Exchanging ideas to create the well-being advantage

What’s your incentive for choosing a healthy lifestyle?

NICE (The National Institute for Health and Clinical Excellence) is putting forward a new initiative to encourage healthier lifestyles – using financial incentives to change behaviour.  Rewards are set to include groceries for quitting smoking, sports tickets for participating in healthy activities and shopping vouchers for staying drug-free.  Already, several NHS Trusts have started their own schemes – for example Tayside in Scotland are offering weekly grocery vouchers of £12.50 to pregnant women if they haven’t smoked that week.

Opinions vary on whether this is a worthwhile initiative.  In support, you might argue that people respond to incentives and anything that encourages people to adopt a healthier lifestyle is a good idea.  In contrast, you consider this to be bribing people to do something that should already do, or even encouragement for people to start smoking a few cigarettes in order to qualify for the scheme.  Critics argue that public money should not be spent in this way – pregnant women should give up smoking for the sake of their unborn children rather than for financial gain.

As with most initiatives, the evaluation process is going to be critical in determining whether it is successful and sustainable.  The Tayside scheme was seen as a success by the NHS because of the 450 women that have taken part, half had given up smoking a month after enrolling and one-fifth (21%) had still quit after a year.  This is twice the success rate of standard stop smoking services.

To answer the sceptics, the evaluation research will need to be broader than measuring drop-out rates for participants.  The cost-benefits for large numbers of people becoming more active and giving up smoking will be reflected in personal health implications and the subsequent effects on NHS services.  Long term savings can be made by reducing levels of obesity and smoking, for example parents who stop smoking will be healthier themselves, and will also reduce their children’s chances of developing asthma.  Only when measuring these wider outcomes can the initiative properly be assessed on whether it is successful, sustainable and value for money.

Of course in an ideal world, everyone would make healthy lifestyle choices without the need for financial incentives.  However, this is frequently not the case.  So realistically, the use of incentives may need to be part of the longer-term solution by embedding healthier behaviours.  If these in turn become the ‘norm’ we could quite quickly see sustained and broader improvements in the overall health of large numbers of people.