Explaining health behavior

Pascaline Dupas has an excellent paper in the Annual Review of Economics: Health Behavior in Developing Countries. It’s well worth reading. Conclusion below:

Good health is both an input into one’s ability to generate income and an end in itself. As such, it is not surprising that a relatively vast literature is devoted to understanding the determinants of health behaviors. This literature has recently expanded to the study of health behaviors in low-income settings, for which good data are becoming increasingly available. This review is too short to be exhaustive, but it tries to present the most compelling evidence to date on this issue. The important thing to take away from this review is that when it comes to health behavior in developing countries, there are a substantial number of deviations from the neoclassical model. First of all, people seem to lack basic information, and sometimes have limited ability to process information, because of low education levels. Second, there are market imperfections and frictions, especially credit constraints, affecting people’s ability to invest in health. Finally, there seem to be some deviations from the rational model, with, as has been widely shown in developed countries, a nontrivial share of people exhibiting time-inconsistent preferences as well as myopia.
Overall, this suggests an important role for public policy when it comes to health. Above we identify four important demand-side policy tools: information, mandates, price subsidies, and financial incentives. All appear to have the potential to increase the sustained adoption of preventive behavior. But the success of these demand-side strategies is contingent on the supply side being adequate: on health services and products being available, with delivery and/or enforcement institutions that are effective. The issue of how to improve service delivery in health is outside the scope of this review, but it has been the focus of a number of recent and ongoing studies that will soon need a review of their own.

Want a Condom? Think again in the land of ABC

Uganda has long been hailed for its success in fighting HIV/AIDS, bringing prevalence rates from a high of 20-30% (depending on estimates) to 6%, where it has remained for the past several years. The success was attributed, among other things, to the ABC campaign — abstinence, “be faithful” and condom use. Well, I’m not sure about either the abstinence or the being faithful bit (though a new effort is being pushed forward with the be red campaign), but condom use remains tricky around here.

New Vision ran a fascinating piece in their Sunday edition, sending out reporters around the city/country asking to buy a condom from various shops. Results were mixed, but in general most were ridiculed, laughed at, or looked down upon for their purchase, where they were able to make it. It seemed to me the women fared worse…The men’s accounts are here and here, the women’s here, here and here.

This combined with the not uncommon idea that using a condom during sex is like eating candy with the wrapper on…

In any case, for those who thought promoting condom use abroad would be as (relatively) easy as it has been in the U.S. (where you often have 12 year olds putting condoms on bananas during sex ed class) should seriously think again, even in countries that have been supposedly successful in the fight against HIV/AIDS….