post by Bill Gardner
Brendan Saloner (in comments here) is not convinced by my attempt at optimism about our prospects for promoting population-wide health behavior change.
It seems to me that we know more about how to prevent people from doing things then helping them to change behaviors they are already engaged in. This makes me less optimistic about winning the battle against obesity through behavior change - to some extent we can teach kids to start eating healthy before junk food behaviors become entrenched, but mainly it's very difficult to get people that are psychologically dependent on unhealthy foods to quit.
I want to say something about his specific example, which is interesting. But, what's our baseline for optimism? Here are some other strategies to lower health care costs. How optimistic should we be about:
- Reforming Medicare in the face of the interests of current recipients (given that they vote more than other constituencies and are focused on this issue)?
- Lowering health care prices. How do we get American health care providers, hospital owners, pharmaceutical industries (etc.) to accept a lower return on their investments (given that they own -- or rent? -- our politicians)?
- Reducing the cost increases associated with new technologies. Can we find social mechanisms that will lead to rational, cost-effective choices of new medical technologies (given lots of political history)?
I put low subjective probabilities on all of these. (And don't get me started about what we will need to do to address global warming... )
My subjective probability on "winning the battle against obesity through behavior change" is also low. Nevertheless, we have to start somewhere, all paths are difficult, and we have at least one encouraging example of a successful mass health behavior change. Maybe 'optimism' is the wrong word. My attitude is, "focus on the most rational path forward, think hard about how to accomplish it, and learn from the successes that you can find." Is there a word for that?