Dying sooner is certainly not why they started.. rather the bleakness of outlook is a (fairly rational) reason why they don’t quit.
If obesity is supposed to be the other main candidate for why life expectancy is down, you can do a similar analysis there. Is life really good enough to prolong or attempt to improve for people that are in at-risk categories? That’s the question people are looking at when they choose to move towards or away from self-care. For someone who makes minimum wage and already has to choose between paying for a date or paying for rent, it makes less sense for them to care much about losing weight, because it makes a bad life longer but won’t help their love life.
This is how practically all population-level analysis of health is just economics in disguise, even without directly looking at costs of medicine/services
I think your hypothesis is correct but your reasoning is wrong. Few people are morbid enough to think "Oh my life sucks so why bother looking after myself". But if you're constantly stressed because you're struggling in life, small indulgences like smoking, alcohol and fast food/sugar are a lot harder to resist as they provide a much needed outlet/release.
If obesity is supposed to be the other main candidate for why life expectancy is down, you can do a similar analysis there. Is life really good enough to prolong or attempt to improve for people that are in at-risk categories? That’s the question people are looking at when they choose to move towards or away from self-care. For someone who makes minimum wage and already has to choose between paying for a date or paying for rent, it makes less sense for them to care much about losing weight, because it makes a bad life longer but won’t help their love life.
This is how practically all population-level analysis of health is just economics in disguise, even without directly looking at costs of medicine/services