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Precision policy: Bringing out the best health behaviors with targeted programs

Technology and data: two of the most talked-about words in any conversation about how to finally get a handle on disease. But my new article in Stanford Medicine magazine highlights the profound importance of another factor – government policy – in the continuing dialogue around the future of health.

As Stanford epidemiologist Sanjay Basu, MD, PhD, recently learned, what seemed a simple policy decision by the Peruvian government made a marked impact on the health behaviors of the country’s low-income residents. After the government decided to decrease the frequency (yet not the overall amount) of its cash-assistance payments to this population, citizens were more likely to spend the money on “temptation goods” – tobacco, alcohol, sweets – that are especially bad for those who suffer from chronic disease. Basu explains why people tended to spend their larger lump-sums of cash this way:

We suspect two behavioral issues may be to blame for this increase… One, there’s the ‘payday’ effect, where people tend to make larger discretionary purchases around receipt of a regular income stream. And two, going without temptation goods for a longer period of time may lead people to binge once they finally do receive a payment.

The good news? A realistic and achievable policy change, back to more frequent payments, can play a big role in improving the health of these individuals. And in middle-income countries like Peru, where chronic disease hasn’t yet, in Basu’s words, “fully ramped up,” governments have a chance to get ahead of the game by making targeted policy decisions.

Basu is now applying lessons learned from this study in the U.S., where he’s piloting a related – but tailored – program in San Francisco’s low-income neighborhoods:

There’s certainly no one-size-fits all strategy when you’re dealing with the public health aspects of chronic disease. We’re taking a precision health approach based not on genetic codes, but on ZIP codes — where very different people from very different parts of the world receive ‘treatment,’ in the form of tailored assistance programs, that is specific to their circumstances. If we get to the point where we can customize to the neighborhood or even to the person, that’s very policy amenable.

Previously: Strive, thrive and take five: Stanford Medicine magazine on the science of well-beingStanford's Sanjay Basu: A career dedicated to the social determinants of healthStanford physician Sanjay Basu on using data to prevent chronic disease in the developing world and Strive, thrive and take five: Stanford Medicine magazine on the science of well-being
Image by Juliette Borda

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