The major cause of death – is personal decisions

The major cause of death – is personal decisions
08 April 2013

“The major cause of death is not heart disease or cancer, nor is it smoking or being overweight. The leading cause of death is personal decision making.”

This is the opening sentence of a far reaching empirical study by Professor Ralph L. Keeney of Duke University, Personal Decisions Are the Leading Cause of Death, and it just blew me away when I read it. I’ve been studying decision making for some time now and working on formulas for improving the biases which we all show in the life choices we make, my research, previous past errors and a life threatening illness have led to deepening my resolve in making better personal decisions and helping others to improve their decision making; as Keeney indicates our inability to make smart choices and overcome our own self-destructive behaviors is what will ultimately lead us to an early grave.

The study calculated the medical causes of death due to each class of personal decisions (e.g., choosing to smoke, inactivity, lack of exercise and poor diet (the UAE Ranks 7th in the world for obesity) and lack of safety habits in automobiles). It showed a significant increase in the causes of death by personal decision making over the last century.

The main results of this research are clear. Over one million people (out of 2.4 million deaths) prematurely die each year in the United States due to causes that can be attributed to personal decisions. This is 44.5% of all deaths. For ages from 15 to 64, about 55% of all deaths are attributable to personal decisions. Well over 90% of these premature deaths can be attributed to decisions of the person who died.

Improved decision making

Dan Ariely, a colleague of Professor Keeney and a leader in the field of Behavioral Economics writes in his book Predictably Irrational: “I suspect that over the next few decades, real improvements in life expectancy and quality are less likely to be driven by medical technology than by improved decision making.”

First let’s look at the definition of ‘decision’: A personal decision is a situation where an individual can make a choice among two or more alternatives. This assumes that the individual recognizes that he or she has a choice and has control of this choice.

Smoking, over eating and binging on alcohol are clear instances where there is an alternative choice, we choose to do these activities knowing full well they are harmful to our health. Most people, including many smokers, believe smoking is stupid – yet with each cigarette they light they take a personal decision to do so. We know that driving excessively fast over the speed limit and not wearing a seat belt are idiotic, yet many choose to do this – their personal decisions endangering their own and others lives.

As the only way to exert purposeful influence over anything in life is by making decisions, it would serve us all well to carefully consider the alternatives when making decisions, be they money, relationship, health choices and so on.

Oh! The choices we make

Sarah Conly has a new book:  Against Autonomy, the opening sentence in the introduction is: “We are too fat, we are too much in debt, and we save too little for the future.” Conly believes we do things that are bad for us -- we take risks we soon regret, we thwart our own desires, we undercut our own fulfillment. In other words our enjoyment of life is less because of the choices we make.

Conly calls for governments and legislators to do more of what she calls coercive paternalism, which is rather more prescriptive than the liberal paternalism called for by Behavioral Economists Richard Thaler and Cass Sunstein in their book Nudge, Improving Decisions about Health, Wealth, and Happiness.  Conly says: “being bankrupt, addicted to cigarettes, or too poor to retire, much less retire as we like, are frustrating, liberty-inhibiting conditions,” so by introducing policies that protect us from ourselves we are potentially wealthier, healthier and happier.

Conly wants government to act to overcome cognitive errors while respecting people’s judgments about their own needs, goals, and values.

Nudging us carefully

Harvard Professor Cass Sunstein co-author of Nudge and a former adviser to the Obama administration wrote about Conly’s coercive paternalism focused on the problem of obesity: “Conly thinks that New York’s ban on trans fats is an excellent example of justifiable coercion. On the basis of the evidence as she understands it, the ban has been effective in conferring significant public health benefits, and those benefits greatly exceed its costs.”

If it’s not good for us, and the majority agree, shouldn’t a democratically elected government be able to help us from ourselves?

As Keeney’s study shows, too many of our decisions fail us; if we neglect to rebalance our retirement accounts, we may end up with less money than we want. Even the simple, save more tomorrow program for pension funds has significantly increased the number of people and the amount they are saving towards their retirement.

Well researched studies in behavioral economics and nudges are helping people to improve their lives – who wouldn’t want that?

My own belief is that a balance should be reached between government paternalism and compulsory education programs that help to improve decision making skills. The impact that better decision making skills could have on people's lives is way underestimated.

How do you feel about governments nudging you into decision making or compulsory decision making programs?


  • Colin

    Cass Sunstein has a new book out about paternalism called Simpler, writing in The New Republic about the book and paternalism he offers us this analogy of paternalism: "paternalism is like a GPS. You can ignore what the GPS says and try your own route, but if you do so, there is a serious risk that you will get lost."

    The article talks about the errors we make and how they can shorthen our life - it is well worth a read.

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