Habit, custom, and power: A multi-level theory of population health

In multi-level theory, individual behavior flows from cognitive habits, either directly through social referencing, rules of thumb, or automatic behaviors; or indirectly through the shaping of rationality itself by framing or heuristics. Although behavior does not arise from individually rational optimization, it generally appears to be rational, because the cognitive habits that guide behavior evolve toward optimality. However, power imbalances shaped by particular social, political, and economic structures can distort this evolution, leading to individual behavior that fails to maximize individual or social wellbeing. Replacing the dominant rational-choice paradigm with a multi-level theoretical paradigm involving habit, custom, and power will enable public health to engage in rigorous new areas of research. (C) 2013 Elsevier Ltd. All rights reserved.