NICE Citizens Council debates incentives for healthy behaviour

Financial incentives to promote active travel: an evidence review and economic framework

CONTEXT

Financial incentives, including taxes and subsidies, can be used to encourage behavior change. They are common in transport policy for tackling externalities associated with use of motor vehicles, and in public health for influencing alcohol consumption and smoking behaviors. Financial incentives also offer policymakers a compromise between "nudging," which may be insufficient for changing habitual behavior, and regulations that restrict individual choice.

EVIDENCE ACQUISITION

The literature review identified studies published between January 1997 and January 2012 of financial incentives relating to any mode of travel in which the impact on active travel, physical activity, or obesity levels was reported. It encompassed macroenvironmental schemes, such as gasoline taxes, and microenvironmental schemes, such as employer-subsidized bicycles. Five relevant reviews and 20 primary studies (of which nine were not included in the reviews) were identified.

EVIDENCE SYNTHESIS

The results show that more-robust evidence is required if policymakers are to maximize the health impact of fiscal policy relating to transport schemes of this kind.

CONCLUSIONS

Drawing on a literature review and insights from the SLOTH (sleep, leisure, occupation, transportation, and home-based activities) time-budget model, this paper argues that financial incentives may have a larger role in promoting walking and cycling than is acknowledged generally.

A framework for assessing the quality of democratic deliberation: enhancing deliberation as a tool for bioethics

The goal of democratic deliberation (DD) bioethics research is to elicit informed and considered opinions on ethically controversial issues. But the trustworthiness of DD outcomes depends on the quality of deliberations. We provide a framework to evaluate the quality of deliberations and apply that framework to a DD project on surrogate consent for dementia research involving randomly selected samples of the older general public. Using a mixed method approach, we found that participants were very satisfied with the sessions, learned and used new information, were respectful and collaborative, and were able to "reason together" to arrive at societal policy recommendations. Implications and limitations of the paper are also discussed.

Financial incentives to encourage healthy behaviour: an analysis of U.K. media coverage

BACKGROUND

Policies to use financial incentives to encourage healthy behaviour are controversial. Much of this controversy is played out in the mass media, both reflecting and shaping public opinion.

OBJECTIVE

To describe U.K. mass media coverage of incentive schemes, comparing schemes targeted at different client groups and assessing the relative prominence of the views of different interest groups.

DESIGN

Thematic content analysis.

SUBJECTS

National and local news coverage in newspapers, news media targeted at health-care providers and popular websites between January 2005 and February 2010.

SETTING

U.K. mass media.

RESULTS

The study included 210 articles. Fifteen separate arguments favourable towards schemes, and 19 unfavourable, were identified. Overall, coverage was more favourable than unfavourable, although most articles reported a mix of views. Arguments about the prevalence and seriousness of the health problems targeted by incentive schemes were uncontested. Moral and ethical objections to such schemes were common, focused in particular on recipients such as drug users or the overweight who were already stereotyped as morally deficient, and these arguments were largely uncontested. Arguments about the effectiveness of schemes and their potential for benefit or harm were areas of greater contestation. Government, public health and other health-care provider interests dominated favourable coverage; opposition came from rival politicians, taxpayers' representatives, certain charities and from some journalists themselves.

CONCLUSIONS

Those promoting incentive schemes for people who might be regarded as 'undeserving' should plan a media strategy that anticipates their public reception.