The difficulty of making healthy choices and "health in all policies".

Editorials 154 Healthy choices are difficult choices. On a Sunday afternoon, how many people would choose the exertion of jogging around the neighbourhood for an hour over the immediate gratification of watching a football game? Similarly, someone having to choose between buying foods that are healthful but hard on the budget and foods that are less healthy but make the budget stretch is likely to end up with a cart low on fruits and vegetables but high on dairy and meat products. 1 Why are healthy choices so difficult? An overlooked, yet fundamental explanation is that we humans are only an approximation – not a perfect example – of the homo economicus that, in standard economic theory, rationally chooses whatever optimizes his well-being. Far from holding time-consistent preferences, being forward-looking and maximizing utility, individuals exhibit intertemporal preferences and bounded rationality. These tendencies lead them – or us, rather – to make suboptimal decisions. 2 " Bounded rationality " , as defined by behavioural health economics, refers to those limits of human cognition that lead to judgment errors or poor decision-making; " intertemporal preferences " undermine individual self-control and bring adverse results in the long run. " Bounded willpower " , on the other hand, refers to the propensity of individuals to choose mitigating losses over acquiring gains and to engage in hyperbolic discounting – i.e. to prefer a smaller, more immediate reward to a larger but more distant one. Even if the healthy choice is obvious to us, our bounded rationality and bounded willpower steer us away from it. Rather than give up smoking because it is harmful and costly, people continue to smoke or turn to " light " cigarettes or electronic cigarettes. 3 Individuals compensate for eating ultra-processed foods by consuming artificially sweetened " light " sodas and snacks. Acknowledging the limitations of human cognition in the design of health policies and interventions can make these more effective, if not cost-effective. 2 This is particularly crucial for the " health in all policies " (HiAP) paradigm, defined by the Helsinki Statement as " an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies and avoids harmful health impacts in order to improve population health and health equity ". 6 The success of the HiAP approach depends on the extent to which it makes healthy choices less difficult, as much …