by Joan Cost-i-Font

An increasingly important share of health care spending is either directly or indirectly linked to the consequences of unhealthy lifestyles. Preventable diseases linked to lifestyle choices such as food overconsumption, smoking and drinking alcohol are increasing health care use. A new special issue of Applied Economic Perspectives and Policy explores some of these lifestyle choices and the strategies which may help in influencing them. 

Take obesity as an example. According to the World Health Organization, the impact of the obesity epidemic on non-communicable diseases such as cardiovascular diseases, diabetes, and cancer is set to become one of the greatest challenges to public health in the twenty-first century. But what can we do about unhealthy lifestyles when people are free to make their own choices?

Attempts to change people’s behavior need to look beyond obvious issues such as money and time constraints in order to be effective. Our lifestyle choices are heavily influenced by our ‘social environments’, for example, social norms about how much to drink socially, or when and at what time it is acceptable to go to bed  heavily influence our choices. In the case of obesity, changing the relative prices of unhealthy foods might not modify the “obesogenic environment” (pdf), and hence have little effect on actual body weight. In contrast, only focusing on increasing the cost of buying food might result in further inequalities in unhealthy lifestyles. Instead, other factors need to be considered, such as interventions that make a difference to the calories burned at work, doing home chores or increasing active leisure pursuits.

That is not to say that monetary incentives don’t play a vital role in discouraging so-called “sin goods” such as smoking or taking illicit drugs. However, without considering factors such as social norms on how much to eat and when (and how) to exercise, as well as “social rewards” of say smoking or binge drinking, the chances are that we will impose wasteful and ineffective policies – which can be worse than doing nothing at all. Unfortunately, we still know very little about what promotes “healthy social environments”, which surely will keep us busy doing research for a few decades.

Joan Cost-i-Font is a Reader in Political Economy at the London School of Economics, and co-editor of the journal Applied Economic, Perspectives and Policy (Oxford University Press). Currently he is on leave as on a Harkness Fellowship at Harvard University.