Associate Professor in Health Economics at Erasmus School of Economics Hans van Kippersluis is dedicated to the topic of ‘disease prevention.’ Smoking and overweight are the main causes of premature death in our current society, which begs the questions: why do some people smoke while others don’t? Why do people who have more money often live healthier in comparison with those less fortunate? And how can we encourage people to live healthier lives? For the initiative Smarter Choices for Better Health, Van Kippersluis collaborates with researchers from different faculties in order to find answers and solutions to these socially relevant questions.
‘Smarter choices to make for better health, that is our goal: to help society make better and smarter choices in the field of healthcare,’ says Van Kippersluis. ‘I’m mostly concerned with prevention, for example: how can we encourage healthier behaviour? At this university a lot of researchers across different faculties are dealing with the topic of prevention and health behaviour. One of the explicit intentions of this initiative is to start collaborating on this, combining our knowledge.’
Who are you collaborating with?
‘Our Initiative is a collaboration between Erasmus School of Economics (ESE), the Department of Public Health at Erasmus MC, and Erasmus School of Health Policy and Management (ESHPM). However, over the past weeks I spoke to sociologists, psychologists, behavioural scientists, researchers from paediatrics and urology – all of whom are interested in the same theme. I also firmly believe that unhealthy behaviour has medical, economic, psychological, biological, and sociological causes. Each of the researchers I spoke to has their own angle, their own way of approaching the topic. I think that’s fascinating.
To put it bluntly: what if the economist thinks you can encourage people with money, the psychologist thinks you should have a good conversation, et cetera. Isn’t it complicated to merge different approaches?
‘On the one hand, I think the different perspectives are enriching. Let me give two examples. First, economists (like me) are not focused solely on money, but most economic theories focus mostly on the individual. Sometimes, we tend to forget that there is also a whole social environment surrounding each individual that might influence certain choices. In the discussion with sociologists Jeroen van der Waal and Willem de Koster, they pointed out that the way a person responds to advice and information may depend on the deeply ingrained distrust in certain social environments towards certain sources of information. As economists we don’t normally take these sorts of things into account.
A second example is the interplay between economics and psychology in encouraging healthier behaviour. Economists have mainly used financial incentives to encourage healthier behaviour, whereas psychologists have focused on training self-control. But self-control without financial incentives (stakes) doesn't seem to be effective, and the other way around it isn't as well. My hypothesis is that a combination of stakes and skills provides the motivation for making a positive behavioural change and avoids relapse.’
And on the other hand?
‘I don’t see major cons to the collaboration but I can imagine that at times it will be a little confusing for the PhD students who are going to be working on this. They will have for example one leg in the sociology faculty, and one leg in economics faculty. It will be a challenge for them to keep everybody satisfied, or to know in what sort of scientific journals to publish, as every faculty has their own publication culture. The nice aspect about this research project is however that even though empirical methodologies differ widely across disciplines, the key empirical tool we will employ is the randomized experiment, and this is almost universally accepted as the golden standard across disciplines.’
Do you think the future lies in the collaboration of different faculties and disciplines?
‘This is arguable. I also hear from people who are a bit more sceptical; they say that for twenty years now there have been attempts to develop multidisciplinary research initiatives and that it never really succeeded. I’m moderately positive. We’ll have to see where this takes us.’
'One concrete idea that I’m really excited about: is to experimentally evaluate several different ways of promoting smoking cessation among employees of the Erasmus MC.'
What are you working on right now?
‘First we’re currently reading existing prevention research across the fields of psychology, epidemiology, and economics, to take stock of what is known already, and map the differences and overlap. We’re focussing on smoking and obesity, the two main causes of premature death. After this we will continue by looking into interventions that can help to encourage healthier behaviour. One concrete idea that I’m really excited about, which was brought up by my colleague Jasper Been from Erasmus MC, is to experimentally evaluate several different ways of promoting smoking cessation among employees of the Erasmus MC. Erasmus MC is the largest hospital in the Netherlands and the largest employer of the province. In this way, we as scientists can really translate our knowledge into socially relevant action.
I also have the pleasure of announcing that professor John Cawley from Cornell University, United States, working on our team. He is an obesity expert. He has a lot of experience in this field and will help us design the interventions.’
What is your personal interest in the subject of prevention?
‘A few years ago, I spent a few weeks in Los Angeles to visit a colleague. There, on Venice Beach Boulevard you see a lot of people who are obese, smoking, drinking Coca Cola by the litre and eating one-dollar pizza slices drowned in grease. Just a few blocks away from the boulevard you will find very fit, trained people shopping in health-food stores with their personal trainers, eating only broccoli and fruit shakes. Never before had I seen opposites this extreme and yet so close to each other. How can we explain these differences in lifestyle and health? And, noting that 80% of smokers would like to quit and more than 50% of the population who would like to lose weight, how can we help those people to translate these healthier intentions into action?
Apart from my own fascination for the topic, rising costs of health care and population ageing imply that we have to encourage preventive efforts. Hopefully we can contribute with the initiative.’
Isn’t obesity a sort of luxury problem?
‘I would say obesity is a negative by-product of a lot of positive developments. In the sense that in the last 200 years food has become a lot cheaper, and standard economic arguments imply that the demand goes up when prices decrease. It was also in this period that many women entered the labour market. This implied that families are having less freshly cooked food, and that the demand for ready-made meals, which tend to be more calorie-dense, has increased. Both of these positive developments (lower food prices and increased female labour force participation) have increased the demand for calorie-dense food. Very important is also that our jobs have changed: people used to be out and about all day long, working on farms or in factories, whereas nowadays we are mainly sitting behind our desks. Hence, in short calorie intake has increased, whereas calories burned has decreased due to these developments. The increase in obesity is the natural result of these developments. Whether it can be reversed? Again, I’m cautiously optimistic; Look, I have a standing desk!’ – Van Kippersluis points to his standing desk. ‘Once you get used to it, it can be really nice to work while standing.’
'Apart from my own fascination for the topic, rising costs of health care and population ageing imply that we have to encourage preventive efforts.'
Hans van Kippersluis, Associate Professor of Health Economics