Why it's so hard to make healthy decisions | David Asch

Prevodilac: Ivana Krivokuća Lektor: Kristina Radosavljević

It's April of 2007,

April je 2007. godine,

and Jon Corzine, the Governor of New Jersey,

i Džon Korzajn, guverner Nju Džerzija,

is in this horrific car accident.

našao se u užasnoj saobraćajnoj nesreći.

He's in the right front passenger seat of this SUV

Bio je na desnom suvozačkom sedištu terenca

when it crashes on the Garden State Parkway.

kada se sudario na auto-putu Garden stejt.

He's transported to a New Jersey trauma center

Prebačen je u centar za traume u Nju Džerziju

with multiple broken bones and multiple lacerations.

sa više preloma kostiju i višestrukim razderotinama.

He needs immediate surgery, seven units of blood,

Bila mu je potrebna hitna operacija, sedam jedinica krvi,

a mechanical ventilator to help him breathe

mehanički ventilator da mu pomogne da diše

and several more operations along the way.

i još nekoliko operacija uz to.

It's amazing he survived.

Pravo je čudo da je preživeo.

But perhaps even more amazing,

A što je možda još čudnije,

he was not wearing a seat belt.

nije bio vezao pojas.

And, in fact, he never wore a seat belt,

U stvari, nikada se nije vezivao,

and the New Jersey state troopers who used to drive Governor Corzine around

i lokalni policajci Nju Džerzija koji su često vozili guvernera Korzajna

used to beg him to wear a seat belt,

molili su ga da veže pojas,

but he didn't do it.

ali on to nije činio.

Now, before Corzine was Governor of New Jersey,

Pre nego što je Korzajn postao guverner Nju Džerzija,

he was the US Senator from New Jersey,

bio je senator iz Nju Džerzija,

and before that, he was the CEO of Goldman Sachs,

a pre toga je bio direktor Goldman Saksa,

responsible for taking Goldman Sachs public,

odgovoran za to što su akcije firme postale dostupne javnosti,

making hundreds of millions of dollars.

čime je zaradio stotine miliona dolara.

Now, no matter what you think of Jon Corzine politically

Šta god mislili o Džonu Korzajnu politički

or how he made his money,

i o tome kako je stekao novac,

nobody would say that he was stupid.

niko neće reći da je glup.

But there he was,

Ali tako se to desilo,

an unrestrained passenger in a car accident,

bio je putnik bez pojasa u saobraćajnoj nesreći,

at a time when every American knows that seat belts save lives.

u vreme kada svaki Amerikanac zna da sigurnosni pojas spasava život.

This single story reflects a fundamental weakness

Ova priča oslikava suštinsku slabost

in our approach to improving health behavior.

našeg pristupa poboljšanju zdravstvenih navika.

Nearly everything we tell doctors and everything we tell patients

Gotovo sve što govorimo doktorima i pacijentima

is based on the idea that we behave rationally.

zasnovano je na ideji da je naše ponašanje racionalno.

If you give me information, I will process that information in my head,

Ako mi date informacije, ja ću ih obraditi u glavi,

and my behavior will change as a result.

i kao ishod toga će se moje ponašanje pomeniti.

Do you think Jon Corzine didn't know that seat belts save lives?

Mislite da Džon Korzajn nije znao da pojas u automobilu spasava život?

Do you think he, like, just didn't get the memo?

Mislite da nije bio obavešten?

(Laughter)

(Smeh)

Jon Corzine did not have a knowledge deficit,

Džon Korzajn nije imao problem u pogledu znanja,

he had a behavior deficit.

već u pogledu ponašanja.

It's not that he didn't know better.

Ne radi se o tome da nije znao šta je ispravno. Znao je.

He knew better.

It's that he didn't do better.

Stvar je u tome što to nije činio.

Instead, I think the mind is a high-resistance pathway.

Zapravo, mislim da je um putanja sa velikim otporom.

Changing someone's mind with information is hard enough.

Prilično je teško promeniti nečije mišljenje pomoću informacija.

Changing their behavior with information

Promeniti ponašanje pomoću informacija

is harder still.

je još teže.

The only way we're going to make substantial improvements

Jedini način da ostvarimo značajna poboljšanja

in health and health care

u zdravlju i zdravstvenoj zaštiti

is to make substantial improvements in the behavior of health and health care.

je da ostvarimo značajna unapređenja

u ponašanju vezanom za zdravlje i zdravstvenu zaštitu.

If you hit my patellar tendon with a reflex hammer,

Ako mi patelarnu tetivu udarite čekićem za ispitivanje refleksa,

my leg is going to jerk forward,

noga će mi se trgnuti napred,

and it's going to jerk forward a lot faster and a lot more predictably

i to će se trgnuti napred mnogo brže i pouzdanije

than if I had to think about it myself.

nego da moram sam da razmišljam o tome.

It's a reflex.

To je refleks.

We need to look for the equivalent behavioral reflexes

Moramo potražiti slične reflekse u ponašanju

and hitch our health care wagon to those.

i na njih se nadovezati u zdravstvenoj zaštiti.

Turns out, though,

Ispostavilo se, pak,

that most conventional approaches to human motivation

da je većina konvencionalnih pristupa ljudskoj motivaciji

are based on the idea of education.

zasnovana na ideji o obrazovanju.

We assume that if people don't behave as they should,

Pretpostavljamo da, ako se ljudi ne ponašaju kako bi trebalo,

it's because they didn't know any better.

to je zato što nisu znali šta je ispravno.

"If only people knew that smoking was dangerous, they wouldn't smoke."

„Kada bi ljudi samo znali da je pušenje opasno, oni ne bi pušili.“

Or, we think about economics.

Ili kada razmišljamo o ekonomiji.

The assumption there is that we're all constantly calculating

Tu je pretpostavka da mi stalno vršimo proračune

the costs and benefits of every one of our actions

koja je cena i korist svake od naših aktivnosti,

and optimizing that to make the perfectly right, rational decision.

i u tome tražimo rešenje da bismo doneli savršeno ispravne, racionalne odluke.

If that were true, then all we need to do

Kada bi to bilo tako, onda nam samo treba

is to find the perfect payment system for doctors

da nađemo savršeni sistem plaćanja za doktore

or the perfect co-payments and deductibles for patients,

ili savršene participacije i učešća za pacijente,

and everything would work out.

i sve bi dobro funkcionisalo.

A better approach lies in behavioral economics.

Bolji pristup leži u bihevioralnoj ekonomiji.

Behavioral economists recognize that we are irrational.

Bihevioralni ekonomisti uviđaju da smo iracionalni.

Our decisions are based on emotion,

Naše odluke su zasnovane na emocijama,

or they're sensitive to framing or to social context.

ili su osetljive na formulaciju ili na društveni kontekst.

We don't always do what's in our own long-term best interests.

Ne radimo uvek ono što nam je dugoročno u najboljem interesu.

But the key contribution to behavioral economics

Ali ključni doprinos bihevioralne ekonomije

is not in recognizing that we are irrational;

nije u uviđanju toga da smo iracionalni,

it's recognizing that we are irrational in highly predictable ways.

već da smo iracionalni na vrlo predvidljive načine.

In fact, it's the predictability of our psychological foibles

Zapravo, upravo nam predvidljivost naših psiholoških nedostataka

that allows us to design strategies to overcome them.

omogućava da osmislimo strategije da bismo ih prevazišli.

Forewarned is forearmed.

Upozorenje omogućava naoružanje.

In fact, behavioral economists often use

Bihevioralni ekonomisti često upotrebljavaju

precisely the same behavioral reflexes that get us into trouble

baš te iste bihevioralne reflekse zbog kojih se nađemo u problemu

and turn them around to help us,

i preokrenu ih da bi nam pomogli

rather than to hurt us.

umesto da nam naškode.

We see irrationality play out in something called "present bias,"

Vidimo da se iracionalnost dešava

u okviru nečeg što se zove „pristrasnost sadašnjosti“,

where the outcomes in front of us are much more motivating

pri čemu ishodi koji su tik ispred nas mnogo više motivišu

than even more important outcomes far in the future.

čak i od značajnijih ishoda daleko u budućnosti.

If I'm on a diet -- and I'm always on a diet --

Ja sam na dijeti - a ja sam uvek na dijeti -

(Laughter)

(Smeh)

and someone offers me a luscious-looking piece of chocolate cake,

a neko mi ponudi parče čokoladne torte koje sočno izgleda,

I know I should not eat that chocolate cake.

ja znam da ne treba da ga pojedem.

That chocolate cake will land on that part of my body -- permanently --

Ta čokoladna torta će trajno otići na onaj deo tela

where that kind of food naturally settles.

gde ta vrsta hrane obično završi.

But the chocolate cake looks so good and delicious,

Ali čokoladna torta izgleda tako dobro i ukusno, i tu je, ispred mene,

and it's right in front of me,

a dijeta može da sačeka do sutra.

and the diet can wait 'til tomorrow.

I used to love the comedian Steven Wright.

Nekad sam voleo komičara Stivena Rajta.

He would have these Zen-like quips.

On je imao fore u zen fazonu.

My favorite one was this:

Omiljena mi je bila:

"Hard work pays off in the future,

„Naporan rad se isplati u budućnosti,

but laziness pays off right now."

ali lenjost se isplati u ovom trenutku.“

(Laughter)

(Smeh)

And patients also have present bias.

Pacijenti takođe imaju pristrasnost sadašnjosti.

If you have high blood pressure,

Ako imate visok krvni pritisak,

even if you would desperately like to avoid a stroke,

čak i ako po svaku cenu želite da izbegnete šlog,

and you know that taking your antihypertensive medications

i znate da je uzimanje lekova protiv hipertenzije

is one of the best ways to reduce that risk,

jedan od najboljih načina da se umanji rizik,

the stroke you avoid is far in the future and taking medications is right now.

šlog koji biste da izbegnete je daleko u budućnosti, a uzimanje lekova je sada.

Almost half of the patients who are prescribed high blood pressure pills

Skoro polovina pacijenata kojima su prepisane tablete za visok pritisak

stop taking them within a year.

prestanu da ih uzimaju u roku od godinu dana.

Zamislite koliko bismo života mogli da spasimo

Think of how many lives we could save

if we could solve just that one problem.

ako bismo rešili samo taj jedan problem.

We also tend to overestimate the value of small probabilities.

Takođe imamo tendenciju precenjivanja vrednosti malih verovatnoća.

This actually explains why state lotteries are so popular,

To objašnjava zašto su državne lutrije toliko popularne,

even though they return pennies on the dollar.

iako je dobitak neznatan u odnosu na uloženo.

Now, some of you may buy lottery tickets --

Neki od vas će možda kupiti srećku za lutriju -

it's fun, there's the chance you might strike it rich ...

zabavno je, postoji šansa da ćete se obogatiti...

But let's face it:

Ali, budimo realni:

this would be a horrible way to invest your retirement savings.

ovo bi bio užasan način da uložite svoju ušteđevinu za penziju.

I once saw a bumper sticker -- I am not making this up -- that said,

Jednom sam video nalepnicu na automobilu - ne izmišljam ovo - koja kaže:

"State lotteries are a special tax on people who can't do math."

„Državne lutrije su poseban porez za ljude koji ne znaju matematiku.“

(Laughter)

(Smeh)

It's not that we can't do the math,

Nije da ne znamo matematiku,

it's that we can't feel the math.

već je ne osećamo.

And we also pay much too much attention to regret.

Takođe previše pažnje posvećujemo kajanju.

We all hate the feeling of missing out.

Svi mrzimo osećaj da nešto propuštamo.

So, actually, there was this recent lottery,

Bila je nedavno lutrija,

a mega-jackpot lottery,

lutrija sa mega džekpotom,

that had a huge payoff, something like over a billion dollars.

koja je imala ogromnu nagradu, nešto preko milijarde dolara.

And everyone in my office is pooling money to buy lottery tickets,

Svi u mojoj kancelariji su skupljali novac da kupe srećke,

and I'm not having any of this.

a ja sam to odbacivao.

There I am, like, swaggering around the office,

Tako sam se šepurio po kancelariji:

"Lotteries are a special tax on people who can't do math."

„Lutrije su poseban porez za ljude koji ne znaju matematiku.“

(Laughter)

(Smeh)

And then it hits me:

A onda mi je palo na pamet:

uh oh.

o, ne.

What if they win?

Šta ako pobede?

(Laughter)

(Smeh)

I'm the only one who shows up at work the next day.

Ja ću se jedini pojaviti na poslu narednog dana.

(Laughter)

(Smeh)

Now, it's not that I didn't want my colleagues to win.

Nije da nisam hteo da moje kolege pobede,

I just didn't want them to win without me.

samo nisam hteo da pobede bez mene.

Now, it would have been easier if I had just taken my 20-dollar bill

Bilo bi lakše da sam prosto uzeo novčanicu od 20 dolara,

and put it into the office shredder,

stavio je u seckalicu za papir,

and the results would have been the same.

i rezultati bi bili isti.

Even though I knew I shouldn't participate,

Iako sam znao da ne treba da učestvujem,

I handed over my $20 bill,

predao sam novčanicu od 20 dolara

and I never saw it again.

koje nikada više nisam video.

(Laughter)

(Smeh)

We've done a bunch of experiments with patients

Sproveli smo gomilu eksperimenata sa pacijentima

in which we give them these electronic pill bottles

u kojima smo im davali elektronske bočice za pilule

so we can tell whether they're taking their medication or not.

tako da možemo da znamo da li uzimaju lekove ili ne.

And we reward them with a lottery.

Nagradimo ih lutrijom.

They get prizes.

Dobijaju nagrade.

But they only get prizes

Ali dobijaju nagrade

if they had taken their medication the day before.

samo ako su dan pre toga uzeli lek.

If not, they get a message that says something like,

Ako nisu, dobiju poruku koja kaže nešto tipa:

"You would have won a hundred dollars,

„Mogli ste da dobijete sto dolara,

but you didn't take your medicine yesterday, so you don't get it."

ali niste uzeli lek juče, pa zato ih nećete dobiti.“

Well, it turns out, patients hate that.

Pa, ispostavilo se da pacijenti to mrze.

They hate the sense of missing out,

Mrze osećaj propuštanja,

and because they can anticipate that feeling of regret

i zato što mogu da predosete taj osećaj kajanja

and they'd like to avoid it,

i žele da ga izbegnu,

they're much more likely to take their medications.

veća je verovatnoća da će uzeti lek.

Harnessing that sense of hating regret works.

Korišćenje tog osećaja nepodnošenja kajanja deluje.

And it leads to the more general point,

To nas dovodi do opštije poente,

which is: once you recognize how people are irrational,

a to je: kada shvatite na koji način su ljudi iracionalni,

you're in a much better position to help them.

nalazite se u boljem položaju da im pomognete.

Now, this kind of irrationality works out even in men's restrooms.

Takva vrsta iracionalnosti se odvija čak i u muškim toaletima.

So, for those of you who don't frequent urinals,

Za one među vama koji ne posećuju pisoare često,

let me break this down for you.

da vam nešto objasnim.

(Laughter)

(Smeh)

There is pee all over the floor.

Mokraća je svuda po podu.

(Laughter)

(Smeh)

And it turns out that you can solve this problem

Ispostavilo se da možete rešiti taj problem

by etching the image of a fly in the back of the urinal.

ako ugravirate sliku muve na zadnji deo pisoara.

(Laughter) (Applause)

(Smeh) (Aplauz)

And it makes perfect sense.

To skroz ima smisla.

(Laughter)

(Smeh)

If I see a fly,

Ako vidim muvu,

I'm gonna get that fly.

ima da je uhvatim.

(Laughter)

(Smeh)

That fly is going down.

Ta muva je gotova.

(Laughter)

(Smeh)

Now, this naturally begs the question that if men can aim,

To, naravno, pokreće pitanje: ako muškarci umeju da ciljaju,

why were they peeing on the floor in the first place?

zašto su uopšte prethodno mokrili po podu?

In fact, if they were going to pee on the floor,

Zapravo, ako su nameravali da mokre po podu,

zašto bi to činili ispred pisoara?

why pee in front of the urinal?

You could pee anywhere.

Može bilo gde da se mokri.

(Laughter)

(Smeh)

And the same thing works in health care.

Ista stvar važi u zdravstvenoj zaštiti.

We had a problem in our hospital

Imali smo problem u bolnici

in which the physicians were prescribing brand-name drugs

u kojoj su lekari prepisivali brendirane lekove

when a generic drug was available.

kada je generički lek bio dostupan.

Each one of the lines on this graph represents a different drug.

Svaka linija na ovom grafikonu predstavlja drugi lek.

And they're listed according to how often they're prescribed as generic medications.

Navedeni su po tome koliko često se propisuju kao generički lekovi.

Those are the top are prescribed as generics 100 percent of the time.

Oni na vrhu se prepisuju kao generički u 100 odsto slučajeva.

Those down at the bottom are prescribed as generics

Oni dole na dnu se prepisuju kao generički

less than 20 percent of the time.

u manje od 20 posto slučajeva.

And we'd have meetings with clinicians and all sorts of education sessions,

Održavali smo sastanke sa kliničarima i najrazličitije edukativne sesije,

and nothing worked --

i ništa nije pomoglo -

all the lines are pretty much horizontal.

sve linije su bile uglavnom horizontalne.

Until, someone installed a little piece of software

Sve dok neko nije instalirao mali softver

in the electronic health record

u elektronsku zdravstvenu evidenciju

that defaulted the prescriptions to generic medications

koji je preokretao recepte na generičke lekove

instead of the brand-name drugs.

umesto brendiranih.

Now, it doesn't take a statistician

Ne treba da budete statističar

to see that this problem was solved overnight,

da biste uvideli da je problem rešen preko noći,

and it has stayed solved ever since.

i ostao je rešen od tada.

In fact, in the two and a half years since this program started,

Zapravo, za dve i po godine otkad je program započet,

our hospital has saved 32 million dollars.

naša bolnica je uštedela 32 miliona dolara.

Let me say that again: 32 million dollars.

Da ponovim: 32 miliona dolara.

And all we did was make it easier

A samo smo olakšali doktorima

for the doctors to do what they fundamentally wanted to do all along.

da rade ono što su u suštini sve vreme hteli da urade.

It also works to play into people's notions of loss.

Takođe pomaže igrati se sa pojmom gubitka kod ljudi.

We did this with a contest to help people walk more.

To smo uradili kroz takmičenje da bismo pomogli ljudima da više šetaju.

We wanted everyone to walk at least 7,000 steps,

Hteli smo da svi hodaju najmanje 7000 koraka,

and we measured their step count

i merili smo im broj koraka

with the accelerometer on their cell phone.

pomoću akcelerometra na njihovim mobilnim telefonima.

Group A, the control group, just got told whether they had walked

Grupi A, kontrolnoj grupi, je samo rečeno da li su napravili

7,000 steps or not.

7000 koraka ili ne.

Group B got a financial incentive.

Grupa B je dobijala finansijski podsticaj.

We gave them $1.40 for every day they walked 7,000 steps.

Davali smo im 1,40 dolara za svaki dan kada naprave 7000 koraka.

Group C got the same financial incentive,

Grupa C je dobila isti finansijski podsticaj,

but it was framed as a loss rather than a gain:

ali bio je formulisan kao gubitak umesto kao dobitak:

$1.40 a day is 42 dollars a month,

1,40 dolara dnevno je 42 dolara mesečno,

so we gave these participants 42 dollars at the beginning of each month

pa smo tim učesnicima uplaćivali 42 dolara na početku svakog meseca

in a virtual account that they could see,

na virtuelni račun koji su mogli da vide,

and we took away $1.40 for every day they didn't walk 7,000 steps.

i oduzimali bismo 1,40 dolara svakog dana kada ne bi napravili 7000 koraka.

Now, an economist would say that those two financial incentives

Ekonomista bi rekao

da su ta dva finansijska podsticaja ista.

are the same.

For every day you walk 7,000 steps, you're $1.40 richer.

Svakog dana kada pređete 7000 koraka, bogatiji ste za 1,40 dolara.

But a behavioral economist would say that they're different,

Ali bihevioralni ekonomista bi rekao da su različiti,

because we're much more motivated to avoid a $1.40 loss

jer smo mnogo više motivisani da izbegnemo da izgubimo 1,40 dolara

than we are motivated to achieve a $1.40 gain.

nego što smo motivisani da ostvarimo dobitak od 1,40 dolara.

And that's exactly what happened.

To se upravo i dogodilo.

Those in the group that received $1.40 for every day they walked 7,000 steps

Oni iz grupe koji su primali 1,40 dolara za svaki dan kada pređu 7000 koraka

were no more likely to meet their goal than the control group.

nisu imali veću verovatnoću da ostvare cilj u odnosu na kontrolnu grupu.

The financial incentive didn't work.

Finansijski podsticaj nije pomogao.

But those who had a loss-framed incentive

Ali oni koji su imali podsticaj formulisan kao gubitak

met their goal 50 percent more of the time.

ostvarivali su cilj u 50 odsto više slučajeva.

It doesn't make economic sense, but it makes psychological sense,

To ekonomski nema smisla, ali psihološki ima,

because losses loom larger than gains.

jer se gubitak čini većim od dobitka.

And now we're using loss-framed incentives to help patients walk more,

Sada koristimo podsticaje formulisane kao gubitak

da bismo pomogli pacijentima da više hodaju, smršaju

lose weight

and take their medications.

i uzimaju lekove.

Money can be a motivator.

Novac može da motiviše.

We all know that.

Svi to znamo.

But it's far more influential when it's paired with psychology.

Ali mnogo je uticajniji kada je uparen sa psihologijom.

And money, of course, has its own disadvantages.

Naravno, novac ima svoje nedostatke.

My favorite example of this involves a daycare program.

Moj omiljeni primer za to ima veze sa jednim obdaništem.

The greatest sin you can commit in daycare is picking up your kids late.

Najveći greh koji možete počiniti u vrtiću je da zakasnite da dođete po decu.

No one is happy.

Niko nije srećan.

Your kids are crying because you don't love them.

Deca plaču zato što ih ne volite.

(Laughter)

(Smeh)

The teachers are unhappy because they leave work late.

Vaspitačice su nezadovolne jer će kasnije izaći sa posla.

And you feel terribly guilty.

Vi osećate veliku krivicu.

This daycare program in Israel decided they wanted to stop this problem,

U jednom vrtiću u Izraelu su rešili da reše ovaj problem

and they did something that many daycare programs in the US do,

i uradili su nešto što rade mnoga obdaništa u SAD-u,

which is they installed a fine for late pickups.

a to je da su uveli kaznu za kasno dolaženje po decu.

And the fine they chose was 10 shekels,

Odlučili su se za kaznu od 10 šekela,

which is about three bucks.

što je oko tri dolara.

And guess what happened?

Pogodite šta se dogodilo?

Late pickups increased.

Povećao se broj kašnjenja.

And if you think about it, it makes perfect sense.

Ako malo bolje razmislite, to sasvim ima smisla.

What a deal!

Kakva pogodnost!

For 10 shekels --

Za 10 šekela -

(Laughter)

(Smeh)

you can keep my kids all night!

moja deca mogu da ostanu celu noć!

(Laughter)

(Smeh)

They took a perfectly strong intrinsic motivation not to be late,

Uzeli su sasvim jaku intrinzičku motivaciju da se ne kasni

and they cheapened it.

i umanjili joj vrednost.

What's worse, when they realized their mistake

Što je još gore, kada su shvatili da su pogrešili

and they took away the financial incentive,

i kada su ukinuli finansijski podsticaj,

the late pickups still stayed at the high level.

kasno dolaženje je i dalje bilo na visokom nivou.

They had already poisoned the social contract.

Već su bili zatrovali društveni ugovor.

Health care is full of strong intrinsic motivations.

Zdravstvena zaštita je puna snažnih unutrašnjih motivacija.

We have doctors and patients who already want to do the right thing.

Imamo doktore i pacijente koji već hoće da rade ono što treba.

Financial incentives can help,

Finansijski podsticaji mogu pomoći,

but we shouldn't expect money in health care

ali ne možemo očekivati da će novac u zdravstvu

to do all of the heavy lifting.

odraditi sav težak deo posla.

Instead, perhaps the most powerful influencers of health behavior

Umesto toga, možda najmoćniji uticaj na ponašanje vezano za zdravlje

are our social interactions.

imaju naše društvene interakcije.

Social engagement works in health care,

Društveni angažman deluje u zdravstvu,

and it works in two directions.

i to u dva smera.

First, we fundamentally care what others think of us.

Prvo, nama je suštinski stalo do toga šta drugi misle o nama.

And so one of the most powerful ways to change our behavior

Zato je jedan od najmoćnijih načina da promenimo ponašanje

is to make our activities witnessable to others.

da podesimo da naše aktivnosti postanu vidljive drugima.

We behave differently when we're being observed

Ponašamo se drugačije kada nas neko posmatra

than when we're not.

nego kada nas ne posmatraju.

I've been to some restaurants that don't have sinks in the bathrooms.

Bio sam u nekim restoranima koji nemaju lavabo u kupatilu.

Instead, when you step out, the sink is outside

Kada izađete iz njega, lavabo je ispred, u glavnom delu restorana,

in the main part of the restaurant,

gde svi mogu da vide da li ste oprali ruke ili ne.

where everyone can see whether you wash your hands or not.

Ne znam zasigurno,

Now, I don't know for sure,

but I am convinced that handwashing is much greater

ali sam ubeđen da se mnogo više peru ruke

u tim konkretnim okolnostima.

in those particular settings.

We are always on our best behavior when we're being observed.

Uvek se ponašamo najbolje što možemo kada nas neko posmatra.

In fact, there was this amazing study

Zapravo, bila je jedna sjajna studija,

that was done in an intensive care unit in a Florida hospital.

sprovedena na odeljenju intenzivne nege u bolnici na Floridi.

The handwashing rates were very low, which is dangerous, of course,

Učestalost pranja ruku bila je vrlo niska, što je opasno, naravno,

because it can spread infection.

jer se tako mogu raširiti infekcije.

And so some researchers pasted a picture of someone's eyes over the sink.

Zato su neki istraživači zalepili sliku nečijih očiju iznad lavaboa.

It wasn't a real person, it was just a photograph.

Nije to bila prava osoba, samo fotografija.

In fact, it wasn't even their whole face, it was just their eyes looking at you.

Zapravo, nije to bilo ni celo lice, već vas gledaju samo oči.

(Smeh)

(Laughter)

Učestalost pranja ruku se udvostručila.

Handwashing rates more than doubled.

It seems we care so much what other people think of us

Izgleda da nam je toliko stalo šta drugi ljudi misle o nama

that our behavior improves

da nam se ponašanje popravi

even if we merely imagine that we're being observed.

čak i ako samo zamislimo da nas neko posmatra.

And not only do we care what others think of us,

Ne samo da nam je stalo do toga šta drugi misle o nama,

we fundamentally model our behaviors on what we see other people do.

već i suštinski modeliramo svoje ponašanje prema tome šta vidimo da drugi rade.

And it all comes back to seat belts.

Vraćamo se na sigurnosni pojas.

When I was a kid, I used to love the "Batman" TV series with Adam West.

Kada sam bio mali, voleo sam TV seriju „Betmen“ sa Adamom Vestom.

Everything that Batman and Robin did was so cool,

Sve što su Betmen i Robin radili bilo je toliko kul,

and, of course, the Batmobile was the coolest thing of all.

a najviše, naravno, Betmobil.

Now, that show aired from 1966 to 1968,

Ova serija se prikazivala od 1966. do 1968,

and at that time, seat belts were optional accessories in cars.

a u to vreme je pojas bio neobavezan dodatak automobilima.

But the producers of that show did something really important.

Ali producenti serije su uradili nešto vrlo značajno.

When Batman and Robin got in the Batmobile,

Kada su Betmen i Robin ulazili u Betmobil,

the camera would focus on their laps,

kamera bi im se fokusirala u krilo,

and you would see Batman and Robin put on their seat belts.

i videlo bi se da Betmen i Robin vezuju pojaseve.

Now, if Batman and Robin put on their seat belts,

Ako se Betmen i Robin vezuju,

you can bet that I was going to wear my seat belt, too.

možete se kladiti da ću i ja da se vežem.

I bet that show saved thousands of lives.

Kladim se da je ta serija spasila hiljade života.

And again, it works in health care, too.

To, opet, deluje i u zdravstvu.

Doctors use antibiotics more appropriately when they see how other doctors use them.

Lekari koriste antibiotike prikladnije kada vide kako ih drugi lekari koriste.

So many activities in health care are hidden, they're unwitnessed,

Toliko aktivnosti u zdravstvu je skriveno, niko im ne prisustvuje,

but doctors are social animals,

ali doktori su društvene životinje

and they perform better when they see what other doctors do.

i bolje obavljaju posao kada vide šta drugi doktori rade.

So social influence works in health care.

Dakle, društveni uticaj deluje u zdravstvu.

So does tying it to notions of regret or to loss aversion.

Isto tako i njegovo vezivanje za kajanje ili izbegavanje gubitka.

We would never think of using these tools if we thought that everyone was rational

Ne bismo nikad pomislili da se služimo tim sredstvima

da mislimo da su svi stalno racionalni.

all the time.

Now, just to be clear: I am not condemning rationality.

Samo da se razumemo: ne osuđujem racionalnost.

I mean, that really would be irrational.

Mislim, to bi bilo iracionalno.

But we all know that it's the nonrational parts of our minds

Ali svima nam je poznato da iz neracionalnih delova uma

where we get courage, creativity, inspiration

dobijamo hrabrost, kreativnost, inspiraciju

and everything else that sparks passion.

i sve ostalo što podstiče strast.

And we know something else, too.

Znamo još nešto.

We know that we can be much more effective at improving health behavior

Znamo da možemo mnogo delotvornije poboljšati zdravstvene navike

if we work with the irrational parts of our nature

ukoliko sarađujemo sa iracionalnim delom naše prirode

instead of ignoring them or fighting against them.

umesto da ga ignorišemo ili se borimo protiv njega.

When it comes to health care,

Kada se radi o zdravstvu,

understanding our irrationality is just another tool in our toolbox.

razumevanje naše iracionalnosti je samo još jedna alatka na raspolaganju.

And harnessing that irrationality --

A korišćenje te iracionalnosti -

that may be the most rational move of all.

to je možda najracionalni potez od svih.

Thank you.

Hvala.

(Applause)

(Aplauz)