Pregnant women were offered cash to give up smoking in one NHS pilot Saturday, January 29, 2011
Rewarding clean living
Pregnant women were offered cash to give up smoking in one NHS pilot We all know what we should be doing to be healthy. But that doesn't meant that we actually do it. In this week's "Scrubbing Up" health researchers Becky Brown and Marianne Promberger say the NHS should pay people if it stops them pursuing unhealthy behaviour.
Schemes that offer financial reward for healthy behaviour are being tried out across the UK. Rewards have been seen to work well in drug treatment programmes and in helping pregnant women stop smoking. Even so, where the financial rewards work should we use them?
The use of incentives is controversial. Should people be paid to do what they ought to do anyway?
The issue here is one of fairness, and to what extent we should hold people responsible for diseases they suffer as a result of what some consider to be a lifestyle choice.
Evidence however suggests that much of our behaviour is automatic and cued by the environment, and that socio-economic and genetic factors influence how well we can resist this influence. With this in mind, we must consider carefully how we apportion responsibility to people who smoke or are overweight. Where incentives prove to be cost-effective, are we willing to pay even more money - through later NHS treatment - because of our distaste for "unfair" rewards?
Becky Brown and Marianne Promberger“As taxpayers, we'll all be paying later to treat diseases that people contract through over-eating, smoking or not taking enough exercise.”
Policy makers are showing an interest in the potential for incentives to help tackle difficult public health issues we are currently being faced with. One scheme outlined in the recent government White Paper on health, "Step2Get" proposed to encourage more school children to walk to school. Points are collected (and redeemed as rewards) by swiping a card against receivers placed along a safe walking route to school. Pilot studies indicate that such schemes could significantly reduce overcrowding on buses and associated anti social behaviour, as well as increasing physical activity.
Individual PCTs have also introduced incentive schemes. For example, in Birmingham pregnant women have been offered vouchers in exchange for quitting smoking. In Kent, participants in 'Pounds for Pounds' have been rewarded for losing weight with cash payments.
The evidence for the effectiveness of incentives is mixed. Rewards seem to work well in drug treatment programmes and in helping pregnant women stop smoking, but less so in programmes for general smoking cessation and weight loss. There is little evidence about whether they work long term, especially after the incentive has been removed.
We need more systematic research based on established behavioural principles to understand the conditions under which incentives work best. However, we believe that policy in this area should be results driven. Concerns about fairness and encouraging responsible choices must be subject to scrutiny, and must be traded off against other outcomes such as money, and reduced pain and suffering.
The burden of chronic disease brought about by smoking, unhealthy diet and physical inactivity continues to increase, in the UK and elsewhere. As taxpayers, we'll all be paying later to treat diseases that people contract through over-eating, smoking or not taking enough exercise. Where there are shown to be cost effective ways of improving health, there will need to be strong justification for turning our backs on them.
This article is from the BBC News website. � British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.
Source: http://www.bbc.co.uk/go/rss/int/news/-/news/health-12180526
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