9. Why the Poor Don’t Use Cheap, Life-Saving Tech: Surprising Theories Behind the Puzzle

Hey everyone! Today I will share some of my takeaways and thoughts after reading about some possible theories behind a puzzling question we left off from yesterday: If the poor demand so much healthcare, why do they show such indifference towards cheap, effective technologies that can benefit their health?

Theory 1

One theory follows along this thought process: If poor people don’t take advantage of the cheap technologies, is it because they are cheap and therefore they associate it with “worthless”? Does it mean they judge quality based on price?

The sunk cost effect explains this. The plain vanilla economic rationality suggests that the cost, once paid or “sunk,” should not have any effect on usage.  However, there is also a “psychological sunk cost”— people are likely to make use of something they paid for. Therefore, cheap items are valueless.

Studies, however, found no evidence of behavior associated with one using things less because they got them for free. For example, people are more likely to buy bed nets when they are very cheap or free, and the usage rates range from 60-90 percent. No difference in usage rates existed between those who paid for them and those who did not. 

Theory 2

OK. So that first theory might not be an actual reason, but the book does suggest another possible reason: faith, or to use the more secular equivalents, a combination of beliefs and theories that explain how we all navigate the health system. Trust —how we choose to trust doctors’ prescriptions by making sure studies are reliable—is an important idea. Many times people find it hard to trust doctors because they make choices based on what makes sense to them, but most of them have not had rudimentary high school biology and therefore have no concrete reason to trust the doctors. 

The thing is, many of the poor believe that they need shots to get better and the medicine needs to be delivered directly to the blood. However, they can probably never learn that they are wrong without knowledge on health care.

Immunization is probably one of the hardest things to convince people to do — many uneducated parents probably don’t understand what their child is supposed to be protected against. Immunization doesn’t since it doesn’t fix an existing problem, but rather protects against potential future problems. Also, not all children who are not immunized actually contract the disease, so it’s hard to draw a link between immunization and lack of disease.

Theory 3

When there is little else the poor can do, hope becomes essential. 

The poor in Delhi spend as much more on short-duration ailments as the rich, but the rich spend much more on chronic diseases. The poor may have the perception that at least the little medicines are cheap and they are still doing something important for their health.

Here is the Quote Of the Day: “Beliefs that are held for convenience and comfort may well be more flexible than beliefs that are held out of true conviction.” 

Faith and trust might explain the problem of immunization we talked about earlier. Local experts argued that the reason why many children are not immunized is because immunization had no place in the traditional belief system. Even though various programs that gave the poor incentives have led to an increase in the percent of the population getting immunized (38%), the WHO believes that 80-90 percent is required to achieve “herd immunity.” Additionally, the book states that we shouldn’t try to bribe people to do things that we think they ought to do. Instead, we should focus on convincing them about the benefits of immunization. 

Action follows intention: if people were convinced of the value of immunization, children would be immunized.

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