The ethics of using financial incentives to encourage healthy behaviour
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Efforts to encourage healthy behaviour often fail to bring about sustained changes in people’s lifestyles. New approaches to tackling chronic disease include the use of financial incentives: rewards paid to individuals conditional upon their achieving some pre-specified target, such as losing weight or quitting smoking. Incentives may provide an extra motivation to adopt healthy lifestyles, and structure behaviour change efforts in ways more conducive to success. Health incentives have, however, provoked controversy, attracting accusations of ‘bribing people to be healthy,’ ‘rewarding bad behaviour,’ and ‘wasting taxpayers’ money.’ It remains unclear how viable health incentives could be as a tool for health promotion; but, even if effective, their contentious nature may still give reason for hesitancy. Here, I explore whether such ethical concerns present us with convincing reasons not to use health incentives. I begin by looking at the nature of the criticisms of incentives in the media, and grouping these arguments into more general themes for discussion. I then proceed to consider each of these in turn, beginning first with debates about the requirements for the state to act efficiently without overstepping its legitimate sphere of influence. I then move on to concerns relating to the potential for incentives to undermine liberty and autonomy. Next, I discuss whether health incentives are unjust insofar as they are undeserved, and how this relates to agent freedom and responsibility for adopting healthy lifestyles. Finally, I consider the worry that using money as a healthcare intervention could corrupt certain values that we care about. In concluding, I seek to give an overall idea as to the ethical permissibility of health incentives, and identify some key features that are likely to render incentives more or less acceptable as a means of improving health.
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