Instituto de Neurociencias y Políticas Públicas

Creation of the Behavioral Sciences and Public Policies Unit

elopez — Sat, 21 Aug 2021 21:08:41 +0000

At the launch event, held on Tuesday, July 20, in the Hall of Scientists of the Casa Rosada, the President of the Nation Alberto Fernández, the Secretary for Strategic Affairs, Gustavo Béliz, and international experts in Behavioral Sciences spoke. In turn, the leading economist of the Division of Social Protection and Health of the IDB, Dr. Florencia López Boo, and Dr. Fernando Torrente, Director of the Institute of Neurosciences and Public Policies of the INECO Foundation, presented cases of successful interventions .

We are particularly pleased to announce that the INECO Foundation, together with the Inter-American Development Bank, participated in the launch event of the Behavioral Sciences and Public Policies Unit, an initiative of the Economic and Social Council that will function under the coordination of the Ministry of Foreign Affairs. Strategies of the Nation and in which the Foundation has been collaborating for its realization.

The aim of the Unit is to promote public policy projects based on studies of human behavior. The premise is to study how small changes in context can bring great benefits in people’s lives. Investigating how human beings make decisions – many times it is not in the rational way that we would like so much – can help to design public policies that are low-cost to implement and have a great impact on the well-being of the entire society.

The Behavioral Sciences and Public Policies Unit will be made up of a network of experts in various disciplines and will seek to articulate research with government programs.

Since 2018, the INECO Foundation has been working together with the IDB in a technical cooperation with the aim of promoting research in behavioral sciences throughout Latin America and developing policies that can positively impact people’s lives. The fact that this synergy has been crystallized into a state policy that generates interventions at a very low cost and with a very high impact in the medium and long term fills us with pride and puts us before a challenge: to continue developing research of the highest quality and deepen the dissemination tasks on the potential of these tools.

At the launch event, which took place on Tuesday, July 20 in the Hall of Scientists of the Casa Rosada and which featured international experts and the final phrases of President Alberto Fernández, Dr. Fernando Torrente, Scientific Director of the Cooperation and the Institute of Neurosciences and Public Policies expressed: “We are very honored to support this initiative because we believe that the creation of this Agency is a very important milestone for Argentina and will allow those of us who work in the behavioral sciences to articulate efforts to improve public policies. ”

Dr. Torrente spoke with Dr. Florencia López Boo, lead economist of the Social Protection and Health Division of the IDB and also director of Cooperation, and together they presented some success stories that have already been carried out in the country. One of the examples in which a small push, or “nudge” as they say in English, has been effective, is the intervention carried out with doctors from PAMI to reduce the prescription of a drug widely used to treat cognitive disorders but that lacks scientific evidence of its operation for this purpose. Simply by sending an email with updated information on the use of this drug and with a message comparing the prescription level of each doctor with his colleagues – what is called the “social norm” -, it was possible to reduce the rate of indication of this drug . In this way, a simple and low-cost intervention had an impact, not only on the health of the patients, but also on the economy of the health system.

Video projected on the day of the event in which Dr. Fernando Torrente explains the intervention and the randomized controlled trial carried out by the INECO Foundation together with PAMI and which was published in a very high impact scientific journal (if you want to know more about the research and see the published article you can continue reading here).

Gustavo Béliz, Secretary for Strategic Affairs of the Nation, was very enthusiastic about promoting the initiative from the Economic and Social Council and pointed out: “in general, behavioral sciences are very taken into account by politics when it comes time for a campaign. electoral: there is a lot of interest in the polls and in how the population reacts. However, there is little attention to these issues when it comes to designing public policies designed to have a better level of impact, refining them with a greater sense of humanity and personalization. ” In this sense, Béliz mentioned the importance of generating more humanized state interventions that take into account people’s emotions, perceptions, prejudices and cognitive biases. “This is possible today since we have an unsuspected amount of data that each of us generates daily from technology,” he added.

For his part, Iván Budassi, National Director of Strategic Analysis and who will be in charge of the Unit, said that when public policy is planned, it is always assumed that people act in a conscious, reflective, thoughtful way, that is, “we think that we think ”. The interesting thing that the Behavioral Sciences show is that although we sometimes do this type of thinking, perhaps most of the time we react in a different way: automatic, not so reflective or biased by some error. “Not only do these biases make us consistently err and they can be systematized, but they can also be studied and used to improve public policies,” said Budassi. And in turn he added that, although people all over the world have similar characteristics, there may be differences in habits and customs. Hence the importance of conducting local research and not directly applying studies carried out in other parts of the world with other idiosyncrasies.

Summary of the launch event of the Behavioral Sciences and Public Policies Unit held on Tuesday, July 20, in the Hall of Scientists of the Casa Rosada.

In the rest of the world there are already several countries that use behavioral sciences in formulating their policies. Since the UK launched the first human behavior insights unit in 2010, the Behavioral Insights Team, numerous governments including Denmark, Singapore, Canada, the United States, Australia and Peru have followed suit. During the event, Budassi spoke with Cass Sunstein, founder and director of the Behavioral Economics and Public Policy Program at Harvard Law School, advisor to the President of the United States Joseph Biden and one of the authors of the founding book “Nudge: improving decisions about health, wealth and happiness ”.

During the presentation, Cass Sunstein provided some examples of successful interventions – the preference to use clean energy even though it is more expensive in Switzerland and adherence to a free and healthy food program for boys and girls in schools in the United States – and detailed some of the cognitive biases that people have:

The present bias: It makes us tend to give more weight to the present when making decisions.
Procrastination: Leave for tomorrow what can be done today.
Inertia: The status quo cognitive bias that implies preferring the way things are at the present time.
Overconfidence: Consists in overestimating the success of one’s own decisions.

In addition, Sunstein introduced a novel concept that he called Sludge, literally “mud” in English, and which refers to all those bureaucratic barriers that citizens often have to cross to achieve a right or benefit that corresponds to them. “You have to carry out audits to know that” mud “and wage war on it. We have to remove all obstacles, remove behavioral barriers that separate humans from what they need, “he concluded.

Asked whether these behavioral science tools can be applied in developing countries or are only for rich countries, Sunstein’s response was categorical: “I would say that the most interesting work in the next 10 years with practical results they are going to be done in developing countries and I am absolutely expecting Argentina to be a leader in this matter. “

The launch event also featured the participation of psychologist David Halpern, CEO of the Behavioral Insights Team (BIT) of the United Kingdom, and one of the major references in Behavioral Sciences applied to Public Policy. Halpern told about the emergence of the BIT, the first Unit in the world to apply this type of approach: “In 2010 everything seemed like a great experiment, we did not know if it would work, we had a period of two years to evaluate if it was worth it. worth the investment. Fortunately and to our surprise we had a very strong impact on the British government that allowed us to continue to this day ”. In turn, David Halpern emphasized the importance of the work of the BIT with the outbreak of the pandemic, where understanding human behavior was key to be able to design policies that would help change people’s habits, such as promoting the use of chinstraps or maintaining social distance. “The importance of using a different perspective, a more realistic view of human behavior, was evidenced,” he concluded.

Finally, the launch event featured the words of the President of the Nation Alberto Fernández, who celebrated the creation of the Behavioral Sciences and Public Policy Unit and announced that a call will be opened to carry out studies in the national government and also the provincial and municipal governments. After explaining how in Criminal Law the historical idea of conceiving men and women as totally rational beings has been modified, he gave examples in which the study of behavior is already being applied. The President mentioned the project of clear and simple labeling of food that is being debated in Congress, the refund of VAT for beneficiaries of the AUH and the Egresar Plan, so that boys and girls finish secondary school. “What we want is to help people make better decisions for themselves and for the country: Design public policies tailored to the human being,” concluded the President.

Medications that do not work and “social norm”

elopez — Fri, 16 Jul 2021 21:34:01 +0000

An effective and inexpensive intervention to reduce the prescription of unnecessary drugs in older adults

A problem in the care of older adults, not only medical but also economic, is the amount of drugs that are prescribed unnecessarily without scientific evidence. The prescription of drugs not recommended by the evidence can have harmful consequences for health, bring adverse effects and affect the quality of life of people. In turn, this has a negative impact on health systems, since money is wasted on drugs that are not useful instead of being used for other treatments that are beneficial and effective.

In particular, a high prescription of the drug Nimodipine was observed as a treatment for cognitive impairment in older adults in Argentina. However, the evidence supporting the use of Nimodipine for cognitive impairment and dementia is insufficient.

One of the approaches from the behavioral sciences that has been implemented to try to reduce overmedication consists of informing doctors about how their practice of prescribing drugs is compared to that of their peers through email. This “social norm” notification technique by email was used successfully in cases of over-indication of antibiotics, a serious public health problem that can lead to bacterial resistance, and other potentially harmful drugs in the elderly population such as antipsychotics and opioids. However, so far, there was no evidence of its use in drugs for cognitive impairment in Latin America.

With this in mind, the researchers conducted a trial involving 1811 doctors with a history of high prescription of Nimodipine from the National Institute of Social Services for Retirees and Pensioners (PAMI – INSSJP). The participants were randomized into two groups:

Physicians in the “treatment” group (906) were sent 2 emails with evidence-based information on Nimodipine, as well as a comparison of their prescription level of this drug versus the average of their peers (social norm) .
Physicians in the “control” group (905) were sent 2 emails with general information on the risks of over-medication in older adult patients.

The messages were written as an awareness campaign for good medical practices. Terms such as “invite” or “consider” were used to emphasize the idea that health professionals were free to make the decision and so that they did not feel pressured to change their behavior: they were not going to receive a penalty of some kind. The idea is to change the behavior voluntarily and not because they felt forced to do so, bringing information to optimize their medical decision (information based on evidence and the reference of the behavior of their peers) .

The amount of Nimodipine prescribed per month by each professional in both groups was recorded for 1 year prior to the intervention and 6 months after the first email was sent.

The results were very satisfactory. Participants who received the ‘nudge’ prescribed significantly fewer prescriptions for Nimodipine during the intervention period compared to the control group. No differences were observed in the months prior to the intervention, with which the decrease in the indication of this drug can be attributed to the sending of emails communicating truthful information as well as on the frequency of prescription of Nimodipine by each professional.

After the intervention, a reduction was also observed in the control group, although less so. This could be due to the fact that the doctors in the control group were not totally blind to the intervention since it is known that there is communication between colleagues about the prescription of drugs. It should be noted that it is beneficial to have this exchange. Although this “spill” reduces the differences between groups, the reduction in prescriptions as a whole was greater.

The economic costs were also analyzed and it was found that they were lower in the group that received the treatment than in the control group. The researchers estimated that if this intervention were performed on all the doctors included in the study for 1 year, approximately more than $ 200,000 could be saved. The work has just been published in the prestigious scientific journal JAMA Network Open and can be found here.

In conclusion, the randomized clinical trial of this behavioral intervention was successful. The authors were able to verify that by sending scientifically proven information via email, added to the data of the “social norm”, changes could be obtained in the behaviors of health professionals regarding the prescription of a particular drug. Although there are certain limitations, for example, it is not possible to know if Nimodipine was not replaced by another drug with similar characteristics, the result is optimistic.

An intervention of this type has the potential to become a useful and efficient tool since it is well accepted by professionals, easy to replicate, effective and inexpensive. A “push” towards greater social well-being.

What is “Nudge” and how a “little push” can improve our lives

elopez — Fri, 16 Jul 2021 21:24:47 +0000

What does changing the location of food in a cafeteria have in common with placing a picture of a fly in an airport bathroom urinal?

Both strategies suggest that small changes in the environment bring large changes in people’s behavior. Changes in habits that result in greater benefits for health, the economy or the care of the environment.

In the case of the cafeteria, a simple exchange of place between fruits and sweets can bring changes in people’s consumption and therefore in their health. In the case of the flies on the urinals, it just greatly improves the aim of the men who use it! But that little fly saves cleaning work and improves the look of busy airport restrooms.

This type of intervention, low cost and great results, is known in the behavioral sciences as nudge, which means little push. Knowing that people often do not behave in the most favorable way, environments can be designed that help us choose the options that maximize our well-being. Nudges that help us achieve the most convenient behaviors for ourselves and for society.

How to know if an intervention works or not? Did the men’s marksmanship improve in the airport bathroom? Do people eat more fruit with a simple change of place?

To know the answer, we need to perform experiments!

And that is what the INECO Foundation’s Institute of Neurosciences and Public Policies is dedicated to: investigating human behavior in order to transfer it to the creation of norms and public policies that are appropriate for the community.

The two examples mentioned here may seem naive, but it has been studied that knowing more about how people act allows improving the design of the environment or carrying out small interventions that lead to greater social well-being.

In Latin America, two groups seriously affected by social inequality and vulnerability have been identified: childhood and old age. However, so far, these sectors have benefited little from advances in behavioral science (or what is known as Behavioral Insights).

For this reason, the INECO Foundation, with the support of the Inter-American Development Bank, has formed a research group especially focused on social development and health policies as a critical tool in promoting innovative solutions.

The objective of this alliance is to detect problems and explore whether they can be solved with small (and inexpensive) interventions on human behavior and its environment. Study if this new “decision architecture” is effective and achieves that the results are translated into successful public policies that are easy to implement.

Why a happy brain performs better?

elopez — Fri, 16 Jul 2021 21:23:42 +0000

What can neuroscience tell us about the well-being of people and nations? Is a happy brain a more productive brain?

Keys to increasing our levels of well-being and building happiness in times of pandemic

The economic and social progress of a country is often measured by estimating the productivity, growth or longevity of the population. These indicators are used to make decisions and guide policy. However, do these metrics tell us about people and their well-being? Today governments and organizations are increasingly focusing on increasing people’s happiness, overall satisfaction with life, and sense of purpose. Neurosciences, together with other disciplines, offer great potential to try to understand the neurological bases of well-being and contribute with key aspects for its personal and social construction in different areas and moments of life.

With this approach, and taking into account the unprecedented difficulties that the pandemic brought, the INECO Foundation carried out the First International Virtual Symposium on Neuroscience and Well-being. On October 28, researchers of international recognition, experts in cognitive sciences, education, sociology, economics and music therapy, among other disciplines, met virtually to share the latest research in mental health and provide practical tools to cope with the impact that has generated COVID-19. Virtuality, the protagonist of these times, allowed the enormous participation of the public: there were more than 17,000 people from 40 countries registered for the talks.

Facundo Manes, founder of the INECO Foundation, was the first speaker of the afternoon and began his talk by explaining how well-being, a broad term used daily, can be approached from a scientific point of view. “It is not easy to define something as happiness or well-being since they are complex constructs. Many times it is convenient to decompose it, not to minimize or reduce it, but to understand it more clearly ”. One of the notable research focuses of neurosciences has been the determination of the reward circuits in the brain – keys to pleasure and desire -, mechanisms that involve different brain regions and that are communicated through chemical messengers. These circuits are activated when we carry out a pleasant activity or fulfill a goal. But after that task is done, what happens to us? How long does this well-being last?

Happiness is not given only by immediate pleasure, hedonic life, the satisfaction that a meal, a landscape, a meeting with friends can provide us. But also for the satisfaction that long-term achievements give us, fruits that arise from the effort of work and planning: eudaimonic happiness. Manes reminds us that our brains are constantly changing and that each one of us can positively influence these changes: the decisions we make on a daily basis influence our health, our projects and our happiness. While there are studies that show that genetics can determine a proportion of our well-being, this influence is not more than 30%, which means that we can modify it since happiness is built.

And how do we make that well-being happen to us? Some of the key aspects mentioned by Facundo Manes are:

Accept negative emotions and recognize the complexity of life: it means that we are connected with what is happening to us.
Work on the way we think and express our feelings, reducing negative thoughts. “Change the way we feel by changing the way we think.”
Set and achieve realistic goals.
Savor ordinary positive events.
Have healthy habits: physical activity reinforces our creative thinking, it is a good anxiolytic and natural antidepressant. Eating a healthy diet and taking care of your sleep is also important. Sleep between 7 or 8 hours.
Regulate the demands of the environment to our real possibilities: sometimes saying that it is not healthy.
Manage our expectations.
Promote spirituality and sense of purpose.
Meditate, enjoy the present. A brain attentive to the present is a happier and more productive brain.
Be grateful for what you have instead of worrying about what we lack.

At the end of his talk, Manes affirms that we should not think of well-being as something that we have or do not have, but that it is a continuum, and that people can make internal modifications to build happiness if we focus on positive emotions, in carrying out activities in which we lose the notion of time and space, such as cooking, dancing, singing and other activities that lead us to the state of “flow”, a psychological state where even the notion of oneself is diluted. In turn, consolidating intimate and affectionate human relationships is fundamental since we are social beings. Although today in a pandemic we must fulfill a physical distancing, we must remain connected with our loved ones. «Being altruistic or generous activates the pleasure centers. Generous people report having more friends, putting up with life’s obstacles more, and being more resilient. An unhappy brain is a less intelligent, less creative and less productive brain ”, he concluded.

Although this approach focuses on what each person can do individually, during the Symposium this point of view was supplemented with the idea that, although happiness is subjective, it can be measured and related to trends in societies. Beyond the fact that happiness can be worked by individuals, it is closely related to public policies. Facundo Manes explains that the concern for well-being and happiness has spread to other disciplines, such as economics. The World Economic Forum argues that a different economic model must be generated, one that meets the basic needs of all human beings on the planet, respects natural resources, is fairer and whose main objective is not growth per se but to optimize human well-being.

In the same vein, Florencia López Boo, economist and leader in the IDB’s Division of Social Protection and Health, made his presentation, who spoke about the development of public policies for the “new normal”. How to make people lose their fear of going to the doctor for check-ups or going to school after the isolation? Designing effective interventions requires understanding how the pandemic affected people’s minds and behavior. Florencia shared a work carried out by the IDB together with the INECO Foundation in which the impact of the pandemic and confinement on the mental health of the Argentine population was investigated. It was found that more than a third of the participants presented symptoms of depression or anxiety during the first week after the start of quarantine and that the groups most affected in relation to the impact on mental health are young people and people with lower incomes.

Another study shared by López Boo, and carried out jointly between the IDB and the Secretariat of Innovation and Technology of São Paulo, aims to find out what are the effective interventions to promote the use of masks, social distancing and encourage people to stay at home. “Simplifying communication, unifying government messages and taking advantage of messages from family and friends are strategies for the design of effective public policies at this time,” he concluded. Knowing these trends and the state of mental health of the population is important to prevent infections, in addition to impacting the well-being of people.

Marita Carballo, President of the World Public Opinion Association and President of the National Academy of Moral and Political Sciences, focused her presentation on the map of world happiness, identifying the factors that correlate with it and showing how policies Public institutions can contribute to creating the environment and conditions for greater well-being. “Happiness differs from one country to another and over time, due to reasons that are identifiable and that in many cases can be influenced by public policies, such as health, education, family relations or freedom of expression,” he says. Carballo. What can the governments of the region do to improve the well-being of the population at this time of a pandemic? The focus has to be on physical and mental health policies. It is essential that everyone can have access to psychological treatments and help people develop skills to deal with these situations that arise.

At the same time, there were notable presentations by experts in music therapy, technology and exercise neurophysiology who, in addition to inviting reflection on the neuroscience of well-being, provided tools both at the individual and community level. The repercussions of those attending the Symposium did not take long to be noticed on social networks that were flooded with comments of appreciation. It is very possible that going through this pandemic will make us more altruistic, more grateful and more empathetic. But for this to happen, in an extremely difficult and unique context, it becomes imperative to share scientific knowledge to build resilience and to address well-being.

How did the pandemic and isolation affect our mental health?

elopez — Fri, 16 Jul 2021 21:21:58 +0000

World Mental Health Day 2020

This October 10, World Mental Health Day, we find millions of people in a very particular situation. The coronavirus pandemic faced us with very difficult challenges: uncertainty, fear of getting sick or infecting loved ones, economic instability, loneliness, and changes in habits that affect our lives in an unprecedented way.

The unique circumstances we are experiencing in the wake of the COVID-19 pandemic can alter our mood and emotional stability. While many people tend to react resiliently to stress, others may have symptoms related to anxiety or depression. INECO Foundation, with the support of the Inter-American Development Bank, conducted an investigation to learn how the pandemic and isolation affect the mental health of Argentines.

The study had two stages. The first consisted of conducting an online survey of more than 10,000 participants during the first week of Compulsory and Preventive Social Isolation in Argentina. The results were striking since earlier than was supposed, 7 days after the isolation began, symptoms of anxiety and symptoms of depression were recognized in the people surveyed.

Although these were questionnaires in which the participants reported their own perceptions – and there is evidence that this type of methodology tends to overestimate the symptoms of mental health disorders compared to a complete evaluation by a professional – the results were surprising.

More than a third of the participants had symptoms of depression or anxiety during the first week after the start of quarantine. Taking as a reference the prevalence data from a 2018 epidemiological study of mental health in the general population, it can be seen that during the first days of isolation there was a significant increase in symptoms of anxiety or depression. Daily stress together with the feeling of loneliness and repetitive negative thoughts were the most frequently mentioned factors. It is striking that the youngest participants were the most affected by the situation. On the other hand, the research allowed to elucidate that although the existence of previous mental health problems aggravated the reactions, even people who had not previously sought treatment showed signs of psychological impact.

In a second stage, 72 days after the isolation began, another survey of similar characteristics was carried out in which it was observed that anxiety symptoms increased slightly, which is in line with expectations, while depression symptoms increased in greater extent. Sadness, listlessness, tiredness, difficulty thinking and concentrating, difficulty sleeping, and appetite disorders are some of the symptoms of depression, but it is worth clarifying that these symptoms are significant when they interfere with our daily lives. It is interesting to note that in the second survey, people also reported having mental fatigue, cognitive difficulties, financial concerns, and intolerance to uncertainty as weighting factors in the emotional impact.

These results are consistent with research throughout the region and around the world. Among these we can highlight one carried out in the United States by scientists from Boston and Columbia University in which similar results were also observed through a survey and using the same instruments as the INECO Foundation study. This research found that reports of depression symptoms tripled with the pandemic. Income and financial stability were key factors mentioned by the participants: the lower the socioeconomic level, the higher the impact on their mental health.

Click here to read the study.

Knowing more about the Mental Health of the population, whether in a normal situation or in extraordinary circumstances such as a pandemic, is the first step to be able to design adequate public policies to reduce the suffering produced by mental disorders and increase the well-being of the population. population. According to the World Health Organization about 1 billion people live with a mental disorder.

That is why this October 10, World Mental Health Day, INECO Foundation with support from the Inter-American Development Bank, share their research to contribute to one of the most neglected areas of public health and advocate for mental health without stigma .