Press release
WHO research shows Ireland performs well in the use of behavioural and cultural insights for health
From Department of Health
Published on
Last updated on
From Department of Health
Published on
Last updated on
The Minister for Health Stephen Donnelly and the Chief Medical Officer Professor Breda Smyth have today highlighted research by the World Health Organization (WHO) which shows Ireland is performing well in the use of behavioural and cultural insights (BCI) to support better health.
Global evidence shows that using behavioural and cultural insights can improve health outcomes in areas such as immunisation, attendance at appointments, antimicrobial resistance, health emergencies, mental health and health inequalities.
In September 2022, Ireland and other WHO European Region member states agreed to use a new European regional action framework for BCI for health.
The WHO today published its first report into the use of BCI for better health across 44 countries. It shows that Ireland is one of just 8 out of 44 countries that have scored at least 3 out of 5 across all five strategic commitments under the framework. This rating means that Ireland has developed a strong baseline from which to achieve the targets set out for Member States in the years to 2026.
Minister Donnelly said:
"Our health service must support people to make healthier choices and BCI is helping us to do this. Ireland is committed to increasing further the use of behavioural and cultural insights to improve the health of our population and the performance of our health service. I am very pleased to be able to report that Ireland is one of the few countries performing at the upper end of adoption across all the five ambitious strategic country commitments.
"Ireland played an important role in the development and adoption of the action framework. Implementation of its strategic commitments will result in greater use of insights and support better health outcomes. Public health authorities in Europe and Central Asia are keen to use behavioural and cultural insights to combat major health problems.
"The Department of Health will continue to work closely with the WHO Regional Office for Europe to support capacity building along with inter-country sharing and learning."
Chief Medical Officer Professor Breda Smyth said:
"We know that the major health challenges and causes of death and disease have behaviour at their core, including food choices, physical activity, tobacco smoking and alcohol intake. It is vital that we explore the factors affecting health behaviours in order to develop more effective and efficient policy responses that will ultimately lead to better health outcomes.
"We saw during the COVID-19 pandemic how evidence-based behavioural and cultural insights helped to inform our communication of public health measures and the population in Ireland demonstrated a strong adherence to such measures.
"Using BCI is a people-centred approach to health that helps us to better understand needs, motivations and behaviours, and to devise more effective policies that support people to engage in healthier behaviours.
"As the WHO report shows, Ireland is already performing well in its use of BCI and work will continue in this area with the aim of improving overall population health."
The WHO’s next progress report will be issued in March 2025.
The WHO report is available at: Use of behavioural and cultural insights in 2021 –2022 in the WHO European Region: status report.
The WHO Regional Office for Europe defines BCI as:
The WHO’s action framework contains five strategic country commitments:
1. To build understanding and support for BCI among key stakeholders.
2. Conduct BCI research.
3. Apply BCI to improve outcomes of health-related policies, services, and communication.
4. Commit human and financial resources for BCI and ensure their sustainability.
5. Implement strategic plan(s) to apply BCI for better health.
Table A1 in Annex 1 of the WHO’s Status Report presents an overview of performance. Ireland achieved a score of 3 or higher on each of the five strategic commitments. Further details of its performance in each area are outlined below.
Ireland’s rating: 3
This indicates that there is awareness and recognition of BCI for better health among key stakeholders, and some collaboration was initiated. The department has been working in this area since 2015 running staff seminars and undertaking collaborative projects in key topics such as patient attendance, obesity, and antimicrobial resistance. The response to the COVID-19 pandemic by the Department of Health and the Health Service Executive was also informed by advisory groups which included behavioural scientists. Ireland also scored well on the WHO’s quantitative indicator, as Ireland was one of only 40% of respondents with a formal network to support the use of behavioural and cultural insights in public policy and services.
Ireland’s rating: 4
This indicates that methodologically sound approaches to exploring barriers and drivers to health behaviours were applied and studies were undertaken across many relevant health areas. This reflects that the department and the Health Service Executive (HSE) have undertaken and funded methodologically robust studies to explore barriers and drivers to health behaviours across many health areas such as: understanding intentions to get a COVID-19 vaccine; perceptions of antigen testing, cancer screening, and of the causes of obesity; informing interventions to increase patient engagement (via the Better Letter Initiative), to support healthy eating, to support healthy behaviours (via Making Every Contact Count), and to reduce the threat of antimicrobial resistance.
Ireland’s rating: 3
This indicates that BCI approaches were occasionally used to inform and improve health-related policies, services, and communication processes. The response of the Department of Health and the HSE to the COVID-19 pandemic involved several applications of BCI to strategic communications. In addition, the use of behavioural insights and plain English has been central to the Better Letter Initiative (BLI) to improve patient engagement with waiting validation letters, offers of publicly funded treatment in private hospitals (commissioning), and hospital appointments.
Ireland’s rating: 3
This indicates that some dedicated funding and people were available for the structured application of BCI work for some health areas. However, the level of resources was not sufficient for systematic application across many health areas. The Department of Health reported a behavioural team working in the Research Services and Policy Unit with two staff trained in behavioural economics / psychology. The department has also invested in an ongoing Research Programme in Healthcare Reform with the Economic and Social Research Institute (ESRI) which includes a behavioural economics workstream that has focused on healthy eating and obesity. Ireland performed better than most respondents as only 35% reported a Level 3 or higher.
Ireland’s rating: 3
This indicates that some strategies/plans made an explicit reference to BCI work and identified related actions and targets. For example, Ireland’s Second National Action Plan on AMR (2021-2025) includes a specific action, namely "Action 5-05: Review the evidence base for behavioural change initiatives to promote optimal antimicrobial prescribing and reduce antimicrobial consumption." Additionally, behaviour change is central to Ireland's national policy "A Healthy Weight for Ireland: Obesity Policy and Action Plan" and a number of behavioural science projects have been undertaken in relation to actions in the plan. Ireland performed better than most countries, as only 29% reported a Level 3 or higher. Ireland has not achieved the quantitative indicator, but neither had most respondents. Only 10% report having a dedicated national strategy or plan across health areas for applying BCI for better health.