How One Small Change Helped People Make Healthier Choices

This piece appeared in The Wall Street Journal on October 20, 2017.


Our health is affected by the decisions we make every day, and promoting healthy choices could dramatically stem the growing tide of chronic disease around the world. Although actually making the switch to healthier choices—as we all know—is an uphill battle, we are discovering more about how we can get people to adopt healthier behaviors by changing the economic, political and social factors that influence their lives.

Even something like changing the frequency of cash-assistance payments to the underserved can make a difference.

This new learning comes from research done by Stanford epidemiologist Sanjay Basu on how the timing of government-sponsored cash assistance affects health behaviors. In 2013, Dr. Basu and his team began researching the purchasing of unhealthy “temptation goods,” including alcohol, cigarettes and sugary foods, among a group of Peruvian farmers who received government assistance. The country was experiencing an alarming growth in diseases like hypertension and diabetes that are exacerbated by the consumption of these goods, and public health officials wanted to know why.

Turns out, the Peruvian government had recently made a change that ended up having an enormous negative impact: It had switched from making twice-monthly assistance payments to a once-a-month schedule. The overall amount of the payments didn’t change, but the move toward less-frequent payments led to a striking increase in the purchase of temptation goods—by as much as 70% in some cases.

Dr. Basu and his team suggest two behavioral issues are likely to blame for this pattern. First, people tend to make larger discretionary purchases when they get paid. Second, people are more likely to binge on temptation goods when the time between payments is longer, because they’ve gone without those goods for a longer period.

Since this initial study, Basu has transferred his findings to other locations, including San Francisco. Working with UCSF professor and physician Hilary Seligman, Dr. Basu is running a new program in San Francisco’s low-income neighborhoods to learn if more-frequent food voucher distribution will help mitigate the purchase of temptation goods in those communities.

Dr. Basu and his team are also looking at broader questions of how public-assistance programs can improve individual health and nutrition, developing machine-learning algorithms to identify which groups of people are best served by different forms of aid such as food assistance, mental-health resources and transport aid.

What Dr. Basu is learning will be immensely valuable for governments and physicians alike. By promoting healthy behaviors among low-income individuals, Basu’s research has the potential to improve the efficacy of government aid programs, which in turn could have a huge effect on public health, decreasing the growing burden of chronic disease.

In addition, studies like the one conducted by Dr. Basu and his team are critical for those of us fighting for a new vision of health care that is more preventive, predictive and precise. The more we learn about the factors that drive unhealthy behaviors, the more we can do to  encourage healthy choices and realize a future of patient care that is lower cost, less invasive and more cognizant of the patient as a unique individual.

Dr. Basu’s research can provide valuable information for individuals across the board to apply to their own lives. Being aware of links like the one between payment schedules and unhealthy purchasing can help us identify trends in our own behavior—the first step toward living a healthier life.

We have a long way to go in understanding everything that has an effect on health behaviors. But studies like Dr. Basu’s point in one important direction. If we want to prevent disease and promote health on a broad scale, we need to pay more attention to the environmental factors that help determine the health choices we make on a daily basis.

Read the latest Health Report.