Comparing the Impact of Unhealthy Behaviors and Preventive Services on Chronic Health Outcomes

Abstract

Chronic health outcomes are a leading cause of death and disability, and also prominent drivers of health care costs. Most chronic health outcomes can be attributed to a few risky behaviors. It is believed that chronic health outcomes and their burdens can be alleviated by the use of clinical preventive services. This paper seeks to assess the relative influence of unhealthy behaviors and preventive services on chronic health outcomes using the 500 Cities data. The approach comprises of three-way clustering of the 500 cities, one each based on health outcomes, preventive services, and unhealthy behaviors, and then measuring the pairwise similarity between the clustering solutions based on health outcomes and preventive services, and health outcomes and unhealthy behaviors. A variant of the Rand Index is defined to assess this clustering similarity. Higher similarity between clusterings based on health outcomes and unhealthy behaviors compared to the clusterings based on health outcomes and preventive services is observed. These findings suggest a greater influence of unhealthy behaviors over preventive services on chronic health outcomes. The paper concludes with a question of whether investing in facilitating healthier lifestyle choices will yield a higher return towards promoting health as opposed to investing in improving access to preventive services.