Aiming for better health outcomes without addressing the behavioural roots of health problems is bound to be unsuccessful.
A recent public health issue that has made global headlines and has caught the imagination of public health practitioners the world over has been the spread of Zika– a virus that spreads through mosquitoes. While it hasn’t yet been conclusively established, there’s increasing evidence of the connection between the virus and microcephaly – a birth defect that causes brain damage in foetuses. This possible link between the virus and microcephaly has sent alarm bells ringing. The virus has infected people in more than 20 countries in Central and South America and the Caribbean and has the potential for further international spread. With the World Health Organisation (WHO) declaring the spread of Zika virus as an international public health emergency, countries around the world are announcing a slew of policy measures to tackle the outbreak and spread of the virus.
The WHO estimates that more than half the world’s population is at risk from vector-borne diseases (spread through mosquitoes) and that more than one million people die every year from such diseases. Low- and middle-income countries with high incidence of poverty, tropical weather – in which mosquitoes thrive and fragile public health systems are normally at a higher risk for spread of vector-borne illnesses. Clearly, vector control is the most important tool in preventing the outbreak and controlling the spread of such diseases. Indeed, as has been in the case of Zika, fumigation, distribution of mosquito repellant and vaccine development are the immediate measures that various countries adopt. Other solutions promulgated range from the benign travel advisories to the more controversial ones advising women to not get pregnant until the crisis has passed.
However, it is important that any policies for vector control do not just rely on traditional methods but also include insights from the recent advances in behavioural economics. This branch of economics, which has made inroads into public policies (at least in the US and the UK), counters neo-classical economics in that it does not assume (and rightly so) human beings to be fully rational agents when it comes to making decisions and choices. Various research studies in this area have shown how humans tend to consistently make sub-optimal choices. One of the insights is that of present bias, wherein the human mind disproportionately weighs present costs over future benefits and hence makes people deviate from their own desired behaviour. For instance, the cost (time and money) of getting a vaccination today outweighs the unseen future benefits and hence many people (especially the poor) delay getting the vaccinations. The researchers have also studied and proposed how policies – often termed as “nudges” can be designed that match people’s actual psychology. Typical health ailments that have been targeted through nudge approaches are obesity and smoking. However, the concept has not yet found currency to fight the diseases of the global South.
As human beings are at the centre of all policies that are aimed at improving public health, achieving improved health outcomes is nearly impossible without addressing the behavioural roots of health problems. It is therefore critical that developing countries’ large-scale public health policies to contain the spread of vector-borne diseases must utilize the insights from behavioural economics.
Nidhi Gupta is a Programme Manager at the Takshashila Institution and tweets at @nidhi1902