Bryan Caplan  

Self-Harm is a Luxury

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From Cutler and Lleras-Muney, "Understanding Differences in Health Behaviors by Education" (Journal of Health Economics 2010):
Differences in prices or in response to prices are a second potential reason for education-related differences in health behaviors. This shows up most clearly in behaviors involving the medical system. In surveys, lower income people regularly report that time and money are major impediments to seeking medical care. Even given health insurance, out-of-pocket costs may be greater for the poor than for the rich--for example, their insurance might be less generous. Time prices to access care may be higher as well, if for example, travel time is higher for the less educated.

A consideration of the behaviors in Table 1 suggests that price differences are unlikely to be the major explanation, however. While interacting with medical care or joining a gym costs money, other health-promoting behaviors save money: smoking, drinking, and overeating all cost more than their health-improving alternatives. It is possible that the better educated are more responsive to price than the less educated, explaining why they smoke less and are less obese. But that would not explain the findings for other behaviors which are costly but still show a favorable education gradient: having a radon detector or a smoke detector, for example. Still other behaviors have essentially no money or time cost, but still display very strong gradients: wearing a seat belt, for example.

More detailed analysis of the cigarette example shows that consideration of prices exacerbates the education differences. A number of studies show that less educated people have more elastic cigarette demand than do better educated people. Prices of cigarettes have increased substantially over time. Gruber (2001) shows that cigarette prices more than doubled in real terms between 1954 and 1999; counting the payments from tobacco companies to state governments enacted as part of the Master Settlement Agreement, real cigarette taxes are now at their highest level in the post-war era. Yet over the same time period, smoking rates among the better educated fell more than half, and smoking rates among the less educated declined by only one-third. For these reasons, we do not attribute any of the education gradient in health behaviors to prices. [footnotes omitted]
In other words, self-harm is a luxury.  I've made parallel points for crime and staying single before.



COMMENTS (3 to date)
Dan King writes:

My book Hookernomics: The Business of Sex (available on Kindle) is directly relevant to the "staying single" part of this argument, and indirectly relevant to the argument as a whole.

Jameson writes:

I'm a bit perplexed by your use of the term "luxury." When I hear that word, I think of something you pay for based on a conscious decision to enjoy some of the "finer things" in life. But things like smoking are, as indeed you suggest, impulsive behaviors, addictions, the result of a lack of training in self-discipline. They're vicious cycles. They're anything but "finer things" that one rationally chooses.

So it just seems like the word "luxury" is misplaced. Either you're being polemical, suggesting we need to stop feeling sorry for these losers and see them for what they really are (irresponsible, I suppose), or you're using the word in an idiosyncratic way that doesn't really mesh with the way others use it. Neither of these possibilities is really helpful to public discourse on the topic.

IVV writes:

I think it's important to remember why people smoke or drink or overeat. They aren't doing these things specifically because they don't know better, much of the time. I'd argue that most people today do know the dangers.

However, they smoke or drink or overeat to relieve stress. If being poor is a more stressful condition than being rich, then we would expect more of these behaviors to occur among the poor, even if everyone, poor or rich, had the same education of the circumstances.

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