Scarcity: The New Science of Having Less and How it Defines Our Life

By Dennis Archambault

A few years ago, one of our academic interns expressed frustration with so many people missing their medical appointments. She learned that the reason is simple and complex: simple in that people without personal transportation have to rely on public transportation which may not be available. However, on a deeper level, their lives are chaotic and the priority for meeting a medical appointment may not factor high on the list.

The impact of social and financial influences on health behavior has become well-documented. An emerging factor is the social determinant of “scarcity.” Not having enough to meet needs is an obvious characteristic of poverty. Scarcity may create motivation to find ways to meet needs and improve one’s lifestyle. However, in many cases it undercuts that ability in profound ways.

Elder Shamir and Sendhil Mullainathan have summarized this emerging area of research in their recent book, Scarcity: The New Science of Having Less and How It Defines Our Life. In his review of the book, journalist Daniel Pink made some interesting observations on how scarcity affects how a person thinks, which affects a person’s actions. “It’s something deeper and more universal than a character flaw,” he writes. “The premise is simple: When we don’t have enough of something – Time. Money. Energy. Food. It doesn’t just stress us out. It changes how we think.”

Scarcity, he says, creates tunnel vision. “Worried about paying this month’s bills? You stop thinking long term about your health, education, or career. The urgent crowds out the important.”

An observation that we at Authority Health are examining through the Healthy and Resilient Communities initiative is how  the “grab and go” food culture is often driven by forces beyond just hunger. Even for dieters, “just feeling hungry make more impulsive choices,” Pink says.

Nike’s adage, “just do it,” and the related slogan often used in drug abuse promotions, “just say no,” seem so simplistic. Pink concludes, “When people in poverty make short-term or irrational decisions, it’s not a failure of willpower. It’s the predictable effect of a scarce environment.”

We can hope that our intern learned that patients who miss their appointments may not just be “irresponsible.”  It’s as simple, and complex, as “scarcity.”

Dennis Archambault is vice president of Public Affairs for Authority Health.