Save your own life
What would you think if someone told you: Do the right thing because your life may depend on it. Or more accurately, that you better start making better decisions because it is a matter of life and death. This may sound like something an overprotective parent would tell their child) but in reality it’s the way most of us should start to think about our day to day decisions and their potential to lead to harmful habits and fatal consequences. It is hard to believe that this is true, but recently, researchers have done some interesting analysis on this topic and the results support the idea that personal decisions, and often fairly mundane ones, are a leading cause of premature death in the United States (and I suspect that similar numbers are also the reality in the rest of the developed world).
One of the most interesting analyses on the ways in which our decisions kill us is one by Ralph Keeney (Operation Research, 2008), where Ralph puts forth the claim that 44.5% of all premature deaths in the US result from personal decisions – decisions that involving among others smoking, not exercising, criminality, drug and alcohol use, and unsafe sexual behavior. In his analysis Ralph carefully defines the nature of both the type of personal decision and what is considered premature death. For instance, dying prematurely in a car accident caused by a drunk driver is not considered premature in this framework because the decision to drive somewhere is not one that can logically be connected to the premature death. Unless, of course, the person who dies is also the drunk driver, in which case this counts as a premature death caused by bad personal decisions. This is because the decision to drive drunk, and dying as a result, are clearly connected. In this way you can examine a large set of cases where multiple decision paths are available (the drunk driver also has the option to take a cab, ride with a designated driver, or call a friend), and where these other decision paths are not chosen despite the fact that they won’t directly result in the same negative outcome (i.e fatality). As other types of examples, consider the decisions to smoke (when not smoking is an option), to overeat (when watching our weight is an option), or for people with long term medical conditions to skip taking insulin or asthma medication when these are important to their ongoing health.
Using the same method to examine causes of death in 1900, Keeney finds that during this time only around 10% of premature deaths were caused by personal decisions. Compared to our current 44.5% of premature deaths caused by personal decisions, it seems that on this measure of making decisions that kill ourselves we have “improved” (of course this means that we actually got much worse) dramatically over the years. And no, this is not because we’ve become a nation of binge-drinking, murderous smokers, it’s largely because the causes of death, like tuberculosis and pneumonia (the most common causes of death in the early 20th century) are far more rare these days, and the temptation and our ability to make erroneous decisions (think about driving while texting) has increased dramatically.
What this analysis means is that instead of relying on external factors to keep us alive and healthy for longer, we can (and must) learn to rely on our decision-making skills in order to reduce the number of dumb and costly mistakes that we make.
The question then becomes how to help people become better decision-makers. Or at least better at making decisions where their health is concerned. If nearly half of premature deaths in the US can be avoided by making better decisions, it is clear to me that it would be worthwhile to spend much more time and effort to disseminate the knowledge we have gained in social science about the main ways in which people fail to make good decisions. It is of course over-optimistic to expect that just helping people to see what mistakes they are likely to make will fix the problem, but personally I would be happy even if it only slightly reduced the number of catastrophic decisions. The next step we need to take is to expand upon the research that examines what kind of methods encourage healthier decision-making and conduct much more research in areas that could help us limit our mistakes. For example, based on research about how people make different decisions when they are sexually aroused we might concentrate on providing comprehensive sexual education that teaches teenagers how to make decisions while in the heat of the moment. Similarly, by understanding how people think we might be able to teach people to enjoy eating fruit and vegetables; how to make exercise part of their ongoing lifestyle; and develop effective smoking cessation programs. And it would also help to remember, in light of this, that every decision counts.
The Upside of Irrationality, explores some positive and some negative ways that irrationality plays out in our lives.
What about the deaths caused by the political decisions? Is there any research about it? I guess I am disappointed about the rising nationalism in my country and I wonder if people would respond if they would be shown statistics about how many deaths their single vote given to a party supporting an inner war causes.
Good points. The one comment I have is that you report P(death by bad decisions | died premature), but don’t we really want P(death premature | bad decisions) and P(death prematrue | good decisions) or something in terms of expected DALYs lost from bad decisions?
Or maybe if you report the number you did (its so big!) I’m more likely me off my couch and onto the court for some exercise?
Dan, I love your work/ insight. Whenever I hear you on the radio, I pay attention and learn something new. I am surprised you gave the example of “[teaching] teenagers how to make decisions while in the heat of the moment”. It seems to me avoiding the heat of the moment is the best way to avoid succumbing to temptation and making bad decisions. Seems like teaching teenagers to see in advance where situations are leading would be far more effective in enabling them to make good decisions. No?
Dan,
I think that a bigger chalange then helping/educating people to be better decisioin makers is the chalange in understanding what are the mechanisms of their perception of what they gain from the decisions they take. The chalenge of researching What can be done to disconמect the ties between stimulation -perception-action that frames our habbits.
Most people are aware of the bad results of eating too much, smoking, texting while driving etc, yet they still cannot stop this behaviour.
Well combining what I have read by other economists. People respond to incentives, so I suppose the research to help promote better decision making would be to either prevent the situation where a decision has to be made or give an incentive for making the right decision. It is too bad that living a longer healthier life is not enough of an incentive for all people.
Hi,
Making a decision is one thing , acting apon it , following through is another matter
Dan, I usually love you work. Its fascinating and intelligent.
I do see some issues with this type of thinking in the post and in the comments. I feel like you are vastly overlooking the portion of the population that is very well aware that their decisions may cause premature death, but derive enough pleasure from the activity that they are willing to carry on with it anyway. They have done the internal risk-reward evaluation and have made a rational decision. I a well aware, that this does not apply to all cases, that often the risks are grossly undervalued, and that asymmetric information problems surrounding the risk of a particular decisions will often lead to misjudgments and actions that may not initially be undertaken, but take for instance the act of smoking. I smoke occasionally. I am well aware of the consequences of my actions, but derive enough pleasure from the act of smoking that I am OK with the risk. I know this is a very utility driven example and that it does not apply to all cases, but to some it does. One of the other posters referenced peoples “inability” to stop making “bad” decisions which might lead to premature death. I think that IN MOST CASES people are fully capable of exercising restraint or action, but make a conscious choice not to do so. The biggest duty then is to create structures which increase or decrease people’s incentives to undertake potentially harmful actions (especially when those actions pose potential negative externalizes upon the rest of the population), and more importantly we must educate the public on the true risks associated with such decision making.
I’d be very interested in hearing your response. I realize that much of mainstream economic theory doesn’t offer all the answers, but one should not ignore it either. We have to find a balance between cognitive ignorance and rational choice in order to arrive at outcomes that benefit our society, but do not limit our liberty or confuse chosen actions with involuntary (and ultimately unconscious) responses in the process
I like what Dan has said, but it is written in such an absolute way where we perceive what he is saying is “black or white”.
However, what i have gathered from this is that Dan is potentially trying to convey that we should all be aware of moderation.
If we smoke 40 cigarettes a day apposed to 4, we have increased our risk for pre-mature death; same goes for having 40 beers at a party as to 4.
The fact of the matter is that our bodies and minds build up a tolerance to substances which then results in us needing double and then exponential amounts to get the same affect/effect on our bodies and minds.
If we learn to moderate these substances we will be able to prolong or extend pre-mature death. Death is unavoidable in most if not all cases; but to be forewarned is to be prepared.
I guess we’re all waiting for Dan to give his response because in all honesty i can only see moderation as a precursor to extend our already premature lives.
I see this entirely differently. In public health, we see health outcomes as part of a chain of more to less proximate causes. Even thinking in terms of the drunk driving example, one proximal cause of the death of a drunk driver is the decision to drive while drunk. However, what is not known in any individual case is what the alternative options are. Is there public transit available? How much does a cab cost, and would one be able to find one in the place where one finds himself too inebriated to drive safely? Does the individual have (or perceives having) someone to call for a ride? Is anyone else going in the same direction, or willing to give a ride? These distal factors may also involved in creating the conditions for the death. A black man leaving a downtown Boston bar, who is new to the city and has no friends, may find it very difficult to get a cab if he lives in East Boston because cabs don’t like to come out this way due to the additional toll fees they are required to pay. The choice to drive in this case is facilitated by a whole lot of factors beyond the control of the individual and separate from the choice to get behind the wheel.
The problem with analyzing “bad” decisions is that this is generally a hindsight test. When people make real world decisions, they generally don’t consciously after to act stupidly after doing academic probablity analysis. People make basd decisions in different states of mind (spontaneous) considered, but careless and deliberate, but incorrectly weighted. Changing is not easy.
How does looking at cigarettes, drunk driving and McDonald’s as a life and death situation change behavior compared to looking at it from a money perspective
Tom123, good question… I like that line of thinking. Both seem to have about the same effectiveness… neither seems to work very well. It seems like the Starbucks phenomenon in both cases… each time one might say to oneself “it’s only $3.50″. Then if the coffee drinker sits down at the end of the month and adds it all up they realize they’ve spent a hundred bucks on coffee. Same thing with one more cigarette perhaps?… it seems true that smoking one cigarette isn’t going to shorten your life nor cost you a bundle, but over the long haul, many smokes later, both will be true. Maybe there’s also the belief (in the case of dying while driving drunk for example) that “this won’t happen to me.” I think in his writing Dan calls this the tendancy to be overly optimistic.
The Documentary Super-Size Me might convince a person to moderate MacDonalds. MADD is an organisation called Mothers Against Drunken Driving – they lost their children in drink driving accidents… Google smokers lung…
Money gives access to the ability to make these irrational decisions, take away the money and immediately the decision is limited to moderation or fair use of what ever money is available.
It is interesting in that we tend to harbour the predjudices imparted onto us by our parents/teachers (if such is the case). If our parents didnt smoke and often commented on the health aspects we will tend to be non smokers, similar for drinking, eating habits etc. It has always been my thought that if man were as intelligent as he supposes he is, why does each generation spend thier lives learning the same lessons thier parents did (money managment, healthy lifestye, social integrations etc). If we as mankind could only find a way to harness our ‘decision making’ process seperating out emotions in a non-drugged manner; we would eliminate so many deaths, heinous crimes, depressions etc. Keep up the excellent work Dan!
Since I’m currently reading “Identity Economics” (turning out to be a good read), my thoughts immediately went to the issue of identity, norms, and social category. Here’s a smoking example. From 2007-present I’ve lived in Tennessee, Vermont, and North Carolina. Now, you can immediately pick out which place I lived that had a general culture (social category) that reinforced the adopting of certain norms leading to an identity that made it very difficult for people to want to smoke. I spoke to some smokers, in VT, who said that they felt like they couldn’t smoke in public because it was to taboo. While others, in very specific cliques (chefs), had no problem lighting up all the time.
I’m sure that people, in each of these states, know that smoking is bad for their health and the health of people walking near them. However, VT is the only state that exuded such strong “anti-smoking” vibes throughout its general culture.
So, if we can start creating and adopting identities that include such “healthy” and “do gooder” norms, we should start to behave in ways that correspond to them. Dr. Ariely has a paper that looks at a similar issue (image motivation) and how it effects people’s behavior in public versus private settings.
Dr. Nortin Hadler in his book ‘Worried Sick’ infers, from some salient research, that 75% of our risk of premature death can be explained by job satisfaction and socioeconomic status.
Thanks for the insightful post.
I just read your book, and I love your book, but I disagree with this:
“For instance, dying prematurely in a car accident caused by a drunk driver is not considered premature in this framework because the decision to drive somewhere is not one that can logically be connected to the premature death.”
I don’t see why this follows unless you assume (wrongly) that driving is a non-decision.
Whether to drive or not is a decision.
Cars are really expensive, and the majority of the world will never afford them. For the most part, driving is not an option at all.
In the United States, we are extremely wealthy, even the poorest of us. If we have the money to do something that most can not do, drive, we have the money to do what the poor do: not-drive.
I have not driven in over a decade. This is a decision I have made.
Has this been tough?
No.
It requires no more thought or effort than the other things you listed as “decisions”. Cycling is the best part of my day.
People with children in cold climates cycle year round.
Merve, sorry to hear about your disappointment about the rising nationalism in your country…yes the subject has had specific research shown at the website reached by clicking my name here…DEMOCIDE is the term used…political decisions leading to death…this is of course a tremendously complicated subject and in my opinion has to do basically with the human desire for revenge…not politics as such
I guess many of us know what is right and the reason we do not choose the right healthy way is because we are naturally mis-programmed. Or, in other words we are programmed to natural life and not to the urged 2010 life. To make the right decisions requires moving from our automatic to self-regulated procedures and it is not trivial. please see my article: Obesity – Two urges to eat
http://wiki.medpedia.com/Obesity_-_Two_urges_to_eat
I hope you misunderstood or miswrote your example, that the person who dies at the hands of (another) drunk driver DOES count as a premature death, just not a premature death caused by his own decision. That is, if the 44% ratio is bad-decision-deaths/overall-premature-deaths, this example does need to count in the denominator, and not be left out completely from the calculation, which is what your article suggests happened.
Arguments by other commenters as to whether driving is or is not a decision raises some big questions about what is the appropriate context to even determine when we’re making decisions. I lived in Los Angeles in the mid-80s, and believe me, in that place and time, driving was NOT an option for someone who wanted to live in a safe neighborhood but worked in an unsafe one. On the other hand, many would argue that the kind of physical addiction that tobacco causes in some people would mean that smoking isn’t really a “decision” (after the initial exposure that was probably made in childhood) in the sense of being comparable to, for instance, skydiving for recreation is.
Sounds like another case of using statistics to reinforce someones preconceived point of view. I could use the same statisitcs to argue that things are better today. In 1900 only 10% of people “choose their death” today 45% of people get to choose their death.
Humans exhibit human behavoir. Dogs exhibit dog behavoir. The only way to keep my dog from following his dog instincts and running into the street is to leash him and fence him in. There is no entity on this planet to do that for humans.
Though maybe I’m just proving Dan’s point. We need to try harder to be our own masters.
Dan
(first of all I found “Predictably Irrational” to be both delicious and portentous — I hope to be using these ideas for a long time.)
Your encounter with the white phosphorous gave you an opportunity for an extensive experience which put you completely outside what almost everybody else ever knows about. I have had similar experiences, such as going through puberty with both an IQ and a body each, separately marking me as one-in-ten thousand. Sometime I hope we can talk.
fish don’t know about water, because they have never been outside of it. You do.
On this particular issue, though, you are right there with the main stream. You are accepting a priori something which has been taught to you by other people who have less than altruistic motives,
namely, that longer life is always desirable.
Try out that assumption in your rational mind and see how much water you really believe it holds. If you need any props, drop in at the local Alzheimer’s clinic, maybe later on after most of the families have gone home.
many, many thanks for your books,
John
Dan,
Met you in Toronto when you were here. Cited your global warming analogy in a blog article. http://retailprophet.com/blog/?p=689
Stay well!
-Doug
Dan, you describe a classic system of two things, one short-term and one (generally) long-term where attaining the short-term gratification (smoking, sex, another beer) lead to long term consequences (cancer, AIDS, death in a car accident). We face similar systems in business all the time: Attaining a satisfactory quarterly report leads us to decisions that destroy the company in the long term. It’s a notoriously difficult system to affect (as I learned from quitting smoking and am now learning from stopping overeating). The only way I know is for the magnitude of the long-term effect to become greater than the immediate, short-term gratification.
Love your work!
Nosy
Everything Mr. Ariely talks about in this book is helpful to my thinking and the actions I take. I’m in complete admiration of his intellect and work.
making the right decissions in life probably get us really far not acting on impule will help and when we need help we need to seek it we have to think more long turm with the deccisions we make to we are alive for a while and we want to live longer so we have to make good educated choices