Changing behaviors is seldom easy. Behavioral economics and habits play a crucial role in our response, and undoubtedly, we do not fully appreciate the complexity of these issues when providing care. Often, we believe that if we merely educate an individual on what they should be doing to improve their health or incentivize them to do the “right thing,” all will work out.
Currently, social determinants of health are receiving a tremendous amount of attention. As we pivot to addressing social barriers and, therefore, all of the needs of those we serve and thus, move away from examining their clinical condition solely, it is readily apparent that there is a strong correlation between the nonclinical “dis-eases” of living and a person’s illness.
Healthy eating and poor diet are a primary focus as it relates to overall health, especially as obesity is a leading cause and factor in many diseases. Food choices drive our nutritional state; consequently, the habits formed in childhood influence our food intake throughout our lives. Hence, it is essential to improve the decision-making concerning these choices, especially in families with children. For instance, we seek to substitute fruits and vegetables for processed foods to improve nutrition. One common practice is to offer financial incentives for the purchase of these certain foods.
A recent study by Moran et al., Financial Incentives Increase the Purchases of Fruit and Vegetables Among Lower-Income Households with Children, reports an intriguing, yet, unfortunate, finding. Though financial incentives increased the purchasing of fruits and vegetables weekly by 27%, there was no change in purchases of frozen and canned produce. Furthermore, the annual average daily consumption of fruits and vegetables by the incentivized shoppers and their families did not change, even when there was an offering of a healthy cooking class option since meager attendance occurred. This latter intervention addresses a previous finding that indicated, although one has a higher quality of food options, not knowing how to use them is a barrier.
These findings tell a fascinating story, providers can help their patients increase the purchase of something good, and yet, it is incredibly challenging to change unhealthy habits of these same patients. From a positive perspective, we are halfway there as incentives do create a positive result in that I can increase a given intervention. However, what can we do to have this be a substitution for what we are attempting to avoid?
Here is a situation where behavioral economics is so strong. Undeniably, habits are a challenge to break. Merely offering education does not mean one absorbs it or that one will change. A mentor of mine once told me that the best way to create an impact is to “make it easier to do the right thing and harder to do what you do not want to happen.” No matter how effortless you make it; you must incentivize in both directions. On most interventions concentrating on incentives, they only focus on making it easier. It’s intriguing to ponder what would have happened if the frozen and canned produce were entirely removed from the shelves or even placed higher on the shelves with the fresh produce then positioned right below it. What if we incentivized positive choices and taxed negative ones, thereby creating a double incentive?
Regardless of the interventions we choose, understanding human behaviors and “swinging through the pitch” by expanding our thinking and actions to the myriad of behavioral components is paramount if we genuinely desire to impact those we serve.