Health Behaviors and Behavioral Economics in the Context of HIV, Malaria, and Exercise

Abstract

Although the challenges of population health differ widely between rich and poor countries, fundamental features of health behavior shed light on how individuals make choices about their health. These insights that can cut across countries and cultures. In this thesis, I apply concepts from behavioral economics to provide insights into how cognitive biases and social influences guide health behavior.

Paper 1 addresses inter-household spillovers and knowledge of HIV status. Using regression discontinuity design and a population-based dataset from South Africa, I estimate how a person's ART eligibility affects their household member’s HIV status knowledge. ART led to a large increase in HIV status knowledge among the patient's male household members. Although prior studies have noted a correlation between ART expansion and testing rates, this study is among the first to causally link ART initiation to increased awareness of HIV status among household members.

Paper 2 assesses the role of present bias and salience in malaria prevention behavior and risk perception in northern Ghana. Using lab-in-the-field measurement and high-frequency surveys of market vendors in Tamale, Ghana, I find that time preferences do not predict spending on malaria prevention or bednet utilization, but recent illnesses are associated with malaria prevention spending. I investigate the role of beliefs about malaria risk and find that respondents whose children had been ill in the past two weeks report higher subjective expectations of malaria risk, suggesting that recent episodes of illness may increase an individual's perception of risk and lead to increase spending on malaria prevention.

Paper 3 uses a behavioral field experiment to evaluate whether personal, goal-oriented reminders are an effective means to increase exercise frequency. I ran a 12-month randomized controlled trial on members of a chain of gyms in Montreal, Quebec. The trial compared generic SMS reminders with personalized reminders that recalled members' own exercise goals, which were elicited via a questionnaire at the time of study enrollment. I find that individuals who received personalized reminders did not exercise more frequently than the general reminder group and present suggestive evidence that recalling their goals generated a discouragement effect.