Sunday, June 14, 2009

The Persistence of Bad Habits

It's not because no one knows. As Roni Caryn Rabin reports in The New York Times, everyone knows that bad habits contribute to ill health. Link here.

Yet, the better we know it the worse we become at putting it into practice. Over the past 20 years Americans have defiantly held on to their bad habits: insufficient exercise, improper nutrition, smoking, and too much alcohol.

Of course, we do not really need to know why we do it. We do need to find a policy that will reverse the trend, that will encourage good habits.

Nonetheless, Rabin includes some speculation about why we have held on to our bad habits, so why not amuse ourselves with the issue.

One physician offered that people have so much faith in medicine that they believe that they can do as they please and that modern medicine will save them.

Others have suggested that the people handing out the advice sound like dour scolds, and no one likes to feel that he is sacrificing his autonomous judgment to that of a scold.

Another reason is that we have also been told that we should only act on our true desires, that we should express our true feelings, and that we should follow our bliss.

The fact is, if you follow your bliss it is not going to lead you to the gym.

Anyway, the problem of bad habits lies at the center of our health care debate. It is one of the least discussed aspects of the debate.

Take the following facts reported by Steven Burd, CEO of Safeway in a Wall Street Journal op-ed: "...70% of all health care costs are the direct result of behavior.... 74% of all costs are confined to four chronic conditions (cardiovascular disease, cancer, diabetes, and obesity.) Furthermore, 80% of cardiovascular disease and diabetes is preventable, 60% of cancers is preventable, and more than 90% of obesity is preventable." Link here.

Safeway looked at this information and decided to establish corporate policies that would encourage better habits.

It did so by introducing the profit motive. It paid people to get healthy.

Employees who maintained good habits, as measured by medical tests, were rewarded with lower health insurance premiums.

Safeway reasoned that since drivers were paying different premiums depending on their safe driving records, why shouldn't people pay different health insurance premiums based on their good health habits.

The policy worked. Over a four year period Safeway kept its per capita health care costs stable. During the same time the health care for the rest of the country increased by 38%.

Does it matter that people are motivated by financial incentives? Surely, it does not. The important part is whether or not the policy pushes people to improve their health habits.

The same applies to experiments where underachieving children have been paid money for better grades. Apparently, the love of learning is a less powerful motivating force than the wish to buy a new ipod.

Of course, some people will only accept changes of behavior when these are motivated by deep insight into what made them have the bad habits in the first place. Unfortunately, if you wait for insight to cure your bad habits, you are going to have a very long wait. At times, it will feel interminable.

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