Working Paper: NBER ID: w20631
Authors: Susan T. Stewart; David M. Cutler
Abstract: Adverse behavioral risk factors contribute to a large share of deaths. We examine the effects on life expectancy (LE) and quality-adjusted life expectancy (QALE) of changes in six major behavioral risk factors over the 1960-2010 period: smoking, obesity, heavy alcohol use, and unsafe use of motor vehicles, firearms, and poisonous substances. These risk factors have moved in opposite directions. Reduced smoking, safer driving and cars, and reduced heavy alcohol use have led to health improvements, which we estimate at 1.82 years of quality-adjusted life. However, these were roughly offset by increased obesity, greater firearm deaths, and increased deaths from poisonous substances, which together reduced quality-adjusted life expectancy by 1.77 years. We model the hypothetical effects of a 50% decline in morbid obesity and in poisoning deaths, and a 10% decline in firearm fatalities, roughly matching favorable trends in smoking and increased seat belt use. These changes would lead to a 0.92 year improvement in LE and a 1.09 year improvement in QALE. Thus, substantial improvements in health by way of behavioral improvements and public health are possible.
Keywords: behavior change; public health; life expectancy; quality-adjusted life expectancy; health-related quality of life
JEL Codes: I1; I10; I12; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| reduced smoking (I12) | improved life expectancy (I14) |
| reduced smoking (I12) | improved QALE (J17) |
| improvements in motor vehicle safety (R48) | increased life expectancy (J17) |
| improvements in motor vehicle safety (R48) | increased QALE (J17) |
| rising obesity rates (I14) | declining life expectancy (J17) |
| rising obesity rates (I14) | declining QALE (I14) |
| 50% reduction in morbid obesity (I14) | increased life expectancy (J17) |
| 50% reduction in morbid obesity (I14) | increased QALE (J17) |
| decrease in poisoning deaths (I12) | increased life expectancy (J17) |
| decrease in poisoning deaths (I12) | increased QALE (J17) |
| 10% reduction in firearm fatalities (H56) | improved life expectancy (I14) |
| 10% reduction in firearm fatalities (H56) | improved QALE (J17) |