Should incentives be used to help people quit unhealthy habits? NICE's Citizens Council reveals its view
The majority of an advisory group made up of members of the public believes that incentive systems could be an effective way of encouraging people to change their unhealthy lifestyles providing that certain conditions are met. The findings are outlined in a report published today (27 September) by NICE's Citizens Council.
At a three-day meeting held earlier this year, NICE's independent Citizens Council was asked to consider whether there are circumstances when incentives could acceptably be used to help motivate people to live healthier lives.
While this approach is not commonly used in the UK to improve areas of public health, the Council heard of examples where local incentive schemes had been piloted. These included an initiative to encourage pregnant women to stop smoking by offering supermarket vouchers; people receiving cash for losing agreed amounts of weight, and children being rewarded with toys in exchange for eating more fruit and vegetables.
By the end of the Council meeting, 20 out of the 32 members (62.5%) voted in favour of incentive schemes, providing conditions such as the following were in place: that incentives should never be exchangeable for tobacco or alcohol; that they are only offered to people who are committed to changing their health behaviours; that cash incentives should be only offered as a last resort; that the progress of participants is monitored throughout; and that the results of the schemes are analysed so that more can be learnt about their effectiveness.
The Council members agreed that incentive schemes are likely to work best when they are targeted and used as part of a wider programme of support. They should also acknowledge the complex factors that motivate people to put their health at risk, such as by excessive eating or drinking, drug-taking, a lack of exercise or smoking.
Council members who voted against the use of incentives (37.5%) did so for reasons including uncertainty over their long term benefits due to a lack of evidence, their potential for abuse, their cost, and because of their perceived unfairness towards people who are able to live healthy lives without them.
NICE is now inviting members of the public to comment on the views of its Citizens Council, before the report is presented to its Board for consideration.
Sir Michael Rawlins, Chairman of NICE, said: “The Citizens Council makes an important contribution to the work of NICE by providing a snapshot of what the general public thinks about controversial health challenges. Their views do not constitute formal guidance, but they do advise us about the social values that should underpin our work. For these reasons I am extremely grateful that the Council has considered whether there is a place for incentive schemes to encourage people to change their bad habits and live healthier lives.
“We clearly face several public health challenges in today's society, some more obvious than others, and we must seek to improve these in ways that are likely to achieve the best health outcomes for those affected. The majority of the Council has voted in favour of the use of incentives under certain circumstances, but this clearly remains a divisive issue. We are now very keen to hear what the general public thinks about their conclusions.”
The Citizens Council report is available and comments must be sent in by 5.00pm on 26 November 2010.
Notes to Editors
About NICE's Citizens Council
1. The Citizens Council consists of a diverse group of 30 individuals, reflecting the age, gender, socioeconomic status and ethnicity of the people of England and Wales. The council meets twice a year to hear expert information on challenging topics and thoroughly discuss the issues raised. It is a formal committee of the Institute, helping identify broad social values and how NICE might apply them in preparing its guidance.
2. Since the Citizens Council was set up in 2002, it has provided valuable input on a range of issues, including patient safety, harm reduction in smoking, and “only in research” recommendations. Previous reports are available.
About the report
1. The Citizens Council meeting on “The use of Incentives to improve health” took place on 20 - 22 May 2010.
2. Further information about the the Citizens Council report on "The use of incentives to improve health".
3. The definition of “incentive” used by the Citizens Council was “a thing of perceived positive value, offered in order that a desirable health outcome may be obtained, to motivate or encourage an individual to change his or her behaviour”.
4. Members of the public have until 5.00pm on 26 November to submit their comments. The report and a summary of the comments made on it will then be presented to NICE's Board in January 2011 for consideration. Read further information about the NICE Board.
5. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
6. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments, procedures and medical technologies within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS
This page was last updated: 27 September 2010