Risk assessment, decision-making and public health: Evaluating individual and environmental factors in behavior change

Much public health research focuses on individual level risk factors, proposing causal pathways that fail to take into account the complexity of social and environmental influences. Given what we are beginning to understand about how difficult it is for individuals to assess risk and make judgments regarding future benefit, our understanding of the boundary between individual rights and societal influence in matters of public health may need to be reconsidered.

This paper presents evidence of the limitations of individual risk assessment and its impact on decision-making in two different areas of current public health concern: obesity control and health insurance coverage. Both arenas historically rely on individual decision-making to assess the risk of future impacts in order to yield the desired outcome. Literature from behavioral economics is reviewed to illustrate the limitations of such an approach in accurately modeling the causal pathways that lead to positive outcomes (e.g., losing weight, taking up available health insurance coverage). Evidence of variations in attitudes towards risk across socioeconomic and racial/ethnic minority populations is also assessed. Alternate models that incorporate societal mechanisms into the analysis of behavioral change are proposed.

Hypothetical interventions that incorporate an environmental component in both of these areas will be presented. Ethical concerns regarding the freedom of the individual and the possible need to enact normative environmental constraints on this freedom will be discussed.