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Is bribery the best route to sustainable health?

Ksenia Zheltoukhova

18 April 2012

A recent Daily Mail article announcing the NHS plans to pay £1 for every pound of lost weight to eager volunteers has sparked wide debate about the ethics of monetary incentives for healthy behaviours. On BBC Radio 4 yesterday  ( 17 April) Michael Sandel questioned the fine line between a bribe and an incentive, when it comes to encouraging people to be healthier.

Schemes that offer successful participants money for losing weight or quitting smoking have been popular for a while; however, it is the first time that the the NHS (who are piloting this along with a local authority) has funded such an initiative. Some argue that this proposal essentially advocates ‘bribing’, and thus patronising on the part of the state. It is also deemed unfair to those who don’t take up unhealthy behaviours in the first place, and are therefore unable to make money by stopping them. A less-authoritarian approach would be, as suggested, to subsidise the price of broccoli.

In opening the debate, Michael Sandel pointed out that 50% of UK health care spending treats the consequences of unhealthy behaviour, while only 0.5% of spending goes on promoting healthy behaviour. Arguably, paying overweight people to lose weight, or paying smokers to quit could reduce the expenditure on chronic conditions in the long run. The danger, of course, is that once the payments stop, the unhealthy behaviour returns.

The money argument is undoubtedly attractive, and this is why monetary rewards for healthy behaviours can be so enticing. There is, however, another, potentially less contentious incentive for individuals to change their lifestyle – a healthy amount of social pressure.
Various organisations have discovered that encouraging staff to compete with each other in how healthy they can be stimulates amazing behavioural change. A mobile phone app by MeYouHealth, for example, not only sends users reminders to complete their daily health challenge, but also allows them to view the results of others and track the progress against that of colleagues and friends.

We at The Work Foundation are about to start a 16-week Global Corporate Challenge and team up to try to walk, run or cycle more each day. With no cash prizes at stake, beating a few colleagues to the 10,000 steps a day mark would feel just as good.