Public health authorities want to use behavioural and cultural insights to combat major health problems but lack both resources and capacity, according to a new report from WHO/Europe.
The Behavioural and Cultural Insights (BCI) Unit published its first status report on the use of BCI in the countries of Europe and Central Asia. This followed a regional resolution adopted in September 2022, which underscored the pivotal role of behaviour and cultural context in achieving equitable health outcomes.
All the major health challenges and causes of death and disease – such as cancer, hypertension, gaps in vaccination coverage, antimicrobial resistance and the health impacts of climate change – have behaviours at their core. These are complex and are affected by individual knowledge and motivation, as well as sociocultural and structural factors. Such behaviours can only be effectively supported, enabled and promoted through an evidence-based and structured approach.
The resolution included an action framework with five ambitious strategic country commitments, each with specific targets, aimed at driving progress in the adoption of BCI:
- to build understanding and support for BCI among key stakeholders;
- conduct BCI research;
- apply BCI to improve outcomes of health-related policies, services and communication;
- commit human and financial resources for BCI and ensure their sustainability; and
- implement strategic plan(s) to apply BCI for better health.
Ambitious targets for 2026
This first status report, covering activities from 2021 to 2022, showcases the progress achieved as well as challenges faced by public health authorities.
“This is a critical juncture as it is the first reporting to WHO following the resolution. Results show that there is still a lot of work to do to meet the ambitious targets set for 2026,” said Katrine Bach Habersaat, WHO/Europe’s Regional Advisor for BCI. “I am confident that together we can successfully navigate the challenges and bridge gaps to better use BCI to address the health challenges and major killers of our time.”
Positive advances in BCI research
Encouragingly, the report highlights positive strides in BCI research, with 56% of public health authorities conducting studies across various health areas.
BCI have informed the development and improvement of health policies, services and communication for three quarters (73%) of public health authorities – for example, through evidence-informed policies, campaigns, letters and guides, and redesigned patient tools and interventions.
BCI is under-funded and under-resourced
The report points to a resource challenge that demands attention. While some dedicated funds and staff are available, these are insufficient for systematic application across diverse health areas, with 69% of public health authorities reporting limited resources and 31% none.
The call to action is clear: the growing acknowledgment of BCI as a critical public health approach needs translation into sustainable funding, staff and structures. This also involves upskilling staff and fostering collaboration with scientific institutions.
Increasing strategic application of BCI
Beyond resource allocation, holistically embedding BCI into health strategies and planning processes stands out as critical, but only 10% of public health authorities currently have a dedicated national strategy or plan for applying BCI to health. The 2026 target is set at a minimum of 38%, underlining the need for a shift in how BCI is incorporated into decision-making processes.
“Governments and health authorities need to apply an evidence-based approach by bridging the gap between those exploring the root causes of behaviour and those making decisions,” explained Julika Loss, Head of the Health Behaviour Unit at the Robert Koch Institute, Germany.
To address this issue, public health authorities need to establish mechanisms that allow interdisciplinary collaboration and integration of BCI, to add value and impact across health areas.
Looking ahead
“It was a milestone event when a global resolution on behavioural science for health was adopted in May 2023 at the 76th World Health Assembly, in addition to the European Regional resolution, with a view to advancing the use of evidence-based approaches for health behaviours across the world. As we strive to meet the 2026 targets for BCI implementation, the WHO resolutions, action framework and reporting requirements stand as robust drivers of change,” added Katrine Bach Habersaat, WHO/Europe’s Regional Advisor for BCI.
“WHO and partners have a key role in establishing country platforms and dialogues, advocacy with decision-makers, sharing success stories and building capacity,” said Robb Butler, Director of WHO/Europe’s Division of Communicable Diseases, Environment and Health. “We need to work together to achieve the capacity-building needed to fully realize the opportunity of BCI in addressing critical public health challenges.”
To delve deeper into the barriers faced by public health authorities, WHO/Europe’s BCI Unit has conducted an interview study set to be released in 2024.
The next status report is scheduled for March 2025 and will cover activities from 2023–2024.
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This article was updated on 15 January 2024 to reflect amendments related to quote attribution and clarification regarding the body that passed the global resolution.