Rational: Chronic disease is a major agent in the gap in expected life span of Aboriginal and Torres Strait Islander people, which some see as the result of self-inflicted lifestyle choices. This need not be the case, however.
Method: An economic optimisation model is used. This is based on choosing between a) self-investing in education, which involves short-term costs and long-term health and economic advantage; and b) shortterm self-gratification, which involves short-term self-gratification and long-term health and economic disadvantages. It is shown that self-gratification can be economically rational; especially in stressful circumstances with an uncertain future outcome. Such circumstances are relevant to Aboriginal and Torres Strait Islander people in remote Australia.
Results: Increasing stress levels result in increasing risk of chronic disease and hormonal responses. On the basis of a number of studies including those carried out on the British public service (Whitehall Studies), less than 25% of this change is attributable to poor lifestyle choices, while more than 50% is explained by other factors, including the loss of personal control due to external factors. In addition, hormonal responses can erode individual willpower including long-term volitional-control including long-term capacity to engage in education. Policies to mitigate the impact of the psychosocial determinants of health on stress levels can change the behavioural incentives necessary to select education in preference to short-term gratification.
Future directions: A possible longitudinal research methodology using a social framework based on the Theory of Planned Behaviour, where the data results are analysed using structural equation modelling is proposed