Cognitive biases in public health and how economics and sociology can help overcome them

Abstract

Objectives: The objective of this study was to identify important gaps in the public health evidence base and consider the implications of these for public health and public health economics.

Study design: This was a review and critique of public health policy in the UK.

Methods: Using two key psychological concepts relating to cognitive biases, viz. cognitive dissonance and heuristics, the shortcomings in public health approaches to confronting the prevalence of non-communicable diseases are described. The implications are drawn out.

Results: Two cognitive biases in public health thinking are identified. (i) A dissonance between what is known and what is done, resulting in the repetition of solutions that have previously been shown to have had little or no effect. (ii) The habitual use of set of heuristics which mean that simple solutions to complex problems are preferred to undertaking the detailed assessment of how to bring about change. These biases mean that the evidence about the dynamics of populations and the ways that the mechanisms of prevention actually operate seldom feature in the way interventions, policy and practice are undertaken. The evidence base is consequently highly skewed.

Conclusions: Health economics combined with sociological reasoning has potentially an important role to play in developing the ideas that will overcome the problems attaching to the cognitive biases.

Keywords: Cognitive dissonance; Decision theoretic models; Heuristics; Mechanisms of prevention; Societal dynamics; Socio-economics.