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Should disadvantaged people be paid to take care of their health? No

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a594 (Published 08 July 2008) Cite this as: BMJ 2008;337:a594
  1. Jennie Popay, professor of sociology and public health
  1. 1Lancaster University, Lancaster LA1 4YW
  1. j.popay{at}lancaster.ac.uk

    Many countries are turning to cash incentives to encourage people to look after their health. Richard Cookson (doi: 10.1136/bmj.a589) argues that such schemes can save money in the long run, but Jennie Popay believes the problems need a deeper solution

    Of course people living on low incomes would welcome more cash, but handouts conditional on behaving in ways defined as good by highly paid health professionals are highly problematic.

    So what is the problem? Poverty has long preoccupied public health, and social reforms and charitable handouts have always been part of the response. But the welfare systems introduced in countries in the Organisation for Economic Cooperation and Development in the early 20th century signalled a shift from “the poverty problem” to a concern with inequality: from charity to comprehensive systems of social protection based on entitlement.1 These systems were not perfect but their fundamental aim—to develop fairer, more inclusive and cohesive societies—remains relevant.2

    Labelling poor people

    Increasingly, however, conditional cash transfers are the acceptable face of contemporary global welfare.3 Like means tested benefits, these transfers are stigmatising, separating off poor people from society. But they are doubly stigmatising because they also mark people out as irresponsible, unwilling to behave in socially acceptable ways. Unlike benefits that require people …

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