NEWS & INSIGHTSOther

Behavioral Economics and Health: Getting It Right

Let’s face the facts. Human beings don’t always make the best decisions. I usually wake up intending on eating healthy meals. This afternoon while out buying lunch at the corner deli I was faced with the choice of an apple or a donut for desert. I figured since I was having a salad and trying to eat healthy I’d go for the apple. A few hours later, during our afternoon staff meeting, I came face to face with the delicious brownies a colleague had brought it. I could not resist and caved to the temptation. Now you see, I’ve been trying to eat healthy and yet somehow temptation usually gets the best of me. I’ve come to realize that I’m not alone in this dilemma. Many people find themselves thinking, “I’ll start that diet on Monday”. We tend to put off decisions for the future even when we know they are in our best interest now. Behavioral economics strives to supplement traditional economics by merging insights about human behavior and psychology to explain why people often make choices against their best interests. This approach enables us to understand a number of behaviors that are critical to the success of development and health policies.
 
The traditional methods used to predict health behavior assume that we know what is best for us. However, they fail to account for the biases that inhibit us from making rational decisions about our health. What is often observed is that despite having all the necessary information to make the right choice, people do not change their actions and miscalculate the risks and benefits. We are easily influenced by the way an issue is framed and presented, most of us are also resistant to change and favor the status quo, often do what friends or relatives tell us to do, disproportionately weigh present costs versus future costs, and are inclined to prefer instant gratification. It is these biases that are extensively studied by behavioral economists. All of them have tremendous implications for many health behaviors, including adherence to medication, seeking preventive care and engaging in risky behaviors.
 
Behavioral factors such as smoking, malnutrition and physical inactivity account for half of the loss in the world’s disability adjusted life years. The cherry on top of this is that a significant portion of the burden associated with communicable diseases is also due to behavioral factors.
 
Risk taking behavior such an unprotected sex, poor hygiene practices, lack of adherence to treatments, and limited use of preventive health care like immunization are all important drivers of life years lost in the developing world.
 
Taking into account these biases can lead to the design of vastly more effective intervention programs. One such example comes from Peru and an attempt to control a Chagas vector problem (1). Previous interventions, mainly spraying homes with insecticide, were not optimally designed and consequently featured less than desirable participation rates. The majority of households refused to allow their homes to be sprayed. This was not a lack of information problem as people were aware of what was making them ill. Instead, one of the biggest reasons people would not allow their homes to be sprayed was because they thought their neighbors weren’t doing it either. Peer pressure at its best. In response, the program had to be redesigned in order to increase participation. They had to allow people to be able to schedule their spraying day and time in advance. Households, were also informed whether or not their neighbors were to be participations and in order to leverage peer pressure, houses were assigned into lottery groups and were eligible for prizes if they and their neighbors participated in the spraying campaign. In the end, the innovations were tested, found to be very effective and will soon be implemented at scale.
 
The impact of behavioral economics is just beginning to be felt. USAID is committed to using behavior change in order to reduce child mortality (2). Similarly, the World Development Report in 2015 will certainly feature global health while at the same time focusing on the behavioral and social underpinnings of economic development.
 
As for me, I’m going to the gym tomorrow!
 
-Maria Nicolaou, Research Officer