Despite lots of education about the potential dangers of certain behaviors, we don't do much to take care of our long-term health. We overeat, even at the risk of putting on dangerous amounts of weight and risking diabetes. We smoke cigarettes. We drink too much alcohol. We lie out in the sun and get a nice tan. One thing that is clear from people's behaviors is that we do a lot of things in the short term that are bad for our long-term health.

A theory published Goldenberg and Arndt in the October, 2008 issue of Psychological Review may help to explain why.

Their theory applies "Terror Management Theory" to health behaviors. I wrote about Terror Management Theory in another post in this blog on anxieties about death. According to this theory, people engage in many behaviors to help them reduce anxieties about death.

In applying Terror Management Theory to health behaviors, Goldenberg and Arndt suggest three principles for thinking about how anxiety about death influences health behaviors.

First, there are times when people are consciously aware of their own mortality. For example, you might hear about a friend who has been diagnosed with skin cancer after years of lying out in the sun. While you are consciously aware of these thoughts of death and mortality, you are likely to react by engaging in positive health behaviors that help to reduce these thoughts of mortality. For example, in this case, you might go out of your way to wear a hat and to put on sunscreen when you go outside.

Eventually, though, the thoughts of death recede from your conscious memory. Those concepts are still active beneath the conscious surface, but you are not thinking about them actively. The second principle argues that when thoughts of death are active but not conscious, then people avoid thinking explicitly about health in order to avoid triggering thoughts of death. So, paradoxically, in order to avoid thoughts of death, you might actually avoid wearing sunscreen, because the act of putting on sunscreen may remind you of your own mortality.

Finally, the effect of thoughts about death is influenced by the degree to which the behaviors you must carry out are related to your physical body. Some health behaviors have a strong involvement of your physical body. For example, mammograms and breast self-examinations used to screen for breast cancer are quite invasive. In contrast, wearing a hat or staying out of direct sunlight can help to prevent skin cancers, but these behaviors have much less involvement with the body. People will exhibit more discomfort with health behaviors that are move invasive to the body relative to those that are less invasive. So, for example, women will be more likely to wear a hat or sunscreen than to perform breast self-examinations.

Theories like this may help point the way to a significant gap in health care. Modern medicine has many recommendations for helping to keep people healthy. Unfortunately, many of those recommendations involve behaviors that need to be kept up every day. Research on terror management suggests that one way we keep thoughts of our own death at bay is to avoid behaviors that relate in any way to our own death. So, in the long-run it is hard for people to keep up with many healthy behaviors. This is a case where medical doctors need to collaborate with psychologists to find ways to describe the behaviors they ask people to perform in ways that do not necessarily relate them directly to thoughts about mortality.

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