Are We Underestimating Why People Engage in Unhealthy Behaviors?

Apr 8, 2011, 3:42 AM, Posted by

This post was contributed to Pioneering Ideas by Kevin Volpp, MD, PhD. Kevin is the director of the Leonard Davis Institute of Health Economics. 

At the Leonard Davis Institute of Health Economics Center for Health Incentives 2011 Symposium on Behavioral Economics  (sponsored by RWJF), we pulled together about 50 behavioral economists, clinical health services researchers, and funders from across the United States to talk about the state of behavioral economics in developing applications to health. During the symposium, we matched people into one of eight workgroups in areas like obesity, medication adherence, and provider payment, where we combined content experts with smart people who had never worked in those areas.  Our hopes being that they would bring fresh insights to areas that are big public health or economic problems with large, unsolved challenges.

We gave each group two hours to put together a group presentation assessing the state of the field in their area and to come up with ideas for future studies. Surprisingly, nearly all the groups actually chose to spend more time than what was allotted, spending about three hours working on this task. The presentations were much more refined than I expected and seemed to reflect an intense dialogue about where behavioral economics could help, and where it is perhaps being oversold. Overall, the workgroups worked out better than I had hoped.

One of the key themes that emerged from the groups is that we – the academic community or others like public health policy makers – often think we know what is best for people, but may underestimate the degree to which people actually prefer to engage in unhealthy behavior. We need to do a better job of systematically building in assessments of why people don't do things whenever we try to develop interventions so that we can understand what works in whom, and, in the future, better target our efforts.

In situations where interventions are appropriate due to either externalities (costs our actions impose on others) or internalities (costs our actions impose on our future selves due to under-appreciation of the future costs of our actions) we should also consider broader use of mandates. For example, it seems reasonable to say that health care workers should be mandated to get flu shots rather than relying on encouragement, or encouragement plus incentives, to get the rates up.

I am hoping that new collaborations will be forged from the discussions that happened. The level of enthusiasm among the researchers in attendance seems high and people are optimistic that behavioral economics can lead to significant improvements in health similar to the contributions that have been made in improving savings behavior.

This commentary originally appeared on the RWJF Pioneering Ideas blog.