positive for the human papillomavirus (HPV)- a risk-factor for certain forms of cancer- was accompanied by feeling stigmatized. Stigma associated with mental diseases is amongst the leading reasons for the underuse of mental health services (Evans-Lacko et al., 2012). Similarly, the stigma associated with degenerative diseases like Alzheimer or other forms of dementia is likely to discourage individuals from following a screening procedure, for fear of the consequences that might follow it.

# **C. Individual decision-making that affects NCD screening and identification**

In the case of aging-related diseases, two behavioral factors are largely responsible for the low uptake of prevention. The first is that, in contrast to other illnesses, most NCDs remain asymptomatic for a long period of time (Bovet et al., 2015) and lack early saliency. The second is inaccurate individual beliefs and overconfidence, which lead people to undervalue the benefits of screening (Baicker et al., 2015).

Even with a clear understanding of which risk factors lead to NCDs, individuals tend to underestimate their likelihood of suffering from an NCD. This issue relates to the risk-taking behaviors described earlier concerning the formation of NCDs, whereby individuals believe themselves to be less likely than their peers to suffer such poor fortunes (Khwaja et al., 2007, Khwaja et al., 2009). Evidence demonstrates that actual risk and perceived risk for CVDs were weakly correlated, with most high-risk individuals being incorrectly optimistic (Van der Weijden et al., 2007), and that people underestimate their own risk for high cholesterol while overestimating the risk of others (Arni et al., 2021). As individuals underestimate their own risk, they are then less likely to value the benefits of screening and to consider that these benefits are larger than the costs of attending a screening session.

This highlights the role of present bias in the low uptake of screening. People generally tend to be timeinconsistent and delay screenings, and the reduced value that people attribute to screenings reinforces the impact that present bias can have in postponing appropriate preventive care. A theoretical study using US data found that time-inconsistent health investment behaviors -including with regard to screenings- could explain a loss of about four years in life expectancy (Strulik & Wener, 2021). Further studies have also shown that high discount rates are associated with lower screening rates for cancer and measurements of blood cholesterol (Bradford, 2010). It is important to emphasize the relevance of motivation in terms of healthy aging, since preventive screenings are not a one-time process. Usually, screening for NCDs needs to be conducted annually after certain ages. Therefore, these biases can have long-term consequences if motivation for screening uptake remains low.

Loss aversion also influences the motivation to attend health screenings in a subtle way. Even people with accurate perceptions may not take up screening to avoid the realization of a foreseeable bad outcome. A qualitative study in the United States found that fatalism and negative outcome perspectives were important barriers to participation in screening for breast cancer (Peek et al., 2008). Similar findings were obtained across multiple countries, linking fatalism to lower attendance at cancer screening programs (De Los Monteros & Gallo, 2011). Another literature review based on the UK population found fear of a negative outcome as one of the reasons individuals did not attend the regular health checks proposed by the NHS (Harte et al., 2018). While one might think that loss aversion would only affect voluntary attendance at screenings, other studies suggest that this fear also leads people to reject explicit invitations to screening programs (Witte & Allen, 2000). More importantly, loss aversion does not only have a personal impact. A field experiment in Australia showed that loss aversion among relatives can influence an individual’s 16