Brain Hacking for Better Health
Millions of years of evolutionary development have given modern humans incredible cognitive abilities and instincts to enhance our survival. So, why do we still do things that we know will harm us?
Half of the U.S. population has cardiovascular disease, diabetes, or another chronic illness. And perhaps rather shockingly, only half of such individuals adhere to appropriate treatments. [World Health Organization 2003] That means 80 million sick Americans do not take their medications as directed, observe an appropriate diet, or make necessary lifestyle changes to manage their medical conditions even though they know they should.
Why do so many of us make unhealthy choices? We know that taking our medicine is important, right? That importance seems to fall by the wayside with our busy lives and the fact that we feel just fine when we miss our pills for a day or two (or ten). The payoff of an improved chance of better health in the future is too vague and far off for us to care about right now. So, we simply don’t see missing a few pills or eating too much sodium as a big deal.
Behavioral economists explain the tendency to choose what seems best right now, even at our future expense, by using the term present bias. To some extent, our brains are wired to heavily discount future benefits because they are intangible, while we really care about things in front of us. Everyone has slightly different perceptions, but in healthcare the result is a major range of outcomes between people who follow their doctor’s recommendations and those who do not.
What can be done to help the nonadherent among us? Better health education and access to care are important but not the core issue. Behavior change depends on motivation. Although we can’t overcome present bias by fast-forwarding those far-off future health benefits to right now, there is something we can do. It involves hacking the brain with one of the most universally valued, tangible benefits there is:
Cold, hard cash.
You might not have thought you could put a price tag on your ability to forgo the french fries, but your health plan, provider, and employer are already thinking about it — and maybe even doing it. Researchers have figured out that $3/day is just about right to get you to stop forgetting your pills; $1.40 will get you walking a thousand extra steps per day; $800 in six months will help you quit smoking; and $100 will get you to go to start going to the gym for the month — and keep up the habit once the incentives are taken away. [Volpp 2016, 2016, 2015, Gneezy 2011]
Cash incentives hold major promise for health systems and are gaining traction from the Centers for Medicare & Medicaid Services, the Affordable Care Act, and bipartisan efforts such as Value-Based Insurance Design. Keep an eye out for incentives you can earn through a health plan, provider, or employer near you. Hopefully a few extra bucks for good behavior will make your daily pills a little bit easier to swallow.
