Blogpost: Are poor lifestyle choices really a choice?

Blogpost: How reliable are tobacco and alcohol prevalence estimates from surveys?
September 14, 2017
Blogpost: Should revenues from tobacco taxes be earmarked?
October 3, 2017

By Laura Rossouw

The rapid increase in non-communicable diseases (NCDs), especially in low and middle income countries (LMICs), is proving to be a global crisis, with increasing health expenditures, premature deaths and preventable morbidity. Focusing only on mortality, approximately 60% of annual deaths globally are attributable to NCDs (Bloom et al., 2011). As such, decreasing NCDs have been incorporated into the 2030 United Nations Sustainable Development Goals.

Since joining the Economics of Control Project (ETCP), my research has focused on the economic costs, health seeking behaviour and health expenditures associated with unhealthy lifestyle choices in LMICs. These lifestyle choices include tobacco use, excessive alcohol consumption and inadequate access to healthy food choices. Poor lifestyle choices are a major modifiable but contributing risk factor to the global rise in non-communicable diseases, and have been linked to poor health outcomes and illnesses such as chronic respiratory disease, diabetes, cancer, stroke and heart disease. Prior to joining the Project, my work had focused predominantly on the demand-side factors related to health and health choices, and so my focus at the ETCP builds very well on this foundation of work.

 The economic costs of NCDs

Poor lifestyle choices such as smoking can pose a significant burden on a country’s economy, either directly by increasing healthcare utilisation and expenditure, or indirectly via a loss of productivity due to morbidity or premature mortality (Goodchild, Nargis & d’Espaignet, 2017). Expenditure on harmful lifestyle choices also have the potential of diverting household expenditure away from necessities such as education and healthy food expenditure, indirectly affecting the health and developmental outcomes of entire households. Goodchild and co-authors estimate that the total economic costs of smoking alone amount to approximately 1.8% of global annual gross domestic product, with about 40% of these costs occurring in the developing world. The economic burden of all NCDs pose an either greater economic threat, and has been estimated to consist of approximately 75% of the global GDP (Bloom et al., 2011). 

Are poor lifestyle choices really a choice?

A crucial factor to consider is whether poor lifestyle choices truly are choices. Poor health choices may be influenced by a range of factors, such as a lack of information on health outcomes, budgetary, time and environmental constraints and social reinforcements such as peer effects. For instance, in the case of unhealthy food choices, budget constraints and residing in so-called “food deserts” (where healthy food choice options are scarce) will influence food consumption. In the case of smoking, an individual may experience poor health outcomes due to second-hand or passive smoking. Tobacco is also an addictive substance, which limits a person’s decision to quit smoking once they’ve already initiated tobacco use. These constraints on choice should be considered when designing policy to tackle rising non-communicable diseases.