Self-Help Is Like a Vaccine
AEI’s Andrew Biggs has a totally reasonable piece arguing that Americans’ unhealthy lifestyles are a major cause of America’s high COVID mortality rate:
Americans entered the Covid pandemic in much poorer health than citizens of other developed countries. For instance, over 27,000 U.S Covid deaths list diabetes as a comorbidity, accounting for 16% of total Covid-related fatalities. But what if instead of having the highest diabetes rate among rich countries the U.S. had the same rate as Australia, with less than half the U.S. level? The same holds for obesity, listed as a comorbidity in 4% of Covid cases. Forty percent of Americans are obese, the highest in the developed world and over twice the OECD average. U.S. death rates from heart disease are also higher than most European and Asian countries. Hypertension is listed as a comorbidity in 22% of Covid deaths. If Americans simply had the same health status as other high-income countries, it is likely that tens of thousands of lives could have been saved.
The obvious upshot is: Individuals can and should reduce their COVID risk by switching to healthier lifestyles. Yet Biggs strangely declares the opposite:
General practitioners tell me that their Type 2 diabetes patients can tell you their weight and know how it relates to their illness. They know that by losing weight their can reduce their risk of blindness, limb amputations or death. They simply aren’t able to do it.
If anything is obvious, however, it is that they simply are able to do it. Anyone can. Eat fewer and smaller meals… and you will lose weight. Exercise more… and you will lose weight. Everyone knows this. And everyone can apply their knowledge. Put less food in your mouth, move your body more, and your risk of dying of COVID will crash.
Why then do so many people remain unhealthy, even the midst of an historic pandemic? Because they prefer (the pleasure of food and idleness plus the attendant health loss) to (the pain of hunger and exertion plus the attendant health gain). To quote Al Pacino in Scent of a Woman:
I always knew what the right path was. Without exception, I knew. But I never took it. You know why? It was too damn hard.
If this is all undeniable, why do so many smart people refuse to assent? Social Desirability Bias, naturally. When the truth sounds bad, people say – and perhaps even believe – the patently untrue. As I’ve explained before:
“Sorry, I can’t come to your party.” This common excuse is almost always literally false. You’re working? Unless your boss chains you to your desk, you can come to the party. You’re in Paris, and the party’s in DC tomorrow? If you can beg, borrow, or steal airfare, you can come to the party. The same goes for most social uses of the word “can’t” – everything from “We can’t be together” to “I can’t help myself.”
Why say, “I can’t” when the truth is “It’s too costly for me” or “I don’t feel like it”? Because “I can’t” sounds better. It insinuates, “The only reason I’m not doing X is because I lack the ability to do X. Otherwise I would totally do it.” “It’s too costly for me” and “I don’t feel like it” are insulting by comparison. Both blurt, “X simply isn’t my top priority. Get used to it.” In short, the way we use the word “can’t” is a clear-cut case of Social Desirability Bias: our all-too-human propensity to lie when the truth sounds bad.
The literally-false “can’t” is hardly alone. Social Desirability Bias permeates our diction – i.e., the specific words we choose to use.
What’s so awful about sugarcoating the harsh reality that the obese are fully capable of reaching a healthy body weight?
Simple: Sugarcoating distracts and confuses. Self-help is a virtually foolproof solution for obesity; as long as you strictly follow the recipe, you won’t be obese for long. Ignoring or denying the possibility of self-help discourages people from fixing – or even saving! – their own lives.
One could scoff, “Human beings are weak. What’s the point of telling them to diet and exercise for the rest of their lives when we know they won’t? We might as well just spare their feelings.”
Perhaps, perhaps.
Consider, though, this parallel argument: “Anti-vaxxers are crazy. What’s the point of telling them to get vaccinated when we know they won’t? We might as well just spare their feelings.”
Can you think of any decent objections? Because I definitely can.
1. There’s a continuum of crazy. Some anti-vaxxers are beyond hope. Others will only bend the knee in the face of overwhelming shame. A great many, however, are only skin-deep crazy. Moderate shame – or persistent persuasion – will eventually get the vaccines in their bloodstreams.
2. Crazy is contagious. If no one challengers anti-vaxxers, undecided bystanders are more likely to adopt their crazy ideas. These “converts,” in turn, can easily go on to corrupt others. Given how conformist human beings are, the anti-vax movement can spread even in the absence of deliberate recruitment efforts. Initially non-crazy people notice the rising prevalence of crazy ideas – and casually become crazy themselves.
3. Someone’s gonna get blamed. If you refuse to blame anti-vaxxers for their own bad choices, people are likely to look around for someone else to blame. For example: “People would probably be happy to take vaccines, if doctors weren’t so arrogant.” The result: Instead of “sparing people’s feelings” in the aggregate, you wind up redistributing the hurt feelings over to innocent bystanders.
What then is the right message to send? This: “Anti-vaxxers are totally able to get vaccinated. The are making bad choices. They should make better choices.”
This isn’t merely helpful; it is true.
The same goes for obesity. The right message is not: “They are simply unable to lose weight.” The right message is: “The obese are totally able to be thin. They are making bad choices. They should make better choices.”
This isn’t merely helpful; it is true.
The same principle holds for self-help generally. Self-help is like a vaccine: When used, it works wonders. The fact that many people refuse to do what works is a flimsy reason to humor them. And it is a terrible reason to endorse clear-cut errors like, “They just can’t do it.” Anyone can get vaccinated; just roll up your sleeve and let the doctor stick you with the needle. Anyone can be thin; just eat moderately and exercise regularly. And anyone can improve his own life; just stop making excuses and follow the path of prudence.
The post appeared first on Econlib.
I do think one thing that libertarians need to contend with a bit more seriously is the obvious tension pointed out here.
Entrepreneurs have built out huge companies based on serving all the classic biblical vices. Gluttony, Envy, Lust, Gambling, Sloth, Drugs & Alcohol, etc. The availability & quality of indulging in those vices has gone way up, the cost has gone way down. As a high conscientious individual, the maximum-liberty standpoint is very compatible with me. But it obviously has serious deleterious impact on a large portion of society, especially once any social pressure has disappeared to avoid them. The result is a population that is less productive, more unhealthy, more unhappy. It's like the narrative behind the fall of Rome.
How does libertarianism address this problem?
The claim that “anyone can get thin by making different choices” was nonsense until the introduction of GLP-1 drugs. NOW it’s at least plausible - or will be as drugs in that category proliferate and cost comes down. The fact that most people can easily lose weight by making the “different choice” to take a drug that changes their setpoint confirms there exist biological processes which affect it.
It seems plausible that most people *could have been* thin by making different choices but once they get fat that screws up the metabolism in ways such that the body wants to keep the fat it already has - losing weight is harder than gaining it so weight tends to ratchet up over time absent heroic effort of will to avoid temptation, hunger and general food obsession…or trivial application of Tirzepatide to make the food noise go away.