Organizations that want to reduce healthcare costs must first identify those drivers that are preventable and then determine the optimal path to avoid them. For lifestyle-related diseases like Type 2 diabetes, health promotion and lifestyle change programs present a real opportunity to lower healthcare costs while improving people’s health outcomes and care experience—all goals of the Institute for Healthcare Improvement’s Triple Aim.
In Iceland’s capital, Reykjavik, a combination of behavioral economics, big data and mobile technology is a promising way forward to identify individuals at increased risk of lifestyle-related diseases and reverse their condition.
What is behavioral economics? It combines lessons from psychology and economics to consider how people behave—as opposed to how they would behave if they were perfectly rational, with unlimited willpower, and solely acting out of self-interest. It considers how people are influenced by their emotions, identity, environment and the framing of information.
Behavioral economics can be applied to the prevention and management of diabetes, a disease that now costs an estimated $825 billion each year globally. A significant part of the economic burden stems from the number of people affected. About 422 million people have the disease, which equates to about 8.5% of the world’s population. In Iceland, where the population tends to be more physically active than the norm, the rate is 6.1%. However, it is experiencing an upward trend.
Because Type 2 diabetes develops slowly over months and years, the good news is the disease can often be delayed, prevented or even reversed. More than 1 in 3 adults are prediabetic—at higher risk for type 2 diabetes and cardiovascular disease—but a structured lifestyle change program focused on diet and physical activity can be an effective formula for achieving and maintaining a healthy weight and normal blood sugar level.
Large clinical trials, including the Centers for Disease Control and Prevention’s National Diabetes Prevention Program, have shown this type of program can cut the risk of progression from prediabetes to type 2 diabetes.
As a physician who has worked with thousands of patients with lifestyle diseases, I recognize that messages of behavior change—eating right, exercising more and managing stress—do not so easily translate to everyday life. People have priorities that demand their time and attention, from managing a career to raising a family, that often relegate lifestyle choices to an afterthought.
In addition, adult health literacy is a challenge, and many people may have a low motivation for lifestyle change until a medical episode brings new perspective to the effects of unhealthy habits. As the industry looks to combat the impact of diabetes and help people engage in their healthcare, two dynamics have emerged to encourage prevention efforts.
First, we are developing a better understanding for how individuals make their lifestyle choices, particularly when a behavioral economics model is applied. Lessons from behavioral economics can support public health because they help us guide people toward better choices. To date, the more traditional, “rational” appeals—such as black-and-white nutrition labels on the back of a food packages—have fallen short in steering people toward healthier habits. Since the more “emotional” part of our brain is responsible for most of our lifestyle choices, targeting decision-making with emotional appeals—such as games, instant gratification and rewards—can more effectively activate the triggers that motivate people.
That dovetails well with the fact that mobile devices are approaching ubiquity, providing a direct channel for preventive care. Not only are smartphones widely distributed, but people carry them at all times, spending several hours per day using apps that often deliver powerful emotional triggers in the brain. Mobile devices can increase provider-patient interaction for lifestyle interventions, as well as offer opportunities for primary prevention.