Is it right to pay people to be healthy?

Money The NHS has a mixed record when it comes to offering people financial incentives to be healthy

Offering people financial incentives to adopt healthy behaviour is a controversial area of public policy.

People understandably question why some people should be paid for doing something that many others do for nothing.

Surely, the fact it benefits them personally in terms of their health - or their baby in the case of the latest idea put forward to offer mothers £200 of shopping vouchers to encourage breastfeeding - should be enough of an incentive?

However, advocates of this approach argue sometimes it is not.

They point out that behaviour can be so ingrained or subconscious that people may need something to jolt them out of their bad habits.

As far as the NHS is concerned, what matters is what is cost-effective: do the gains outweigh the costs?

In terms of breastfeeding, the UK has some of the worst rates in the developed world.

Mixed record

Unicef estimates £40m a year could be saved if the numbers were improved because of the health benefits - breastfeeding has been shown to reduce cases of stomach problems, asthma and other respiratory conditions.

But the NHS does have a mixed record with financial incentives.

In 2009, officials in Kent set up a weight-loss scheme - Pounds for Pounds - which offered participants cash payments of up to £425.

Less than half achieved significant weight loss and a high drop-out rate meant that evaluators were unable to recommend it as a way of tackling obesity.

However, health officials in Dundee have had more success with a stop smoking scheme.

The NHS there ran a two-year programme offering smokers £12.50 a week to quit smoking.

By the end of three months, nearly a third of participants end up kicking the habit - more than twice as many as other smoking cessation projects achieved, figures released last year showed.

But one of the key reasons this was a success was that it was easy to police.

Judgement the key

Smokers were asked to take regular breadth tests which were extremely accurate at gauging whether the person had lit up.

By comparison this latest initiative is going to rely on the judgement of midwives and health visitors to determine whether the women taking part are indeed breastfeeding.

This raises the question about whether it will be open to abuse.

Prof Theresa Marteau, director of the Behaviour and Health Research Unit at Cambridge University, says this is often cited as a concern for such schemes.

She is carrying out research into gaming with early findings suggesting it is limited to the "minority".

"It is a debate we need to have. There is understandable sensitivity about rewarding people like this when the finances are so tight. But just because if does happen it doesn't mean we shouldn't do it."

Another potential hurdle is that the team behind it are not imposing any restrictions on what the vouchers could be used for.

It means those taking part could purchase cigarettes and alcohol.

This contrasts with work done by what was the National Treatment Agency five years ago with drug users.

They were offered vouchers, but were not allowed to spend them on luxury items.

One of the key reasons for this was to make sure the project retained the confidence of the public.

But to be fair researchers say this is only the first stage of the piloting of this idea.

If it goes forward for a nationwide pilot next year, changes could be made to the way its run.

What happens next with this project will be watched with interest.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 228.

    If we were all as perfect as some of the people posting on here we wouldn't need the NHS, Police, Emergency Services etc.
    Imagine how much money we could save?

  • rate this

    Comment number 227.

    what about those of us who are unable to breast feed? We already get lumped into the 'won't bother' group. For many of us it is a source of great sadness that we could not nurture our own babies.

    And if you offer an incentiive then say you do not have a free choice of what to spend it on, it is an insult to those eligible to receive it.

  • rate this

    Comment number 226.

    As a mother who is committed to breast-feeding, I have no problem with giving out vouchers to encourage the practice, provided we ALL get them, regardless of what our intentions were before they were offered. And no, they should not be used for booze/fags/etc.

  • rate this

    Comment number 225.

    Why not spend the money are more important things like actual health care?

  • rate this

    Comment number 224.

    Unplug the internet and watch obesity rates fall...
    Take away free healthcare and watch general wellbeing increase
    Remove some of the stress of working in the UK and watch mortality rates reduce.
    We are the architects of our own demise.

  • rate this

    Comment number 223.

    Dumdeedum / Koolkarmauk - agree 100%. This thread more than any other serves to demonstrate a point that I have been making for years - that 'public health' has become an acceptable smokescreen for hatred of poor people, particularly those who also happen to be fat. I would love to believe the vile opinions on here are those of a minority, but daily experience increasingly suggests otherwise.

  • rate this

    Comment number 222.

    Maybe the more pertinent question should be why the BBC sees the need to provide FIVE different forums to discuss this proposal.

    (Yesterday there were two open HYS discussion and a comments thread on each of the FB pages for Breakfast, Look North and One Show).

    What is the Beeb's agenda? To promote health bribery, ferment hostility against fat people etc - or distract from something else?

  • rate this

    Comment number 221.

    Direct treatment of diabetes : 9.8 billion
    Treatment of diabetes complications: 7.7 billion (kidney failure, nerve damage, stroke, blindness and amputation)
    Include extra heart disease, fat cancers etc & the 7.7 billion rises to 11 billion.
    Direct treatment of obesity alone: 4.2 billion (fat operations, fat pills)
    Diabesity total: 25 billion
    Total NHS cost 108 billion

  • rate this

    Comment number 220.

    Is this a rhetorical question BBC?

  • rate this

    Comment number 219.

    No, people shouldn't be paid (from *our* money) to be healthy. Lifestyle is a matter of individual choice. But if someone's lifestyle is shown to cause their ill-health (especially if it disregards medical advice) then it's reasonable to give them lower priority in access to publicly-funded health care.

  • rate this

    Comment number 218.

    Absolutely the right thing. Give one reason why it might be wrong to do so.

  • rate this

    Comment number 217.

    Absolutely, in my case I used to love my work and I was amazed how well I could do from being paid to do the thing I loved most! The thing is, if you don't do the things you love you don't do them well and build up coldness or rage, so yup, only do the work you love and get paid for doing it!!

  • rate this

    Comment number 216.

    If people want the right to take responsibility for their own choices then they should do so.

    It's a case of doing the right thing for the right reasons, and as far as people and their families health is concerned, money is the wrong reason.

  • rate this

    Comment number 215.

    It's a great deal. My partner only has to Breastfeed 24 babies a day and that's better than the minimum wage!

    Where do we sign?

  • rate this

    Comment number 214.

    I'm more concerned about the government 'rewarding' unhealthy people with free medical care. Surely someone who makes sensible decisions deserves recognition in comparison to someone who is morbidly obese and requires expensive medical care that the tax payer has to pay for. If it's self-inflicted then they should be paying for their healthcare themselves. No exceptions.

  • rate this

    Comment number 213.

    Energy bosses & bank executives get paid a lot, & they're quite healthy, a lot more healthier than many people on minimum wage.

    If a living wage was paid, then more people could better maintain themselves with better quality food/diet.

    Poorest people in world are among the unhealthiest, including UK, so paying people enough, is a major contributor to people being healthy

  • rate this

    Comment number 212.

    Why are all these BBC Correspondants 'Men in Black' ?

  • rate this

    Comment number 211.

    No.............its not.

  • rate this

    Comment number 210.

    At the moment the pharmaceuticals profit when we are sick, the goal-posts are in the wrong place, the incentive is for them to make us sick i.e. look through vaccine ingredients, then keep us sick and permanently on their drugs.

    This whole sick system needs to be torn down and replaced with one where the goal-posts are down the other end of the pitch; pay the pharmaceticals per healthy person

  • rate this

    Comment number 209.

    Responsibility,dignity... dare I say nobility!!!!!!!!!!!!
    Our culture seems to be lost, drowning in a sea of selfish non reflective ignorance; which ultimately, is completely self destructive, whether a slovenly bum or a ruthless city banker. Where did moderation go, insight into our lives???


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