The acceptability of carrots

Jane Eunson and Lorraine Murray on the moral acceptability of using financial incentives to change behaviour.
Download the article as a PDF Using financial incentives to encourage behaviour change raises questions about their effectiveness - but also about their acceptability in the face of moral concerns. We look briefly at the current evidence base before exploring the views of the Scottish public on whether, and when, they should be used. One way that public bodies try to encourage better, healthier lives is by using financial incentives. People who make positive steps to change their behaviour - stopping smoking or taking more exercise classes for example - are rewarded with cash or vouchers. As with any intervention, incentive schemes need to be shown to be effective before they are implemented more widely. Incentive schemes, however, face the additional task of overcoming the moral concerns of some sections of the public. Incentives can work – at least in the short-term Some incentive schemes show impressive short-term results but several studies show disappointing results a year or so after the intervention. While the literature identifies some features of incentive schemes that appear to impact on their success, a greater understanding of how incentives influence behaviour is needed to maximise their effectiveness. It does, however, appear that incentives have the potential to act as a ‘hook’, encouraging people to engage with services and make short-term changes. Professionals then have the chance to work with them to tackle the root causes of their behaviour and help them to sustain the changes – an opportunity they must take full advantage of. But they raise moral concerns However, even if incentive schemes show long-term results, governments still have to convince some of us that they are acceptable. Criticisms include it being an unfair use of public money to ‘reward’ people for their previous ‘bad’ behaviour (e.g. smoking, over-eating or drug-taking) and concerns about the potential negative effect on our intrinsic motivations – could we become a society driven by the need for a reward and less willing or able to do things for our own sake? There are also those who feel such schemes are morally wrong because they amount to bribery or coercion. What do the Scottish public think?

Results from our recent survey show that Scottish adults are more likely to oppose than support schemes which involve paying people to encourage them to change their behaviour. However, as the chart below illustrates, there is less opposition to some things than others. Opinion is divided on paying people to give up smoking when pregnant (49% support and 44% oppose) or attend parenting classes (42% support and 44% oppose). For other behaviours, higher proportions oppose than support, with the highest levels of opposition being for paying people to lose weight (58% oppose) or take more exercise (57% oppose). It seems there is a little less opposition when there is a direct benefit to children.

Levels of opposition/ support for PAYING people to change different behaviours[1]

Scottish adults (n=497), interviewed by telephone 7-14 June 2012

However, the results also show that the nature of the incentive and the way schemes are described affects how people respond. Half of our sample was asked the same question with the words ‘payment’ and ‘paying’ replaced by ‘reward’ and ‘rewarding’ - descriptions which do not necessarily imply the use of money. As the charts below show, this makes a big difference: we now have a majority in support of schemes which ‘reward’ people.

Levels of opposition/ support for REWARDING people to change different behaviours[2]

Scottish adults (n=506), interviewed by telephone 7-14 June 2012

Increase in support when asking about ‘REWARD’ rather than ‘PAYMENT’

Scottish adults (n=1,003), interviewed by telephone 7-14 June 2012

But perhaps some of the opposition is because people are sceptical of the benefits of such schemes - rather than because they are morally opposed. People who said they were opposed (to paying or rewarding people to change one or more of the behaviours listed) were asked whether their view would change if incentives were found to save the country money overall. This shifted the views of half of those who were initially opposed: 26% said they would be more likely to support such schemes and a further 27% said they would be more likely to support them for some of the behaviours but not others. The remaining half (47%) said it would make no difference. Where next? There is still a way to go before financial incentive schemes are recognised as effective mechanisms for behaviour change, with further research required to identify the situations in which they work best and the factors which maximise their long-term effectiveness. And the debate about the morality of such schemes will continue – a minority remain opposed on principle. But the nature of the incentives, what they are called (‘rewards’ rather than ‘payments’) and evidence that schemes are cost-effective will make a substantial difference to their acceptability in the eyes of the public.

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Notes [1] The question was “Governments often encourage people to improve their health and well-being. One way they do this is by offering people some kind of payment to encourage them to change their behaviour. For each of these behaviours, would you support or oppose the Government paying people?”

[2] The question was “Governments often encourage people to improve their health and well-being. One way they do this is by offering people some kind of reward to encourage them to change their behaviour. For each of these behaviours, would you support or oppose the Government rewarding people?”

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