Imagine yourself standing at a crossroads - one leads to a cheese-burst pizza and the other leads to a vibrant healthy salad. Now, picture yourself choosing the road less taken. Despite the myriad health benefits that the salad promises, many of us would unwittingly want to go down the pizza route simply because of the instant gratification it would offer us. Humans are estimated to make about 35,000 decisions daily. Out of these, on average 220 decisions are food-related. Whether we are contemplating the contents of our plate, the urgency of scheduling a doctor's appointment, or selecting the right insurance coverage, the challenge remains the same.
Are humans making all these decisions actively? Or are these mindless pursuits? The sheer volume makes a thorough analysis and considering their impact on our present and future selves impossible. While one might argue that we are rational human beings, reality often strays far from that ideal. For instance, Prospect Theory proposed by Kahneman and Tvserky argues that humans’ actions are often at odds with the fundamental beliefs of utility theory. Some argue that it is in particular, the role of poor decision-making on consumers’ part that contributes to the growth of illnesses and therefore, higher healthcare costs. Health-related decisions are often made in a hurry, without understanding their full implications.
Our decision-making, particularly concerning matters of health, dances to the tune of multiple psychological forces. For instance, researchers at Cornell University in an experiment highlighted the role of visual cues in determining the amount of food we eat. Other studies have advocated for the impact of norms - both situational and personal on our eating habits. Social norms, such as perceptions towards alcohol, often end up influencing our intake of alcohol and how risky we perceive it to be.
Adding to this is the burden of pandemics which have been increasing alarmingly in the current century. The escalating surge in health issues underscores a disconcerting reality: humans are inherently inclined to make suboptimal health-related choices. In light of this, there is an imperative need to foster a deeper comprehension of human decision-making processes and implement effective policies. The integration of behavioural economics in the domain of health, emerges as a pivotal approach, one that holds the promise of cultivating a landscape where sound and informed health decisions prevail.
Behavioural economics examines how psychological and cognitive factors influence economic and decision-making behaviours. It departs from traditional economic models that assume individuals always make rational choices, acknowledging the role of biases, emotions, and heuristics in shaping decisions. It also contributes to providing strategies to enhance decision-making processes.
While public policies aim for broad behavioural change by spreading awareness and knowledge, this approach often falls short. To empower stakeholders in making informed decisions, we must understand the underlying contexts.
Several behavioural economics principles have found use in healthcare. One of them is the oft-mentioned and popular wonder tool, ‘nudge’. A nudge recognises that humans are prone to biases and involves subtly altering the presentation of choices to influence decision-making. Making opting-in the default option while designing choice architecture has become a popular use case for nudges. Researchers tactfully designed responses to questions to ensure greater adherence to getting flu shots. These findings find implications in increasing medical adherence by way of altering how options are presented to patients.
In a study in India, the power of incentives proved itself useful when the effect of non-financial incentives on immunisation rates was investigated. Raw lentils were provided to a group of children and the other group was not provided any incentive. The group given incentives witnessed significantly higher immunisation rates than the other group.
Several frameworks such as the COM-B model, Behaviour Change Wheel, and the Intervention Mapping Framework have been proposed to better organise theory and for an easier evaluation of their effectiveness. Looking at the mounting evidence for using behavioural economics, even organisations like the UN are emphasising the incorporation of these principles to achieve their long-term development goals and create an impact across areas like health and climate change.
The integration of behavioural economic principles into health-related policy decisions equips policymakers to bring about far-reaching and enduring change. However, this can be an extremely challenging task since their use will be context-dependent given a wide variety of cultural norms and varying context-dependent differences in behaviour. It will also require extensive data collection, evaluation of the efficacy of interventions, and constant reiterations to achieve the desired goal. While certain strategies may be more effective in specific contexts, many find application across various scenarios, making it a versatile and invaluable approach to improving decision-making and fostering healthier behaviours.
Bhavleen Singh
