Monday, 27 September 2010

The Incentive Dilemma

“Can cash incentives encourage better health choices?” That is the question being bounded around by the media today.

The answer, it seems is ‘yes’. With the mainstream media reporting this morning that a report by the independent Citizens Council, run by the National Institute for Health and Clinical Excellence (Nice), backs schemes that offer incentives to people to quit smoking or eat healthier food, i.e. leading to positive changes.

This was always going to be a thorny issue and with the BBC using the catchy “Swap ash for cash” and “Gain pounds for losing pounds” in a report this morning, it’s something that will bring out strong opinion.

Britain is the most overweight country in Europe and fifth in the developed world; hardly a great endorsement ahead of the 2012 Olympics celebration of physical achievement. However, when we look at this, perhaps the fact that we have such a developed NHS helps create an environment in which its OK to become obese, because there are plenty of safety nets and support services available for free (at least as it would seem).

So, we hear that these incentives are “an effective way of encouraging people to change their unhealthy ways”. With pressures to cut costs in the NHS, the business case for programmes like this suggests that it could be a worthy investment.

However, it’s the question of morality that is going to rage on this one. A question that will be addressed in further posts and as this story develops.

In the meantime, I have some fears about the message this story sends. In particular, to smokers considering stopping smoking or overweight people preparing to improve their lifestyle.

Are “Swap ash for cash” and “Gain pounds for losing pounds” schemes on their way? Is this an incentive to smoke for a while longer to wait for the pay-off? This might sound like an infantile comment to make, but when faced with the pain of breaking an addiction, we often look for reasons to maintain our behaviour and this could be yet another excuse to put it off for another day.

Its pretty clear that we haven’t heard the last of this one.


You can view the press release from NICE here:

Read the BBC article at;


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