Creating a Legacy of Healthy Decisions
Laura Roser’s Q&A with Emily Oster, Professor, Brown University
LR: Tell us about your work and where your passion lies related to your research.
EO: My work focuses on health economics and, in particular, on understanding when people make choices that do not seem in their best interest with respect to their health. Much of my earlier work focused on these issues in the developing world. I studied, for example, why there was not much change in sexual behavior in Africa in response to the HIV epidemic. My more recent work takes up similar question in the USA. At the moment, I am engaged in a series of projects which study dietary choices and what types of information or other changes can prompt improvements in diet.
The thing that drives me in much of my work is the goal of understanding what data is telling us about how people behave, about what policies are the best, or simply about how the world works. There is no better moment in my research when I realize I have learned something new from data – something no one else knows – and I’ll be able to share it.
This goal of understanding data also drives the second arm of my research, which focuses on improving the use of statistical tools to learn from data. Data can be wonderful, but used incorrectly it can also pull us far astray. Developing better, easy to use, tools to improve our understanding of statistical relationships can help us draw the right conclusions – and not the wrong ones – from the data.
LR: What influenced your research toward economics and health?
EO: Prior to becoming an economist I had designs on being a doctor. I think this is still evident in much of my work. I like the tools and the central ideas in economics, but topic-wise my heart is really in the health space. One of the things that is really special about my job is that I can combine these two.
LR: How should our readers think about health related to the legacy they are leaving?
EO: In the United States, in particular, there is enormous inequality in health outcomes across socioeconomic groups. Several years ago I did a project on infant mortality in the US and Europe. It is well known that the USA has extremely high infant mortality relative to Europe. By some metrics it is twice or three times as high as the most successful European countries. Our paper delved into the reasons for this and one of the most striking findings was that well-off women in the US (those with a college education or more) had infant mortality rates virtually indistinguishable from their counterparts in Europe. The difference was that less well educated mothers in the US has dramatically higher infant mortality than similar cohorts in Europe. This inequality extends to other parts of the life course. Poorer individuals in the US are more likely to die at all ages, are more likely to be overweight and obese, have more heart disease, strokes and cancer. They are also more likely to have conditions like opioid dependence. Knowing how to use a legacy to impact these problems is difficult. We do not have many good evidence-based solutions for these issues. It may be self-serving, but funding research into solutions is an approach which could help in the even slightly longer run. We have little or no idea, for example, how to produce sustained improvements in diet, which would have positive impacts on all kinds of health outcomes. Learning more about what works would be a first step.
Related: Why Write Your Legacy?
LR: What kind of legacy would you like to leave behind for your family, community, and world?
EO: I hope my best legacy will be my children. But from my work I hope to ultimately deepen our understanding of what works to change behavior and what doesn’t.
LR: What is one principle from your research that our readers could use for practical decision making for future health care decisions?
EO: Take this example. Let’s say there is a disease that affects 1 in 10,000 people. There is a test for the disease. Everyone who has the disease receives a positive test result. Most people who do not have the disease get a negative
test result. 2% of healthy people will get a positive test result. These are “false positives.” Still, this is a great test.
Now imagine you get a positive test result. What is the chance you have the disease? Most people would say quite high – maybe close to 100%, 98%, maybe 99%. In fact, this is also what many doctors answer when faced with this question. The answer is actually about 0.5% – that is, one half of one percent, or 1 in 200.
Once you know this, it is easy to see why it’s true. Since the disease is rare, most people do not have it. 2% of those who do not have it – so 200 of every 10,000 – will be a false positive. But within that 10,000 people there is only ONE
true positive. So even if your test result is positive, it is still very likely you are healthy.
This rule is important because of the tendency most people have to want to ACT on health information, especially bad news. Over-reacting to a test of this type – and this is a common feature for many kinds of tests – can create problems where there are none. Taking a step back, repeating the test if necessary, trying another diagnostic test to be sure – these are all crucially important things in making sure you end up making the right decisions.
NBA Player Carl Landry Demonstrates the Value of Persistence in Life and Work
Written by: Jon Sabes
When you meet Carl Landry, stand-out college basketball player and nine-year NBA player, you imagine that becoming a professional basketball star was a straight forward run for the 6-foot-nine-inch power forward.
However, when you go deeper into Carl’s background, becoming a NBA professional was less than certain and little came easily to the 33-year-old from Milwaukee:
- He was cut from his high school team as a freshman and averaged less than ten points a game when he did play as a senior.
- He started his college career not at Purdue, but a junior college where it was not clear he would play.
- When he finally got to Purdue, he tore his ACL in his knee his first year and reinjured it the next year.
- While his family held a party for him the night of the NBA draft, he slept in the Philadelphia airport after missing a flight following a workout for the 76ers.
- In the NBA playoffs, Carl had a tooth knocked out, but came back in the same game to make a game-winning blocked shot as the Rockets beat the Utah Jazz 94-92.
Landry, who I interviewed on my podcast, Innovating Life with Jon Sabes (www.jonsabes.com), is a remarkable example of the value of “persistence.” In a time where technology creates the image that anything is possible at the touch of a button, persistence is an under-appreciated trait. When I spoke with Carl, I clearly saw someone for whom success has only come through a force of will that made him a NBA player, but it also made him a better player every year he played. That’s the kind of personality that has produced greatness in business as well as sports.
Carl was, in fact, drafted that night he spent in the airport. The Seattle Supersonics chose him as the 31st overall pick and then traded him to the Houston Rockets where he rode the bench for much of the first half of the season. When All-Star teammate Yao Ming was injured, he stepped in and played a key role in the Rockets astonishing 22-game winning streak (the third longest streak in NBA history). And, that season, after sitting on the bench for 33 of the first 36 games, he was named to the All-Rookie second team.
Carl was the first in his family to go to college. “I told myself that this was my ticket out, so I did everything I possibly could to be the best person in school and also on the court,” he said.
His family life in Milwaukee showed him what he didn’t want to do. “Just being honest with you, seeing some my cousins, peers, they went to work for jobs paying six, seven dollars an hour or they didn’t go to work at all and then living off welfare. I didn’t want that.”
When he was first injured, he had to contemplate the end of a career before it even got started. “When you have an ACL tear, it’s over…no more basketball,” he told me. “I said, God, give me health again and I’ll do everything I can to leave it all out on the line and be a successful individual.”
On my podcast, Carl pointed out another interesting lesson he learned in the NBA: Not doing things just to fit in.
“Fitting in was easy,” he said. “Doing everything that everybody else does was easy. If I stood out in some type of way, I’m going to have different results. I’m going to have stand-out results.”
That’s called the “Law of Contrast” and it produces that exact effect of changing the outcomes that everyone else is experiencing. Carl is smart, he recognized that differences make a difference, and doing whatever it takes is what is required to make real, meaningful differences.
Every off-season for the last 11 years, he has run a camp for kids in Milwaukee where he tells youth his story of hard work and persistence. “I always tell the kids to apply themselves and always be persistent,” he said. “If you dream, apply yourself and be persistent. With hard work, man, the sky’s the limit.”
When Carl says the sky’s the limit he means it. He is smart to recognize that it’s important to dream big, because if we don’t – we may be selling ourselves short. “You have to dream bigger than your mind could ever imagine,” he said. “I wanted a nice house. I wanted a nice car. I said, and I got all of that. So, what do I do, do I stop now? Maybe I didn’t dream big enough.” That’s a big statement coming from a kid who grew up to be the first in his family to graduate college and go on to be not only a top NBA basketball start, but a good businessman, father and someone who gives back to the community.
I’m convinced that in whatever he takes on as a basketball player or in his post-hoops career, Carl Landry is not going to stop getting better at whatever he does, and in the process of doing so, make the world a better place.
- 1 of 1625