Rather than attend this year's party conferences, I decided instead to take the temperature on US health reform at the two presidential nominating conventions.
At the Democrats' bash in Denver I saw Barack Obama accept his party's nomination in front of 84,000 people, watched by another 38 million on US TV and millions more internationally. A week later in St Paul, Minnesota, I heard John McCain set out his stall to a similarly huge TV audience.
There is lots to be said about their differing health policies. But also of interest in this incredibly close election is how the latest campaigning techniques could be retooled for the world of public health in Britain. I have identified three rather different approaches which are commanding the attention of the political class and which, by analogy, have some relevance to promoting healthy lifestyles.
First is what you could call the idea of consumer-literate public health. This approach assembles data on people from highly diverse sources to make quite detailed predictions of who will benefit from and respond to a given tailor-made offer, message or outreach technique. Set texts for those interested in this approach are BusinessWeek writer Stephen Baker's The Numerati (being published in Britain in November) and Microtrends by Hillary Clinton's pollster Mark Penn.
By combining sophisticated predictive models based on health need and health-seeking behaviour with demographic, economic and psychographic data, the new public health marketers have the potential to improve dramatically the effectiveness of their outreach efforts.
A second emerging notion is the idea of emotionally intelligent public health. This starts from the realisation that for many years public health activists have struggled to find the right way of framing the dual facts that while there are social influences of health status, people still have the power to make lifestyle decisions. Blame has been apportioned to oppressive economic and social structures on the one hand or negligent individuals on the other.
But rather than mobilising effort this sterile dichotomy has bred paralysis and excused inaction. Smoking by the poorest is often seen as an almost inevitable response to life circumstances, even though 70 per cent of smokers say they want to quit and up to half of class inequality in death rates is now explained by differential smoking rates. Or as shadow health secretary Andrew Lansley put it in a recent speech: "Tell people that biology and the environment cause obesity and they are offered the one thing we have to avoid: an excuse."
So emotionally intelligent public health means taking account of two important insights from the world of political campaigning: that any call to change individual behaviour has to be emotionally compelling, not just factually rational, and has to harness the power of social networks and peer group norms.
On the first of these prescriptions, clinical psychologist Drew Westen uses his book The Political Brain to dissect the science of persuasion, arguing that "facts, figures, policy statements, costs and benefits and appeals to intellect and expertise" will have a strictly limited impact on behaviour. A clue as to what is needed? The fact that "motivation" and "emotion" share the same Latin root, "movere", meaning "to move". Emotional intensity, storytelling, personal narratives and values are the preferred way forward.
Perhaps it has taken the arrival of Facebook, YouTube and other Web 2.0 applications to underline the importance of peer groups in either challenging or reinforcing risky health behaviours such as poor diet and binge drinking. Both health secretary Alan Johnson and Andrew Lansley have recently given thoughtful speeches on this topic.
Reverting to a more rationalist stance, the third new approach is what you might call economically savvy public health. Its defining belief is that the problem is not that incentives don't work in public health, rather it is just that they haven't been properly applied.
So for example, last year this column advocated experimenting with "PCTs working with local authorities to offer council tax discounts for taxpayers in lower bands in return for being a non-smoker, or participating in a smoking cessation programme, or attending parent/child health clinics". Plaudits therefore to Liberal Democrat health spokesman Norman Lamb for now suggesting at his party conference that primary care trusts and local authorities do exactly that. It's at least worth experimenting with.
But economically savvy public health also means going one step further than simple incentivisation. It means changing the structure of individual decision making. The key volume here is the fashionable Nudge, by US academics Richard Thaler and Cass Sunstein. Their point is that by altering people's "choice architecture", it is possible to square the circle between the desirability of offering people choice versus the likelihood that cognitive constraints will sometimes lead people to make sub-optimal decisions. And that given our tendency to equivocation, ensuring the default option is the "right" one leads to improvements in human welfare on subjects as diverse as contributing enough to your pension, choosing your healthcare and donating your organs after death.
So if lifestyle is the new public health front line and motivation the new medicine, we've got lots to learn from leading edge political campaigning and public policy debate. Now is the time for some consumer-literate, emotionally intelligent and economically savvy public health.