Labour’s nanny state’s health bribes of questionable value
Their verdict comes as advisers to the Department of Health are promoting such schemes and as private health insurers are offering discounts to subscribers who go to the gym, eat more fruit and take other steps towards a healthier lifestyle.
In Dundee, smokers are being offered £12.50 a week by the NHS if carbon monoxide testing shows they have quit. In Essex, pregnant women can claim a £20 food voucher from the NHS after stopping smoking for one week, £40 after four weeks and another £40 at the end of a year if they have still quit.
Brighton offers children £15 for quitting smoking for 28 days, while overweight patients in Kent are also being offered incentives for losing weight. In the US and other countries incentives have been offered for weight loss, complying with diabetes treatment, or regularly testing negative for sexually transmitted diseases.
Such schemes are controversial with the public and professionals, say Theresa Marteau and Richard Ashcroft, professors of health psychology and bioethics at King’s College and Queen Mary universities in London.
Writing in the British Medical Journal, they say the programmes are attacked as “a form of bribery” and “rewarding people for unhealthy behaviour”, while others believe they undermine the doctor patient relationship and remove patients’ autonomy.
But they say evidence is emerging that some programmes may work, although research is needed to establish “the conditions under which change is achieved and sustained, and for whom”, and to identify unintended consequences.
“Using payments may be more powerful than providing information, and less restrictive than legislation [which attempts to ban or punish activities],” they say. “Ultimately, if incentives prove to be effective in only a few contexts, they may still offer an important means to improve health.”
Julian Le Grand, chairman of Health England, said the difficulty with prevention programmes was that the costs of unhealthy lifestyles could be far off in the future, while the pleasures from them were felt now. Policies were needed that provided some of the benefits of changing lifestyle in the present, he said.