The economics of risky consumption in the light of public health policies.

Summary This dissertation for the Habilitation to Supervise Research examines the relationship between the economic analysis of 'risky' consumption and the public policies aimed at regulating it. More specifically, the aim is to understand the difficulties of the economics of risky behaviors to impose itself in the process of elaboration of public policies. To do this, we must identify the positive and normative contributions of economic analysis to the understanding of these behaviors and to the justification and construction of policies aimed at regulating them. It is also necessary to confront these contributions with what these policies really are: a project of risk management and normalization of behavior through health education. This confrontation is essentially based on my own work, which I use from both a critical and programmatic perspective. I present the main features of Grossman's model of health capital, emphasizing its modernity. On the one hand, it gives form to behavioral mechanisms well identified by the sociology of health through the concepts of health capital and production technology (Section II-1). On the other hand, it proposes a normative approach to health behaviour, which is apparently in line with the evolution of ways of thinking about and constructing public health policies: emphasis on individual responsibility and action on behaviour, consideration of the natural springs of individual behaviour, and the use of information and prices as regulatory tools, with due respect for individual freedom (Section II-2). This suggests, to use a Foucauldian reading grid, that the health demand model could be the basis for a quasi-pure form of neo-liberal governmentality of individual health behaviours in the positive and normative order. However, in reality, public health policies are hardly inspired by this model. I recall that information policies aim at changing both the perceptions of risks and the preferences of individuals, thus contravening Becker's "De Gustibus Non Est Disputandum". I show that the dissemination of information on the generic risks of consumption has little effect on individual risk perceptions, thus underlining a limitation of the economic approach from the point of view of public health promoters committed to the effectiveness of prevention measures (Section III-1). This is why targeted health information and education actions, relying on intermediaries, seem a priori to be more effective, and are implemented by Public Health. But their effect is very heterogeneous. It depends in particular on the proximity of the source of information, as well as on the psycho-social characteristics and the consumption career of the beneficiaries of the action (Section III-1). These results show that the economic analysis of information policies is, from a positive point of view, off-topic, in that it ignores the real aim of the institutions and actors of these policies: a setting of norms for individual behaviour (Section III -4). I show how this complicates any ex post evaluation of public information campaigns (Section III - 2). Policies that tax risky behaviors are probably more effective than information policies, even if they are regressive and weigh more heavily on the working classes (Sections IV-1 and IV-2). An analysis of the discourse of public health promoters also reveals that the price tool is used to enforce behavioural norms, rather than to internalise the externalities they produce. Thus, policies for regulating risky behaviour are not inspired by the neo-liberal forms of governmentality identified by Foucault at the end of the 1970s, forms embodied in particular in the health demand model (and more generally by the neo-classical approach). Why, then, remain attached to this model? How can it be reformed? To answer these questions, it seems to me that we must return to the analysis of the two types of factors that constrain action: (1) constraints, which means going beyond the budget constraint and integrating physiological and perceptual constraints in particular. (2) the agents' representations. On this last point, and perhaps surprisingly, the neo-classical approach appears to be particularly useful for the analysis of social inequalities in health, in relation to social differences in representations. The prevalence of labelled risk behaviours is higher in the working classes, and pricing and information policies seem to increase these inequalities. I examine two explanations: social differences in the opportunity costs of risky behaviors (Section V) . the rejection of behavioral norms promoted by public health in the name of norms of taste based on social interactions (Section VI). My work leads me to relativize the argument of the autonomy and resistance of social norms of consumption, and to validate the hypothesis of differences in opportunity costs. The poorest take more risks because they have less to lose, and their apparent lack of temperance is the product of a more consequentialist rationality than it appears at first sight. Their representations of the future differ from those of the wealthy classes, not so much out of myopia as out of realism about their life chances. However, this small success of the theory in the positive order should not obscure the magnitude of the scientific challenges facing the economics of risk behaviour (Sections VII and VIII). First, representations are not just about opportunity costs. They also include the way in which individuals think about the process of producing their own health: the role of individual responsibility, belief in the effectiveness of market or medical devices, etc. Second, the models must incorporate the physiological and perceptual constraints that affect the range and value of choice options available to consumers. I therefore conclude that there is a need to model and analyze in more detail the effect of biological constraints, market devices, and body-governing techniques on consumption choices. Finally, economic analysis is confronted with a major normative challenge: how to think about public action when public health policies aim at normalizing behaviors, in a competitive relationship with the market? I discuss the propositions of behavioral economics and suggest that, from a normative point of view, it is necessary to reject both the dogma of consumer sovereignty and the capture of public policy by a bureaucratic and technological 'enlightened' elite. This implies a radical rethinking of the democratic process of public policy making.