New York’s road to healthBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a673 (Published 08 July 2008) Cite this as: BMJ 2008;337:a673
All rapid responses
New York’s Road to Health. Article published 8/7/08 BMJ
Should we applaud or cry when we discuss how appropriate is it to
provide cash incentives for people to look after their health?
Opportunity NYC ( Pilot Project through The Rockefeller
Foundation)certainly is well backed by a number of leading private
organizations and is attempting to alleviate the poverty cycle, but to
what extent should they alleviate a national government’s responsibility
with respect to health provision ( which they state is a response to a
lack of federal government action)and access for all? Jennie Popay (2008)
Professor of sociology and Public Health, suggests we are creating further
stigmatization and isolating poor people from society.
The Australian Health System offers universal healthcare coverage.
One of the underlying Health Systems Principles we have is that health
care must be accessible and based on health needs and not the ability to
pay. ( Duckett S 2007)
Any form of health inequality must be addressed beyond such existing
programs as identified above, and requires action that will further
influence political policy makers to respond and recognize the needs of
According to Braveman et al (2003) a community’s response to any
measure which is attempting to address inequality is linked too learned
behavior. How individuals respond to changes in their health system will
most likely be influenced by their physical and social circumstances,
opportunities and their environment. Empowerment and better decision
making in these areas will not only be valued if there is a sense of
shared responsibility where participation is freely engaged in, but also
where the community can make informed decisions through their access to
By equity in health we also mean equal opportunity to be healthy and
this can’t be separated from the concept of equal rights to health. This
has been clearly identified within the Universal Declaration of Human
Rights where it is stated that “the attainment by all people of the
highest possible level of physical and mental well being “.
If communities are to respond effectively to these principles, then
access to health should not be dependant on a fee for service for those
who have money, nor should there cash incentives provided for rewards.
Everyone should have equal access and incentives should pertain to the
attainment of healthy lifestyles. (Parry et al 2003)
Health access must be a national issue, and the goal is to address
ways to ensure that there is equal access for all, if social disparities
are to be reduced in health. A commitment needs to come from everyone if
there is to be a positive change in health behavior.
1. Braveman, P et al. (2003) Defining equity in health. Journal of
Epidemiology Community Health, 57, 254-258.
2. BLOOMBERG, M. (2007) Mayor Bloomberg announces first Incentive
payments to families in Opportunity NYC, The nation's first conditional
3. DUCKETT, S. J. (2007) The Australian Health Care System.
4. PARRY, J. (2003) Health impact assessment and the consideration of
health inequalities. Journal of Public Health Medicine 25, 243-245.
5. POPAY, J. (2008) Should disadvantaged people be paid to take care
of their health? No 10. British Medical Journal, pp: 673.
Competing interests: No competing interests