The Influence of Present & Limited Attention Biases on Socioeconomic Status

PART OF A BEHAVIORAL SCIENCE LENS ON SOCIAL DETERMINANTS OF HEALTH

Key Terms

01.

Socioeconomic Status

Based on the American Psychological Association, Socioeconomic Status (SES) refers to an individual's quality of life based on array of factors. It encompasses educational attainment, prestige of occupation, income and perceived social standing. It can be used as a reliable predictor for a wide range of psychological outcomes and health during a person's lifetime .

02.

Present Bias

Present bias refers to our tendency to make decisions more heavily based on the present versus the future. Generally, people have a harder time expending money, time and energy up front for greater benefits in the future . For individuals with lower SES, present bias makes it challenging to prioritize long-term health care when faced with immediate competing priorities.

03.

Limited Attention Bias

Limited attention bias refers to a cognitive limitation where individuals can only focus on a finite amount of information at any given time. This is especially relevant to individuals with lower SES because a lack of money, time, and basic necessities like sleep and food—affect psychological functioning in ways that can hinder their ability to optimally plan for the future .

How Socioeconomic Status Impacts Health

It can be argued that Socioeconomic Status (SES) has the most overarching and pervasive affect on health outcomes than all other Social Determinants of Care. This singular determinant can dictate every other aspect of healthcare and shape them for the better or worse. It influences a person's capacity to manage stress, afford medical care, and participate in wellness and health-related pursuits in order to prevent costly chronic illnesses. The enablements and limitations posed by an individual's SES is so powerful, scientists use it as a reliable predictor of life quality and expectancy .

People with lower socioeconomic status (SES) consistently experience worse health outcomes compared to their wealthier counterparts. Research has shown that low SES is linked to reduced access to healthcare, increased morbidity, and higher rates of mortality. For example, in a cross-sectional study of nearly 50,000 older adults in the United States, financial barriers were a major reason cited for not obtaining necessary medical care . Furthermore, individuals with lower SES are less likely to access preventive care and screenings, contributing to poorer health over time. These disparities highlight the critical need for targeted interventions to improve healthcare access and outcomes for individuals in lower socioeconomic classes.

The gap in life expectancy between the top 1% of wage earners and the bottom 1% is stark: men in the highest income bracket live 15 years longer, and women live 10 years longer than their lowest-income counterparts .

The significant disparity in health outcomes between socioeconomic statuses is a global issue that necessitates a coordinated effort from organizations of all levels to redesign infrastructure for economic growth. Despite the widespread and significant nature of this issue, we can still implement solutions and address health outcome disparities at the local level. Specifically, understanding how economic scarcity affects cognition is crucial for designing lasting solutions.

Limited attention bias and present bias are two cognitive biases that significantly affect decision-making for individuals in lower socioeconomic classes. These biases can impede an individual's ability to take care of their health, often leading to poor outcomes. By understanding these on a deeper level, healthcare organizations can design better interventions to support those living in scarcity .

Present bias is the tendency to prioritize immediate rewards over future benefits. For those in lower socioeconomic statuses, feeling uncertain about having resources in the future can cause someone to prioritize short term benefits over long-term benefits. This short-term focus often leads to neglecting preventive health measures, such as vaccinations, regular check-ups, or adherence to treatment regimens and can also be particularly detrimental in managing long-term health issues.

Limited attention bias refers to the cognitive limitation where individuals can only focus on a finite amount of information at any given time. For people in lower socioeconomic classes, daily life involves a constant struggle to secure basic necessities such as food, shelter, and safety. This struggle consumes most of their cognitive bandwidth, leaving little room to invest in wellness and manage health. Everyone has limited attentional capacity, but wealthy individuals, relieved from the constant need to secure necessities, have more mental resources available for managing their health and treating unexpected health issues in a timely manner.

To illustrate how limited attention bias affects health outcomes across socioeconomic statuses, consider this scenario: A person living in poverty diagnosed with diabetes might often forget to take their medications because their attention is consumed by immediate concerns, such as securing food or ensuring their family's safety. This limited cognitive capacity makes adhering to complex medical regimens challenging, potentially leading to more severe health complications due to inconsistent medication adherence.

Limited attention bias and present bias present significant challenges for individuals in poverty, affecting their ability to make optimal health decisions. Banyan Consulting Co can help your organization better understand and address the underlying cognitive challenges faced by those in lower socioeconomic classes. Partner with us and together we can design a more effective and equitable healthcare system.

Interventions

Reduce Up-Front Costs and Inconveniences: Subsidize Preventive Health Products at reduced or no cost to significantly increase uptake. Developing a financial assistance program. Eliminating or reducing upfront copayments for essential health services can remove a major barrier to accessing care. Research has shown that even small reductions in upfront costs can significantly increase utilization for preventative care products.

Simplify Access to Services: Reducing logistical hurdles, such as travel time and paperwork, can make it easier for people to utilize health services. Providing services within communities or offering transportation assistance can significantly improve access. Simplifying the paperwork required to quality for financial aid or auto-enrolling patients in financial programs can also reduce the barriers to care.

Follow-Up Care after Emergency Department Discharge: Individuals with low SES are more likely to visit emergency departments for non-urgent conditions, costing health systems billions of dollars a year. These individuals may not have the infrastructure available to seek a primary care doctor and manage their health conditions. To alleviate this, health systems can institute better follow-up care after the patient is discharged from the emergency department.F or example, if a patient wants to schedule an appointment with a primary care clinician, they can be promptly connected to a service that can arrange appointments, apply for financial assistance, and plan transportation in advance, thereby removing several common barriers to managing their health preventatively.

Digitally Engage: Implementing reminder systems, such as text messages or phone calls, and designing a more robust patient platform system, can help patients remember to take medications, attend appointments, or engage in preventive care. These reminders can bridge the gap caused by limited attention. It also enables more opportunities for equitable communication because patients are able to manage their health outside of office hours, whenever convenient for them.

Offer Commitment Devices: Create programs that encourage or facilitate saving for health-related expenses to help individuals allocate resources for future needs. Soft commitment devices, such as labeled savings accounts for health expenses, can help individuals save money while allowing flexibility for unexpected needs.

Sources

1. American Psychological Association. 2022. “Socioeconomic Status.” American Psychological Association, 2022. https://www.apa.org/topics/socioeconomic-status.

2. S, Bryan,Christopher J. ,Vakis,Renos,Mazar,Nina,Jamison,Julian C,Braithwaite,Jeanine,Dechausay,Nadine,Fishbane,Alissa,Fox,Elizabeth,Gauri,Varun,Glennerster,Rachel,Haushofer,Johannes,Karlan,Dean. n.d. “Overcoming Behavioral Obstacles to Escaping Poverty.” World Bank. Accessed May 30, 2024. https://documents.worldbank.org/en/publication/documents-reports/documentdetail/535211507029479808/overcoming-behavioral-obstacles-to-escaping-poverty.

3. Conway, David I., Alex D. McMahon, Denise Brown, and Alastair H. Leyland. 2019. “Measuring Socioeconomic Status and Inequalities.” Edited by Salvatore Vaccarella, Joannie Lortet-Tieulent, Rodolfo Saracci, David I. Conway, Kurt Straif, and Christopher P. Wild. PubMed. Lyon (FR): International Agency for Research on Cancer. 2019. https://www.ncbi.nlm.nih.gov/books/NBK566205/.

4. McMaughan, Darcy Jones, Oluyomi Oloruntoba, and Matthew Lee Smith. 2020. “Socioeconomic Status and Access to Healthcare: Interrelated Drivers for Healthy Aging.” Frontiers in Public Health 8 (231). https://doi.org/10.3389/fpubh.2020.00231.

5. CDC. 2023. “Socioeconomic Factors | CDC.” Centers for Disease Control and Prevention. September 1, 2023. https://www.cdc.gov/dhdsp/health_equity/socioeconomic.htm#:~:text=It%20is%20estimated%20that%20in.

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