Intended for healthcare professionals

Feature Financial Incentives

Does it work to pay people to live healthier lives?

BMJ 2014; 348 doi: (Published 02 April 2014) Cite this as: BMJ 2014;348:g2458
  1. Sarah Strickland, freelance journalist
  1. 1 London, UK
  1. Sarahbstrick{at}

With chronic diseases placing an ever growing burden on health services, governments are increasingly offering financial incentives to encourage healthier lifestyles. Sarah Strickland looks at the trends and the evidence

Although most people value good health in theory, in practice many struggle to lead healthy lives. Even knowing about the long term benefits of regular exercise, giving up smoking, and cutting back on alcohol, sugar, and fat does not necessarily lead people to make those rational choices and forgo more immediate, irrational urges.

With rates of chronic conditions such as cancer, lung disease, cardiovascular disease, and diabetes on the rise around the world (and putting increasing pressure on health services and budgets), the question of what role governments should play in steering, cajoling, or forcing the public to lead healthier lives is more pressing than ever.

“How to have people lead healthier lives is the critical question for modern public health,” says Pekka Puska, former director general of the National Institute for Health and Welfare in Finland, and now a visiting researcher there.

“You need a mix of ‘stick and carrot,’ with the carrot being education, practical services, positive incentives and so on and the stick being regulation and legislation.” Finland has been described as an “international leader” in large scale, government-led health promotion policies (box).

Some countries, including the UK, Australia, and Norway have attempted to nudge people to change their lifestyles by making subtle alterations to their social or physical environment, such as changing the layouts of buildings to encourage the use of stairs and distributing salt shakers with fewer holes free of charge to takeaway restaurants.1

Power of money

In the past few years, as populations have increasingly felt the effects of the global recession, governments have turned their attention to fiscal and cash incentives. Using financial incentives to …

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