A new World Bank report warns that risky behaviors –smoking, using illicit drugs, alcohol abuse, unhealthy diets, and unsafe sex— are increasing globally and pose a growing threat to the health of individuals, particularly in developing countries. The report looks at how individual choices that lead to these behaviors are formed and reviews the effectiveness of interventions such as legislation, taxation, behavioral change campaigns, and cash transfers to combat them.
Risking your Health: Causes, Consequences and Interventions to Prevent Risky Behaviors concludes that legislation and taxation, for example, tend to be effective, especially when combined with strong enforcement mechanisms. Cash transfers also have proven to be promising in some settings. Behavior change campaigns, such as school-based sex education and calorie-labeling laws, are often less effective on their own, unless they are complemented with broader risk behavior change programs.
“Risky behaviors not only endanger an individual’s health and reduce life expectancy, they often impose consequences on others,” said Damien de Walque, Senior Economist in the World Bank’s research department and principal editor of the report. “The health consequences and monetary costs of risky behaviors to individuals, their families, and society as a whole are staggering and justify public interventions.”
The report finds that despite recent progress in prevention and treatment, the HIV/AIDS epidemic —one of the most devastating consequences of risky sex— remains a heavy burden in Sub-Saharan Africa, especially in its southern cone where between 11 and 26 percent of all adults are HIV positive.
Drug and alcohol abuse have been relatively stable over the past decade, but smoking and obesity linked to unhealthy diets are on the rise in many developing countries and have the potential to substantially increase mortality and morbidity. Close to 20 percent of the world’s adult population smoke cigarettes and smoking causes more than 15 percent of deaths among men and 7 percent among women globally. While smoking prevalence is decreasing in the developed world, it is on the rise in many developing countries.
Obesity due to both unhealthy foods and physical inactivity is also increasing in the developing world, especially in the Middle East, the Pacific Islands, and Latin America and the Caribbean where many countries are experiencing obesity rates above 20 percent for males and more than 40 percent for females.
Engaging in such risky behaviors, according to the report, exerts a significant toll on the individual’s productivity in the long-run. Society suffers as immediate peers of those who engage in risky behaviors may also experience declines in their productivity. Children are at particular risk, for example if they have to stop schooling due to a sick parent or if development of their cognitive abilities is compromised due to early exposure to harmful substances.
Furthermore, in most low-income countries, it is difficult to formally insure against these costly consequences, given the rarity of both health insurance and public or private disability benefits. According to the World Bank’s World Development Indicators, 75 percent of private expenditure on health was financed through out-of-pocket payments in low-income countries in 2011.
“Individuals’ risky behaviors that cluster amongst the poor ripple throughout entire populations, crippling families’ potential and undermining the great health and economic progress we’ve seen in low- and middle-income countries in recent years,” said Tim Evans, Director of Health, Nutrition and Population at the World Bank Group. “Reversing the tide of these pernicious behaviors by promoting societal conditions for better health choices will pay dividends for families and countries across the globe, ultimately helping us end extreme poverty and promote inclusive and healthy growth.”
The report concludes that the costs and spillovers associated with risky behaviors justify public interventions and that certain policies, when done properly, can improve overall welfare. Evidence suggests that legislation tends to be effective, especially when enforcement mechanisms are strong. Tax policies can be efficient mechanisms to prevent smoking and alcohol consumption. Most of the evidence comes from developed countries, but emerging evidence from developing countries –such as from China and Indonesiafor tobacco taxes and from Kenya for alcohol prices— points in the same direction.