Unreasonable Health Choices

Long before reaching 65, most people know all too well the costs of decades of going against their own best interests by engaging in practices they knew carried risks for their health – as with smoking or overeating. In at least some respects, they resonate to Oscar Wilde’s “I can resist everything except temptation.” Even if they have finally succeeded in bringing about change, as many seniors have with respect to smoking, they may ask, looking back, “Why did I not decide to try to stop much sooner?”

According to Professor Ichiro Kawachi, public health advocates fail to be of much help in persuading us to overcome harmful health choices. In an interview with Amy Gutman in the Harvard Public Health Review, Kawachi argues that public health theories often simply assume that people are rational and ought to be capable of making personal decisions to serve their own long-term interests, as long as they receive correct information about risks and benefits.

Instead, Kawachi suggests, we need to draw on insights from behavioral economics research on the emotional forces that induce us again and again to make irrational choices – to set aside warnings of risks to come decades later, as of lung cancer from smoking. And when cigarettes or sweets or other products are advertised as giving a good feeling, consumers’ assessments of the benefits go up whereas their assessments of the risks go down.

The food and tobacco industries aiming to influence consumer patterns are well aware of these insights and tailor their advertising and persuasion accordingly. It is no wonder that public health messages that warn of long-term risks are often drowned out.

Kawachi cites Ralph Keeney, emeritus professor at Duke, in stressing that we should stop thinking about the major health problems in America as being cancer and cardiovascular disease. Instead, “smoking, a sedentary lifestyle, and overeating represent the lion’s share of preventable causes of illness. It’s personal decisions that are the major cause of our health problems.”

Unless we recognize the emotional components of decisions affecting our health, it will be difficult to counter the skewing of personal risk assessments that contributes so greatly to ill health. Once we become aware of the irrationality of persisting in unhealthful practices, we can do much more to avoid them.

But recognizing them is not always enough. For example, Kawachi, when asked whether he ever finds himself making irrational health choices such as those he describes, mentions a Burger King at Boston’s Logan Airport: “Even though I tell myself that I’m falling prey to this pattern – even though I tell myself the night before that I’m not going to do it this time – the moment I’m there, I smell the french fries and find myself making a beeline.”

Sissela Bok, 78, is Senior Visiting Fellow at the Harvard Center for Population and Development Studies.