Identifying and removing “sludge” in public health: Acceptable, straightforward, and better for everybody?

Abstract

Public health interventions usually mean pain now with (possible) benefit later. Sludge – unnecessary barriers to engagement – compounds this problem. Whether it involves form-filling, inconsistent instructions, or multistep paperwork, sludge can distract, delay and confuse people into missing out on health promoting choices. In this presentation, I will describe approaches to identifying and measuring sludge when people try to register with a GP, present new data on inconsistency in instructions, and share the results of a survey showing public support for de-sludging policies beats support for nudges (with important caveats). I will argue that removing sludge improves equity but also increases the acceptability of public health interventions for all potential beneficiaries.