective then they could be scaled back. Either way the results have strong potential to improve decision making in the NHS and will enhance the evidence base of the NHS Health Check.

Local Authorities will benefit also from the enhanced evidence base of health information provision. From January this year, as a trial initially, the government have introduced a health premium incentive scheme for local authorities that will distribute £5 million across local authorities. This has continued into 2015/16. Authorities are incentivised to improve the health of the local population and reduce health inequalities. Therefore our findings will be directly useful and important for local authorities.

General Public: The findings of our research will be of interest to the general public. Those who will particularly benefit are people with undiagnosed health conditions, particularly hypertension, in the UK. The public will also benefit if the research is used to identify policy interventions which could substantially reduce the long-term costs of hypertension - a widespread condition.

National Health Charities: Voluntary organisations with an interest in health and hypertension (British Hypertension Society, the Stroke Association, the British Heart Foundation, Blood Pressure UK). For example, a partnership between Diabetes UK, the British Heart Foundation and Tesco are offering 40,000 free Health Checks at their in-store pharmacies. All of these organisations would benefit from evidence on the extent of undiagnosed hypertension in the population and the extent to which health checks could be effective at eliciting behavioural change. They would benefit from being able to better target free health checks at populations with undiagnosed hypertension and also from evidence on the effectiveness of such campaigns.

To make our results accessible to non-academic audiences we will write an Institute of Policy Research (IPR, Bath) policy brief (non-technical report) summarising the findings and pointing out any policy relevant findings to: local, national and international policy-makers, non-governmental organisations (NGOs), charities, interest and advocacy groups, other research organisations, funders, businesses and members of the public. Furthermore, we will produce a policy-relevant overview of research findings, in the form of an 8 page A4 printed policy briefing, published by University print services, which will be formally disseminated to interested groups. We will create an ISER podcast summarising the findings and will submit the work to non-academic workshops including the Westminster Health Forum which directly addresses policy and policy makers.