Time to Make a Move

09 Sep 2010 – Elvira Thissen

We all know broccoli is better for us than burgers (right?) and that smoking kills. Yet, our world is still not predominantly populated by healthy creatures. In fact, to focus on one health-related vice, roughly one in four people in England are currently classed as obese and treating obesity-related illness is estimated to cost the NHS £4.2 billion a year, still modest compared to the $147 billion price tag in the US. And these figures do not include cost to wider society and the economy due to absenteeism, lower productivity and so on.

So, why don’t we do what we know is good for us? Behavioural economics research recently confirmed the obvious: when it comes to making decisions on what we eat and how much we exercise, smoke and drink, we don’t take a rational approach but are more on the lookout for short-term satisfaction. If I may add my less scientifically substantiated theory, people are probably not even programmed to eat what is good for them, but are more inclined to just get the kilojoules that enable them to function. This may have posed few problems in the hunter-gatherer society, but in these days of cheap calorific food in abundance, omnipresent sensory stimuli, and often financial constraints, we could use some help in making healthier choices and ultimately transforming behaviour.

For the longest time, healthcare provision has been characterized by a disproportionate emphasis on treatment, or as some have called it: ‘sickness service’ rather than ‘healthcare service’. With the cost of healthcare rising rapidly, the focus of governments and healthcare providers is now shifting to preventing disease from occurring in the first place. A number of GPs in the US recently started giving out ‘veggie vouchers to be used in local farmers markets to fight obesity in children of low-income families. Similar initiatives have been developed in the UK, such as the Young Foundation’s Healthy Incentives in which participants receive support and rewards such as sports tickets or phone credit for going to the gym, using NHS stop smoking schemes or undertaking other healthy activities.

Many of these initiatives are still pilots, mainly because there is considerable controversy around rolling out reward schemes for kicking bad habits more widely. One conclusion all these projects reach though, is that lasting behavioural change is most successful when information provision, incentives, and support all form part of an integrated programme to promote healthier choices. For the time being, the debate is – perhaps unsurprisingly – mostly taking place in policy circles, involving public health actors and sometimes charity representatives. Private health sector actors are not often mentioned as viable partners in tackling health-related challenges. Yet, with the systems-approach to behavioural change proven to be most successful, it is time private actors start assuming a more active role in the necessary move towards creating healthier societies. After all, there is no better way to ensure access to health and improved quality of life – the ultimate goal of all actors across the health value chain – than by preventing disease.

Some examples are starting to pop up. Private health insurers have been offering discounted premiums to customers who engage in health-promoting behaviour. And Nuffield, Britain’s third largest private hospital operator, bought a gym chain in 2007 and, after achieving a 30% improvement in member retention over its competitors, recently started piloting a ‘recovery programme’, where patients in its hospitals are assessed after surgery and then given an exercise regime in its gyms to ensure more durable health improvements.

With almost nine out of ten adults and two-thirds of all children predicted to be overweight or obese by 2050 if no action is taken, there is a clear need for healthcare actors, public and private, to come together and develop innovative prevention programmes that will lead to lasting change and more manageable healthcare costs. The prize will be a more sustainable future both from a social and economic perspective, and possibly an opportunity to save us from having to return to hunting and gathering (even if that might well be the most sustainable option of all….).