Dr. Bryan Bledsoe was just trying to keep up. The emergency room at his small county hospital was always packed and the top brass had urged him to move patients through more quickly, so when a woman in her sixties came in complaining of head and neck pain, he briskly examined her, hustled her off for an X-ray, gave her some pain medication for a pulled muscle, and dispatched her home.
The next morning she was back, this time in an ambulance. Bledsoe had missed the signs of an impending stroke. The woman died in the hospital that day.
Bledsoe didn’t lack training or a desire to help. The doctor, who today serves as a faculty member and physician in the trauma center at the University Medical Center of South Nevada in Las Vegas, was as eager then to see his patients get better as he is now. But in the moment, strapped for time and overwhelmed by the varied needs of so many patients, he missed a diagnosis. It would haunt him for years.
While there’s no easy excuse for Bledsoe’s lapse, there is something of an explanation: We all have only a finite amount of mental bandwidth, and if we use that bandwidth to concentrate on one thing, it’s difficult to use it for anything else.
Given his profession, Bledsoe was in a privileged position at the time; this mental condition is even more difficult for those on the other end of the economic spectrum. While nearly all of us juggle work, our personal lives, and financial and other obligations, for low-income families the juggling involves constant, agonizing tradeoffs (“Should I pay the rent or the electric bill? Should I fill this prescription or buy food?”). The process of making those tradeoffs day after day comes at a cognitive cost — the equivalent, researchers say, of living each day as if you hadn’t slept the night before.
Living in poverty, having so much bandwidth wrapped up in just making it from one day to the next, decreases a person’s — any person’s — cognitive function, making it harder to solve problems, resist impulses, and think long-term. If a well-off professional like Bledsoe were transplanted into a life of poverty tomorrow, he’d lose the same bandwidth too — and his brain function would show it.
The context of “scarcity” — as Princeton University professor of psychology and public policy Eldar Shafir and Harvard University economist Sendhil Mullainathan dubbed it in their influential 2013 book Scarcity: Why Having Too Little Means So Much — actually changes the way we think. We get tunnel vision, able to focus only on the present problem — the thing we lack, or the thing we need to do right now — in a kind of fire-fighting mode, leaving us with less bandwidth for anything else.
This effect can occur with any key resource — not just scarce money, but also food, and even time. A time-crunched professional feverishly finishing a project will likely fail to eat balanced meals and forget to show up for appointments. A calorie-counting dieter plagued with visions of ice cream will have a harder time concentrating at work or restraining her impatience during the 27th reading of Goodnight Moon. It’s not that they don’t want to — there’s just no room to spare.
Indeed, studies show that subjects perform worse on cognitive tests when they are dieting; Shafir and Mullainathan’s research demonstrates that they’re especially thrown off when the puzzles include words like doughnut and cake. And when the two researchers asked Princeton students to play brain games under time pressure with the opportunity to borrow more time at exorbitant interest rates, the students couldn’t resist borrowing — interest rates notwithstanding — once they started running low.
As for the effects of financial scarcity, when Shafir and Mullainathan tested the cognitive function of sugarcane farmers in India — first right after harvest time when they were flush with cash, and then again right before harvest, when they were barely scraping by — they performed like different people, losing nearly 10 IQ points and faltering in other measures of higher-level thinking. Like computers trying to download too many files at once, they simply had less mental bandwidth available to devote to the test.
“There’s a classic study that shows that if I have you memorize a four-digit number, if I say, ‘Don’t forget 1271,’ and have this other guy memorize an eight-digit number — ‘Don’t forget 12714627’ — the eight-digit guy is going to do less well on cognitive control tests because his bandwidth is already taken up; his mind is busy elsewhere,” Shafir says. “This is basically the same logic.”
But while many diets will eventually fall by the wayside and most work projects will eventually get done, a person living in financial straits feels the mental pull of scarcity every day, all the time. For those who are constantly juggling to make ends meet — which by Shafir’s estimation is some 100 million Americans — the load on their bandwidth is constant.
Take Sirrea Monroe, a former nursing-home aide currently managing the night shift at a convenience store to support her kids. She’s an engaging woman with curly dark hair; the day we meet, she’s wearing a light brown sweater, jeans, and a pink-and-white scarf she knitted herself.
What’s immediately striking about Monroe is her wry sense of humor and her seemingly endless creativity in saving money: There’s the knitting side business (complete with business cards); a weekly family coupon-clipping production (she and one kid cut them out, another checks expiration dates, and they file them all in a three-ring binder); her encyclopedic knowledge of free local children’s events; and the raft of funny homemade Halloween costumes she’s made for the kids out of cardboard boxes (Lego figures, Rubik’s Cubes, a giant flip-flop). “One year I cut a circle out of the front of two white boxes, put some blue cellophane over it, super-glued my oldest daughter’s Barbie-doll clothes in the windows, and they were a washer and dryer,” Monroe says, laughing. “It was awesome.” She pauses, then grins. “Well, until my daughter wanted those Barbie clothes back.”
Monroe, 36, talks with a generous helping of humor, like a woman who doesn’t want you feeling sorry for her. But behind her stories is an astonishing array of mental juggling that never stops. No job Monroe has ever held paid more than $10.50 an hour. She doesn’t have sick time or paid time off, and working from home is a pipe dream — if the car breaks down or her kids get sick, there’s just no pay that day. A simple trip to the grocery store requires extensive arithmetic and that binder of coupons. Halloween costumes are homemade not for fun, but because they have to be. Even the smallest surprise expense — clothes for a school program, a hike in the price of gas — can throw Monroe’s finances into a tailspin. A bigger surprise, like a major car repair or an emergency trip to the dentist, can make that tailspin last for months or even years. Most months, despite her best efforts, there’s just not enough.
“It’s always just, ‘Who do I have to pay today? Can I slide this gas bill three or four days? Can the rent wait ’til next week?’ With the lights, the phone, food, and maintenance on the car, I’m always scraping and moving stuff around,” Monroe says. “And then my daughter just grew two inches and she needs new pants, so it’s always something. Always.”
Indeed, reframed in the context of mental bandwidth, the fact that Monroe successfully holds a job, keeps her kids fed and clothed, and maintains her apartment while simultaneously wrangling the onslaught of brain-taxing complexity inherent in her everyday life starts to seem pretty impressive. The fact that she does it all while also making handmade costumes and knitting her own winter wear makes her downright heroic.
The mentally overwhelming nature of poverty might seem daunting to policymakers and program designers — just one more challenging aspect of an already complex problem. But where some see cause for despair, Anthony Barrows sees opportunity. “I actually find this research to be incredibly refreshing, because it shows that everyone’s brain reacts the same way in the context of poverty — it affects the way you think, the choices you make, and the outcomes that stem from them,” says Barrows, managing director at ideas42, an applied behavioral science non-profit in New York City.
“So we can stop lecturing low-income families about bootstraps or ‘not trying hard enough,’ or suggesting that people are poor because they somehow deserve it, and we can pivot the conversation toward something that’s actionable,” Barrows says. “There’s stuff we can do about this.”
Consider this: During World War II, the military was plagued with a series of accidents in which bomber pilots would successfully complete difficult missions but inexplicably retract their wheels during landing, thus crashing their planes on the runway. No one could figure out why. The pilots were some of the military’s best and brightest. Had they gotten sloppy? Fatigued? Forgotten their training?
It turned out that, in the cockpit, the lever for the wheels looked and felt almost exactly like the lever for the flaps. In the flurry of activity during landing, the pilots were just pulling the wrong one, as Shafir recounts in his book. When the military changed the levers so they could be differentiated by touch, the crashes stopped.
The military didn’t need to get into the pilot’s heads, lecture them about personal responsibility, or tell them to try harder. They just needed to redesign the cockpit.
“In product design, it’s long been understood that you can design things to be more or less conducive to successful performance,” Shafir says. “When you design a stove, if you have four burners in a square and the knobs in a row, people are always going to confuse which knob goes with which burner. But if you put the knobs in a square, it’s very clear — top left goes with top left, bottom right goes with bottom right — and you reduce errors enormously.”
That’s what Shafir, Barrows, and others in the field want to do with anti-poverty programs. “Instead of saying, ‘What is wrong with this person that he is poor?’” Shafir says, “the question should be: ‘How do we design the cockpit around this person to make it more conducive to success?’”
This isn’t coddling — personal responsibility still matters a great deal. “This doesn’t get the pilot off the hook,” Shafir says. “The pilot still has to land the plane, and the pilot that isn’t trying is still going to crash. But what we owe to those who are trying and do care is a cockpit that’s well-designed, so that there’s the best chance that they can fly successfully.”
How does one redesign the cockpit to fight poverty? It helps to realize that, even in the best of circumstances, the human brain is surprisingly quirky, and in consistent, predictable ways.
As researchers like Richard H. Thaler, Cass R. Sunstein, and Dan Ariely have pointed out in the bestsellers Nudge: Improving Decisions About Health, Wealth, and Happiness, and Predictably Irrational: The Hidden Forces That Shape Our Decisions, all of us, no matter our education or income level, routinely act in irrational ways. We eat more in restaurants where the plates are bigger; we buy more when the shopping carts are larger. We are more afraid of flying than driving, even though driving is far more dangerous. We all think we are above-average drivers, despite the fact that that’s impossible. We drive across town to save 20 bucks on an $80 coat, but blithely throw in $1,000 on extras when buying a $20,000 car. We buy new exercise equipment in a flurry of January optimism, and are always genuinely surprised when we’re using it as a laundry rack by March.
Instead of fighting against these and other natural quirks, policies informed by the study of behavioral economics work with them — tailored to the natural contours of our predictably irrational minds.
The classic examples — putting fresh fruit at eye level in the cafeteria because people respond to physical cues in the environment, or automatically enrolling new hires in the company 401(k) because people naturally gravitate to the default option — have been applied in corporate America, often to great effect.
Yet behaviorally informed policies make even more sense for people whose mental bandwidth is already overloaded by the demands of poverty. Rather than asking overwhelmed people to fight upstream against these universal quirks of the mind, it makes sense to design programs that account for and even employ the quirks to propel people to success.
Across the country, non-profits, schools, community colleges, and others are exploring ways to do just that. Sometimes it only takes a small tweak to make a big difference.
In Gillette, Wyoming, the local chapter of the non-profit Blessings in a Backpack is using the natural human affinity for default choices to reach more children in need with its weekend food program. In New York, Guttman Community College is employing an awareness of decision paralysis to create a streamlined program less likely to overwhelm its students with too many choices. At Economic Mobility Pathways in Boston and at Ohio’s Cincinnati Works, leaders are changing their vocabularies, recognizing that the language they use (“members” instead of “cases,” “coaches” instead of “caseworkers”) directly affects their clients’ success. And a study of a small tweak in the process of applying for financial aid has shown organizations at both the state and national level how to bring the rewards of a college education within the reach of more low-income students.
More information about the four successful programs outlined above is available in the sidebars accompanying this piece, but these are far from the only examples of initiatives using behavioral economics to fight inequality.
The school-based health center movement, for example, is bringing primary health care to the educational setting, thus removing any obstacles (cost, transportation, time off work) that might prevent parents from getting their kids to the doctor. An invention called the GlowCap — a prescription bottle whose cap glows to remind you to open it on the prescribed schedule — may help overwhelmed patients manage medication for chronic illnesses more effectively. And some community colleges are now offering free metro cards to low-income students to alleviate the strain of unreliable transportation.
These interventions aren’t a magic bullet — all the behavioral nudges in the world cannot replicate the poverty-reducing impact of a major policy initiative, such as mandated sick or vacation time, or an increase in the minimum wage. Behavioral tweaks can’t replace efforts like the Fight for $15, which last March led California and New York to approve an increase in the minimum wage to $15 an hour.
“But the things behavioral economics can do are relatively low-cost and relatively small, and they can have a disproportionate impact,” Anthony Barrows of ideas42 says. “It’s a complementary tool in the toolbox.”
Understanding the impact of financial scarcity on mental bandwidth can help us redesign the cockpit around low-income families to give them a better chance at success. Behavioral economics may not land the plane, but it can certainly make it easier to fly.