Sendhil Mullainathan: Solving social problems with a nudge

70,235 views ・ 2010-02-02

TED


Please double-click on the English subtitles below to play the video.

00:15
As a researcher, every once in a while
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you encounter something
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a little disconcerting.
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And this is something that changes your understanding of the world around you,
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and teaches you that you're very wrong
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about something that you really believed firmly in.
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And these are unfortunate moments,
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because you go to sleep that night
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dumber than when you woke up.
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So, that's really the goal of my talk,
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is to A, communicate that moment to you
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and B, have you leave this session
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a little dumber than when you entered.
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So, I hope I can really accomplish that.
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So, this incident that I'm going to describe
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really began with some diarrhea.
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Now, we've known for a long time the cause of diarrhea.
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That's why there's a glass of water up there.
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For us, it's a problem, the people in this room.
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For babies, it's deadly.
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They lack nutrients, and diarrhea dehydrates them.
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And so, as a result, there is a lot of death,
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a lot of death.
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In India in 1960,
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there was a 24 percent child mortality rate,
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lots of people didn't make it. This is incredibly unfortunate.
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One of the big reasons this happened was
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because of diarrhea.
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Now, there was a big effort to solve this problem,
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and there was actually a big solution.
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This solution has been called, by some,
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"potentially the most important medical
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advance this century."
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Now, the solution turned out to be simple.
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And what it was was oral rehydration salts.
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Many of you have probably used this.
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It's brilliant. It's a way to get sodium
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and glucose together so that when you add it to water
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the child is able to absorb it even during situations of diarrhea.
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Remarkable impact on mortality.
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Massive solution to the problem.
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Flash forward: 1960, 24 percent child mortality
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has dropped to 6.5 percent today.
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Still a big number, but a big drop.
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It looks like the technological problem is solved.
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But if you look, even today
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there are about 400,000 diarrhea-related deaths
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in India alone.
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What's going on here?
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Well the easy answer is, we just haven't gotten those salts
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to those people.
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That's actually not true.
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If you look in areas where these salts are completely available,
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the price is low or zero, these deaths still continue abated.
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Maybe there's a biological answer.
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Maybe these are the deaths that simple rehydration
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alone doesn't solve. That's not true either.
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Many of these deaths were completely preventable,
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and this what I want to think of as the disconcerting thing,
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what I want to call "the last mile" problem.
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See, we spent a lot of energy, in many domains --
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technological, scientific, hard work,
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creativity, human ingenuity --
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to crack important social problems with technology solutions.
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That's been the discoveries of the last 2,000 years,
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that's mankind moving forward.
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But in this case we cracked it,
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but a big part of the problem still remains.
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Nine hundred and ninety-nine miles went well,
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the last mile's proving incredibly stubborn.
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Now, that's for oral rehydration therapy.
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Maybe this is something unique about diarrhea.
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Well, it turns out -- and this is where things get really disconcerting --
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it's not unique to diarrhea.
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It's not even unique to poor people in India.
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Here's an example from a variety of contexts.
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I've put a bunch of examples up here.
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I'll start with insulin, diabetes
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medication in the U.S.
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OK, the American population.
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On Medicaid -- if you're fairly poor you get Medicaid,
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or if you have health insurance -- insulin is pretty straightforward.
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You get it, either in pill form or you get it as an injection;
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you have to take it every day to maintain your blood sugar levels.
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Massive technological advance:
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took an incredibly deadly disease, made it solvable.
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Adherence rates. How many people are taking their insulin every day?
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About on average, a typical person is taking it 75 percent of the time.
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As a result, 25,000 people a year go blind,
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hundreds of thousands lose limbs, every year,
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for something that's solvable.
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Here I have a bunch of other examples,
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all suffer from the last mile problem.
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It's not just medicine.
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Here's another example from technology:
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agriculture. We think
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there's a food problem, so we create new seeds.
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We think there's an income problem, so we create
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new ways of farming that increase income.
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Well, look at some old ways, some ways that we'd already cracked.
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Intercropping. Intercropping really increases income.
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Sometimes in rice we found incredible increases in yield
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when you mix different varieties of rice side by side.
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Some people are doing that,
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many are not. What's going on?
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This is the last mile.
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The last mile is, everywhere, problematic.
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Alright, what's the problem?
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The problem is this little three-pound machine
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that's behind your eyes and between your ears.
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This machine is really strange,
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and one of the consequences is that people are weird.
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They do lots of inconsistent things.
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05:08
(Applause)
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They do lots of inconsistent things.
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And the inconsistencies
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create, fundamentally, this last mile problem.
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See, when we were dealing with our biology, bacteria,
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the genes, the things inside here, the blood?
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That's complex, but it's manageable.
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When we're dealing with people like this?
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The mind is more complex.
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That's not as manageable, and that's what we're struggling with.
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Let me go back to diarrhea for a second.
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Here's a question that was asked in the National Sample Survey,
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which is a survey asked of many Indian women:
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"Your child has diarrhea.
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Should you increase, maintain or decrease the number of fluids?"
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Just so you don't embarrass yourselves, I'll give you the right answer:
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It's increase.
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Now, diarrhea's interesting
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because it's been around for thousands of years,
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ever since humankind really
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lived side by side enough to have really polluted water.
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One Roman strategy that was very interesting
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was that -- and it really gave them a comparative advantage --
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they made sure their soldiers didn't drink
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even remotely muddied waters.
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Because if some of your troops get diarrhea they're not that effective
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on the battlefield.
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So, if you think of Roman comparative advantage part of it was the breast shields,
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the breastplates, but part of it was drinking the right water.
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So, here are these women. They've seen their parents
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have struggled with diarrhea, they've struggled with diarrhea,
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they've seen lots of deaths. How do they answer this question?
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In India, 35 to 50 percent say "Reduce."
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Think about what that means for a second.
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Thirty-five to 50 percent of women
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forget oral rehydration therapy,
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they are increasing --
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they are actually making their child
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more likely to die through their actions.
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How is that possible?
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Well, one possibility -- I think that's how most people respond to this --
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is to say, "That's just stupid."
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I don't think that's stupid.
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I think there is something very profoundly right in what these women are doing.
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And that is, you don't put water
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into a leaky bucket.
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So, think of the mental model that goes behind reducing the intake.
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Just doesn't make sense.
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Now, the model is intuitively right.
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It just doesn't happen to be right about the world.
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But it makes a whole lot of sense at some deep level.
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And that, to me, is the fundamental challenge
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of the last mile.
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This first challenge is what I refer to as the persuasion challenge.
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Convincing people to do something --
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take oral rehydration therapy, intercrop, whatever it might be --
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is not an act of information:
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"Let's give them the data,
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and when they have data they'll do the right thing."
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It's more complex than that.
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And if you want to understand how it's more complex
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let me start with something kind of interesting.
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I'm going to give you a little math problem,
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and I want you to just yell out the answer as fast as possible.
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A bat and a ball together cost $1.10.
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The bat costs a dollar more than the ball.
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How much does the ball cost? Quick.
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So, somebody out there says, "Five."
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A lot of you said, "Ten."
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Let's think about 10 for a second.
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If the ball costs 10, the bat costs...
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this is easy, $1.10.
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Yeah. So, together they would cost $1.20.
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So, here you all are, ostensibly educated people.
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Most of you look smart.
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The combination of that produces
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something that is actually, you got this thing wrong.
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How is that possible? Let's go to something else.
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I know algebra can be complicated.
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So, let's dial this back. That's what? Fifth grade? Fourth grade?
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Let's go back to kindergarten. OK?
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There's a great show on American television that you have to watch.
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It's called "Are You Smarter Than a Fifth Grader?"
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I think we've learned the answer to that here.
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Let's move to kindergarten. Let's see if we can beat five-year-olds.
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Here's what I'm going to do: I'm going to put objects on the screen.
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I just want you to name the color of the object.
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That's all it is. OK?
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I want you to do it fast, and say it out loud with me,
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and do it quickly. I'll make the first one easy for you.
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Ready? Black.
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Now the next ones I want you to do quickly and say it out loud.
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09:12
Ready? Go.
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Audience: Red. Green.
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Yellow. Blue. Red.
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09:18
(Laughter)
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Sendhil Mullainathan: That's pretty good.
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Almost out of kindergarten.
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What is all this telling us?
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You see, what's going on here, and in the bat and ball problem
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is that you have some intuitive ways of interacting with the world,
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some models that you use to understand the world.
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These models, like the leaky bucket,
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work well in most situations.
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I suspect most of you --
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I hope that's true for the rest of you --
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actually do pretty well with addition and subtraction in the real world.
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I found a problem, a specific problem
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that actually found an error with that.
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Diarrhea, and many last mile problems, are like that.
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They are situations where the mental model
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doesn't match the reality.
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Same thing here:
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You had an intuitive response to this that was very quick.
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You read "blue" and you wanted to say "blue," even though you knew your task was red.
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Now, I do this stuff because it's fun.
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But it's more profound than fun.
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I'll give you a good example of how it actually effects persuasion.
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BMW is a pretty safe car.
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And they are trying to figure out, "Safety is good.
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I want to advertise safety. How am I going to advertise safety?"
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"I could give people numbers. We do well on crash tests."
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But the truth of the matter is, you look at that car,
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it doesn't look like a Volvo,
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and it doesn't look like a Hummer.
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So, what I want you to think about for a few minutes
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is: How would you convey safety of the BMW? Okay?
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So now, while you're thinking about that let's move to a second task.
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The second task is fuel efficiency. Okay?
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Here's another puzzle for all of you.
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One person walks into a car lot,
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and they're thinking about buying this Toyota Yaris.
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They are saying, "This is 35 miles per gallon. I'm going to do
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the environmentally right thing, I'm going to buy the Prius,
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50 miles per gallon."
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Another person walks into the lot,
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and they're about to buy a Hummer, nine miles per gallon,
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fully loaded, luxury.
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And they say, "You know what? Do I need turbo? Do I need this heavyweight car?"
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I'm going to do something good for the environment.
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I'm going to take off some of that weight,
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and I'm going to buy a Hummer that's 11 miles per gallon."
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Which one of these people has done more for the environment?
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See, you have a mental model.
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Fifty versus 35, that's a big move. Eleven versus nine? Come on.
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Turns out, go home and do the math,
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the nine to 11 is a bigger change. That person has saved more gallons.
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Why? Because we don't care about miles per gallon, we care about
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gallons per mile.
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Think about how powerful that is if you're trying to encourage fuel efficiency.
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Miles per gallon is the way we present things.
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If we want to encourage change of behavior,
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gallons per mile would have far more effectiveness.
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Researchers have found these type of anomalies.
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Okay, back to BMW. What should they do?
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The problem BMW faces is this car looks safe.
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This car, which is my Mini, doesn't look that safe.
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Here was BMW's brilliant insight, which they embodied into an ad campaign.
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They showed a BMW driving down the street.
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There's a truck on the right. Boxes fall out of the truck.
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The car swerves to avoid it, and therefore doesn't get into an accident.
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BWM realizes safety, in people's minds, has two components.
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You can be safe because when you're hit, you survive,
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or you can be safe because you avoid accidents.
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Remarkably successful campaign, but notice the power of it.
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It harnesses something you already believe.
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Now, even if I persuaded you to do something,
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it's hard sometimes to actually get action as a result.
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You all probably intended to wake up,
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I don't know, 6:30, 7 a.m.
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This is a battle we all fight every day,
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along with trying to get to the gym.
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Now, this is an example of that battle,
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and makes us realize intentions don't always translate into action,
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and so one of the fundamental challenges
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is how we would actually do that. OK?
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So, let me now talk about the last mile problem.
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So far, I've been pretty negative.
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I've been trying to show you the oddities of human behavior.
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And I think maybe I'm being too negative.
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Maybe it's the diarrhea.
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Maybe the last mile problem really should be thought of
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as the last mile opportunity.
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Let's go back to diabetes.
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This is a typical insulin injection.
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Now, carrying this thing around is complicated.
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You gotta carry the bottle, you gotta carry the syringe.
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It's also painful.
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Now, you may think to yourself, "Well, if my eyes depended on it,
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you know, I would obviously use it every day."
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But the pain, the discomfort,
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you know, paying attention, remembering to put it in your purse
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when you go on a long trip:
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These are the day-to-day of life, and they do pose problems.
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Here is an innovation, a design innovation.
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This is a pen, it's called an insulin pen, preloaded.
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The needle is particularly sharp.
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You just gotta carry this thing around.
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It's much easier to use, much less painful.
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Anywhere between five and 10 percent increase in adherence,
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just as a result of this.
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That's what I'm talking about as a last mile opportunity.
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You see, we tend to think the problem is solved
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when we solve the technology problem.
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But the human innovation, the human problem
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still remains, and that's a great frontier that we have left.
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This isn't about the biology of people;
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this is now about the brains, the psychology of people,
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and innovation needs to continue all the way through
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the last mile.
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Here's another example of this.
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This is from a company called Positive Energy.
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This is about energy efficiency.
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We're spending a lot of time on fuel cells right now.
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What this company does is they send a letter
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to households that say, "Here's your energy use,
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here's your neighbor's energy use: You're doing well." Smiley face.
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"You're doing worse." Frown.
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And what they find is just this letter, nothing else,
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has a two to three percent reduction in electricity use.
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And you want to think about the social value of that
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in terms of carbon offsets, reduced electricity,
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900 million dollars per year.
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Why? Because for free,
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this isn't a new technology, this is a letter --
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we're getting a Big Bang in behavior.
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So, how do we tackle the last mile?
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I think this tells us there is an opportunity.
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And I think to tackle it, we need to combine
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psychology,
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marketing,
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art, we've seen that.
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But you know what we need to combine it with?
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We need to combine this with the scientific method.
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See what's really puzzling and frustrating about the last mile, to me,
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is that the first 999 miles are all about science.
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No one would say, "Hey, I think this medicine works, go ahead and use it."
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We have testing, we go to the lab, we try it again, we have refinement.
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But you know what we do on the last mile?
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"Oh, this is a good idea. People will like this. Let's put it out there."
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The amount of resources we put in are disparate.
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We put billions of dollars into fuel-efficient technologies.
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How much are we putting into
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energy behavior change
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in a credible, systematic, testing way?
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Now, I think that we're on the verge of something big.
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We're on the verge of a whole new social science.
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It's a social science that recognizes --
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much like science recognizes the complexity of the body,
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biology recognizes the complexity of the body -- we'll recognize
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the complexity of the human mind.
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The careful testing, retesting, design,
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are going to open up vistas of understanding,
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complexities, difficult things.
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And those vistas will both create new science,
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and fundamental change in the world as we see it, in the next hundred years.
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All right. Thank you very much.
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(Applause)
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Chris Anderson: Sendhil, thank you so much.
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So, this whole area is so fascinating.
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I mean, it sometimes feels, listening to behavioral economists
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that they are kind of putting into place
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academically, what great marketers
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have sort of intuitively known for a long time.
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How much is your field talking to great marketers
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about their insights into human psychology?
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Because they've seen it on the ground.
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Sendhil Mullainathan: Yeah, we spend a lot of time talking to marketers,
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and I think 60 percent of it is exactly what you say,
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there are insights to be gleaned there.
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Forty percent of it is about what marketing is.
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Marketing is selling an ad to a firm.
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So, in some sense, a lot of marketing is about
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convincing a CEO, "This is a good ad campaign."
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So, there is a little bit of slippage there.
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That's just a caveat. That's different from actually having an effective ad campaign.
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And one of the new movements in marketing is: How do we actually
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measure effectiveness? Are we effective?
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CA: How you take your insights here
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and actually get them integrated
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into working business models on the ground,
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in Indian villages, for example?
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SM: So, the scientific method I alluded to is pretty important.
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We work closely with companies that have operational capacity,
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or nonprofits that have operational capacity.
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And then we say, "Well, you want to get this behavior change.
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Let's come up with a few ideas, test them,
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see which is working, go back, synthesize,
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and try to come up with a thing that works,"
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and then we're able to scale with partners.
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It's kind of the model that has worked in other contexts.
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If you have biological problems
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we try and fix it, see if it works, and then work the scale.
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CA: Alright Sendhil, thanks so much for coming to TED. Thank you.
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(Applause)
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