The effects of a tailored health warning on socio-economic behaviours and health outcomes

一些常见的长期健康状况，如糖尿病和高血压，即使在晚期也没有任何迹象，因此人们可能在没有意识到的情况下携带这种疾病。事实上，有证据表明，这在发达国家和发展中国家都很常见。医学指导表明，如果人们了解自己的临床状况，那么他们就能够通过使用药物改变生活方式和改变健康行为（例如锻炼、水果蔬菜消费、盐消费）来减轻疾病对其健康的长期影响。人们还可以通过改变非健康行为（劳动力市场选择、退休规划、支出、财务规划）来减轻疾病对其福祉的影响。面对这一日益严重的公共卫生问题，一些组织已经开展了促进健康检查的运动（例如NHS健康检查，英国糖尿病和英国心脏基金会提供心脏病，中风，糖尿病，肾脏疾病，高血压和胆固醇浓度的健康诊断检查），以便被诊断患有某种疾病的个人可以在早期阶段做出生活方式的选择。支持这些运动的一个方面是，如果个人知道他们有这种情况，那么他们会采取不同的行动，但目前几乎没有证据表明人们是否会改变他们的生活方式以应对个性化的健康信息。广泛的健康检查给公共财政带来了很大的压力（NHS健康检查的估计年度成本为3.2亿英镑），因此重要的是要知道这种干预是否可能通过改善国家的福祉来节省开支。在这个项目中，我们将通过提供因果证据来填补这一证据空白，这些证据表明，个人在接受个性化健康信息时改变其健康和其他社会经济行为的程度。相关的，有证据表明，针对人口中风险群体的健康信息宣传活动，例如食品标准局减少食盐消费的运动，一直不成功。这些活动可能不起作用的一个原因是，如果个人认为群体水平的信息不适用于他们，因为他们“比平均水平更健康”（这种比平均水平更好的效果已经在其他领域显示出来，例如，一项研究发现，93%的美国司机认为他们比中位数更好）。我们将在这个项目中提供的证据将有助于了解提供个性化信息（而不是人口水平的健康信息）的信息活动是否能更好地让人们改变他们的行为。我们考虑的情况是高血压，这是一个全球公共卫生问题。通过药物和生活方式的选择降低血压是可行的，并显着降低因心脏病和中风（英国和全球死亡的主要原因）和其他衰弱性疾病的发展而死亡的风险。但人们往往不知道他们患有高血压，它被称为“沉默的杀手”。我们首先提供证据，这将有助于在何种程度上，低收入家庭可能更有可能有高血压（临床诊断），但不太可能知道它的健康运动的目标。然后，我们继续从一个个性化的信息处理，让理解社会调查的受访者的血压阅读从受过训练的护士提出的证据。我们创新地利用了这些数据的两个新特征：它包含与丰富的社会经济变量相关联的临床测量的健康指标;也许更不寻常的是，它为我们提供了已经和尚未获得个性化健康信息的个人的子样本。

A number of common and long-term health conditions such as diabetes and high blood pressure display no signs even at advanced stages and so people may carry the disease without being aware of it. In fact, evidence shows that this is a common occurrence across the developed and developing world. Medical guidance indicates that if people were aware of their clinical status, then they would be able to mitigate the long-term effects of diseases on their health by making lifestyle changes through the use of medication and making changes in health behaviours (e.g. exercise, fruit-veg consumption, salt consumption). People may also be able to mitigate the effects of the disease on their wellbeing by modifying non-health behaviours (labour market choices, retirement planning, spending, financial planning). In the face of this growing public health problem, a number of organisations have enacted campaigns that promote health checks (e.g. NHS health check, Diabetes UK and the British Heart Foundation offer health diagnostic checks for heart disease, stroke, diabetes, kidney disease, hypertension and cholesterol concentration) so that individuals diagnosed with a condition can make lifestyle choices at an early stage. One dimension underpinning these campaigns is a belief that if individuals knew they had the condition then they would act differently but currently there is little evidence to say whether or not people do change their lifestyles in response to receiving personalised health information. Wide-spread health checks place a large strain on the public purse (estimated annual cost of NHS health checks is £320m) and so it is important to know whether such interventions are likely to bring savings through the improved wellbeing of the nation. In this project we will make a step towards filling this evidence gap by providing causal evidence on the extent to which individuals change their health and other socio-economic behaviours in response to receiving personalised health information.Relatedly, there is evidence to suggest that health information campaigns that target at risk groups of the population, such as a Food Standards Agency campaign to reduce salt consumption, have been unsuccessful. One reason that these campaigns may not work is if individuals believe that the group level information does not apply to them as they are "healthier-than-average" (such better than average effects have been shown in other areas, for example, where one study found that 93% US drivers think they are better drivers than the median). The evidence that we will provide in this project will be useful in understanding whether information campaigns that deliver personalised information (and not population level health information) are better at getting people to change their behaviours.The condition we consider is high blood pressure which is a global public health issue. Lowering blood pressure through medication and lifestyle choices is feasible and significantly reduces the risk of death due to heart disease and stroke (leading causes of death in the UK and worldwide) and the development of other debilitating conditions. But often people are unaware that they are afflicted with hypertension and it has been called a 'Silent Killer'. We first provide evidence that would help with the targeting of health campaigns on the extent to which low income households maybe more likely to have high blood pressure (clinically diagnosed) but less likely to know it. We then go on to present evidence from a personalised information treatment that gave respondents of the Understanding Society Survey a blood pressure reading from a trained nurse. We make innovative use of two novel features of this data: that it contains clinically measured indicators of health linked to a rich set of socio-economic variables; and perhaps more unusually that it provides us with subsamples of individuals that have and have not been given personalised health information.