When you picture the healthcare of the future, what do you see?

Perhaps it's the stuff of science fiction: cancer curing nanobots, gene editing, an internet of things networked with our health providers. Some of these reflect the direction of today’s science – pockets of it exist already. Others are truly fictional at this point.

Back to earth with a bump: this shiny future sits light years away from the situation in many health economies today. Talk of deficits colours virtually every conversation concerning the UK’s NHS, and concern about mushrooming health costs are troubling people and politicians worldwide. How do we narrow the gap between the healthcare of our dreams and our increasingly limited means?

Focusing on behaviour
We are missing a trick if we reach solely for chemicals and computers as solutions. There is another body of research - behavioural science - which has much to say about achieving timely, effective, sustainable health improvements, if only we start with those most fundamental components of any health system: people.

People’s choices, lifestyles and (crucially) behaviours fundamentally feed into the health they experience. The health system is on the receiving end of ‘bad behaviour’ in one sense, but so are people themselves. Paying attention to the social, cultural, economic and environmental drivers of health is nothing new of course – what is new is that we know much more about how our psychological responses to our immediate environment influence our behaviour.

We can start with four insights that hold great promise for promoting health, but which are currently overlooked:

1. Start small
   It may seem obvious that we are more likely to do something (especially something new) if it is easy - the less effort, the better. But we don’t fully appreciate how even relatively minor changes in the effort required can actually determine very big decisions. For example, research has shown that that making paracetamol slightly more difficult to buy in large doses has put in motion a sustained, long-term reduction in suicides, estimated to have prevented nearly 800 suicides in ten years. Thinking about positive behaviours, the ‘New Year, New You’ blogs that abound every January are on to something this year when they recommend small steps rather than transformational leaps (see here and here – perhaps you’re now reconsidering your own, one month on).

2. Use social contagion
   We need cues about health to come from the communities we live, work and play in. Our peers are more influential than we think. Health campaigns you’re likely to have heard about - such as Dry January and Movember use social contagion to spark changes that can spread rapidly and unpredictably. Signalling what people like us are doing can be more effective than simply stating what you should do (this goes for health professionals as much for the rest of us).

3. Make it rewarding
   We also need health activities to be something that make us feel good in the here and now – so that we keep coming back for more. Health insurance firms tap into this already. South Africans sign up to insurers who give ‘Vitality points’ get a free drink every week that they achieve a personal fitness goal. Americans get discounts when they buy healthy foods at the supermarket. And Brits are being offered cinema tickets, cashback for stopping smoking and half price Eurostar tickets for getting active. Coupling activities with rewards makes healthy living instantly gratifying, rather than just hoping for a pay-off in the future.

4. Time it right
   And finally, as health and healthcare form just one component of ever busier lives, we need prompts to take medicine, attend hospital appointments, become organ donors and a plethora of other health reminders to come at opportune moments. This insight ranges from the very simple (sending a reminder letter at the right time) to the cutting edge of technology (how to harness the infrastructure of personal, wearable, always-on technology).

Now is the time to hard-wire health into our lives; using clinical research, yes, but also tapping into the potential of people themselves to greater effect. It’s the free, renewable energy that will fuel future health.