Carl Hampus Lyttkens

Habit versus choice: the process of decision-making in health-related behaviour

Social differences in the role of habits in health-related behaviour are explored within both sociology and economics, where we define habits as non-reflective, repetitive behaviour. The corresponding theoretical perspectives are the habitus theory, the theory of individualization, and habits as rational decision rules. Sixteen thematically structured interviews are analysed using qualitative methodology. Three aspects of habits emerged from the narrative: the association between habits and preferences, habits as a source of utility, and the relationship between habits and norms. We find that people in lower social positions are more inclined to rely on their habits and are accordingly less likely to change their behaviour. These differences are reinforced as not only the disposition to maintain habits but also the tendency to conceive of the habitual as something good seems to be strengthened in lower social positions. We also note that the intensified individualization that characterizes current society erodes the basis for habit-governed behaviour, which may also contribute to social differences in well-being. Finally, we find that the scientific dialogue has enriched both scientific paradigms, and suggest as a tentative hypothesis that the traditional economic rational-actor model may be relatively less applicable to those with limited resources.

Income Inequality and Health: Importance of a Cross-Country Perspective

This paper uses a unique dataset-containing information collected in 2006 on individuals aged 40-79 in 21 countries throughout the world to examine whether individual income, relative income in a reference group, and income inequality are related to health status across middle/low and high-income countries. The dependent variable is self-assessed health (SAH), and as a robustness check, activities of daily living (ADL) are considered. The focus is particularly on assumptions regarding an individuals reference group and on how the estimated relationships depend on the level of economic development. Correcting for national differences in health reporting behavior, individual absolute income is found to be positively related to individual health. Furthermore, in the high-income sample, there is strong evidence that average income within a peer-age group is negatively related to health, thus supporting the relative income hypothesis. In middle/low-income countries, it is instead average regional income that is negatively associated with health. Finally, there is evidence of a negative relationship between income inequality and individual health in high-income countries. Overall, the results suggest that there might be important differences in these relationships between high-income and middle/low-income countries.

Equity is out of fashion? An essay on autonomy and health policy in the individualized society

It is widely recognized that there is a discrepancy between principle and practice with respect to the health equity aim of public policy. This discrepancy is analyzed from two theoretical perspectives: the individualization of society and the fact that individual beliefs and values are connected to ones position in the social structure. These mechanisms influence both the choice of health policy measures and the normative judgements of preventive efforts, both of which tend to be consonant with the views of dominant social groups. In particular, we focus on the treatment of the ethical principle of autonomy and how this is reflected in health policy aimed at influencing health-related behaviour. We examine the current trend towards targeting health information campaigns on certain socio-economic groups and argue that it entails an ethical dilemma. The dominant discourse of the welfare state is contemplated as a means to understand why there tend to be a lack of emphasis on measures that are targeted at socio-economic inequalities. It is argued that there is no substantive basis in the individualized society for perceiving health equity as an independent moral principle and that the driving force behind the professed health equity goal may be in essence utilitarian.

The influence of economic incentives and regulatory factors on the adoption of treatment technologies: a case study of technologies used to treat heart attacks.

The Technological Change in Health Care Research Network collected unique patient-level data on three procedures for treatment of heart attack patients (catheterization, coronary artery bypass grafts and percutaneous transluminal coronary angioplasty) for 17 countries over a 15-year period to examine the impact of economic and institutional factors on technology adoption. Specific institutional factors are shown to be important to the uptake of these technologies. Health-care systems characterized as public contract systems and reimbursement systems have higher adoption rates than public-integrated health-care systems. Central control of funding of investments is negatively associated with adoption rates and the impact is of the same magnitude as the overall health-care system classification. GDP per capita also has a strong role in initial adoption. The impact of income and institutional characteristics on the utilization rates of the three procedures diminishes over time.

Health care for the elderly: two cases of technology diffusion

Diffusion of medical technology and the growing proportion of elderly people in the population are generally regarded as major contributors to the increasing health care expenditure in the industrialised world. This study explores the importance of one specific factor in this process, the change in the use of technology among elderly patients. In some instances, a new technology is first used among younger patients and then gradually extended to the elderly. Two such cases are studied, both representing costly procedures: coronary bypass surgery (treatment of coronary heart disease) and dialysis (treatment of uraemia). In both cases, we demonstrate significant diffusion to older age groups. It is also tentatively concluded that the diffusion of technology could have an important effect on per capita health care expenditure among the oldest of the old.

Polarization in the reaction to health-risk information: A question of social position?

Dissemination of risk information is ubiquitous in contemporary society. We explore how individuals react in everyday life to health-risk information, based on what they report in personal interviews. Health-risk information was without exception recognized as unstable and inconsistent. This conformity, however, did not extend to the narratives regarding how health-risk information should be handled. Two opposite positions (ideal-typical strategies) are presented. Either you tend to process and evaluate new information or you tend to ignore it as a whole. Our attempt to reveal the underlying rationality in these two very different approaches involved the exploration of three different avenues of interpretation and brings together two scientific paradigms--economics and sociology--that provide the framework for our analysis. First, we suggest that a greater long-term experience of explicit choice implies that this kind of action becomes more natural and less resource consuming, whereas a reliance on habits in daily life--a natural adjustment to a lack of resources--makes it is more costly to bother about new information. Second, with fewer resources in the short run, fewer opportunities to mitigate bad outcomes, and greater exposure to social and material risks, one is less likely to devote resources to deal with health-risk information. Third, there are several possible links between a low propensity to take account of risk information and a high relative importance of genuine uncertainty in ones life. These theoretical perspectives provide a viable set of hypotheses regarding mechanisms that may contribute to social differences in the response to health-risk information.

Do Education and Income Really Explain Inequalities in Health? Applying a Twin Design

We apply a twin design to examine the relationship between health and education and income. The estimated associations between health and education and income, controlling for unobserved endowments, at the twin-pair level, are lower than estimates obtained via ordinary least-squares (OLS) on the same sample. Thus, OLS-based effects of education and income are biased, exaggerating the contribution of education and income to health inequality. The main part of health inequality is explained by within-twin-pair fixed effects, incorporating family background and genetic inheritance. It appears that education and income policies have less to offer for reducing health inequality than is usually assumed.

Institutions, taxation, and market relationships in ancient Athens

This paper explores the institutional and economic development in ancient Athens from around 600 BC into the fourth century, a period during which the Athenians experienced oligarchy, tyranny, a gradually evolving but eventually far-reaching male democracy, followed by a return to more influence for the elite. Concomitantly, economic life changed qualitatively and quantitatively. Self-sufficient farming gradually gave way to market relationships and there was substantial economic growth. This analysis of institutional changes in Athens emphasizes the importance of credible commitments from those in power to other groups in society. It is furthermore likely that the increasing reliance on market relationships gradually transformed individual behaviour and individual beliefs, leading to changes in the formal and informal rules in society. Taxation played an important role: it pushed people into market relationships, illustrated the need for credible commitments, and helps to explain why foreigners were so prominent in trade in ancient Athens.

Effects of the taxation of wealth in Athens in the fourth century BC

In the fourth century B.C., Athenians were often accused of avoiding their civic obligations and of concealing their wealth.1 These attested cases show that economic behaviour in classical Athens could be affected by taxation. The purpose of the present study is to systematically explore the economic incentives resulting from the taxation of wealth. The first issue is the effects of the property taxes on the relative attractiveness of different assets. An important influence is the incentive to avoid taxation, and it will also be demonstrated that the marginal rate of taxation could be quite large. In addition, the difference in treatment between citizens and foreigners will be investigated, as well as some implications of the irregular nature of the taxes on wealth.

Breaking bad habits by education : smoking dynamics among Swedish women

In a dynamic Two-Part Model (2 PM), we find the effect of previous smoking on the participation decision to be decreasing with education among Swedish women, i.e. more educated are less state dependent. However, we do not find an analogous effect of education on the conditional intensity of consumption.