Should people be paid to live healthy lifestyles?

Our behaviour as patients and the lifestyle choices we all make have a big impact on our health. For example, if we smoke, then we are more likely to develop cancer and heart disease and less likely to be able to control our asthma. That has a personal cost but also costs the NHS and the taxpayer.

So far we have been encouraged into healthy behaviour through a mixture of carrots and sticks – better smoking cessation services, for example, and banning smoking in places like bars and restaurants.

Now policy makers are debating whether we should be paid to live more healthily. And asking what the public think is fair.

Experimental evidence suggests that paying people who smoke a regular sum of money – with some cash dependent on keeping away from cigarettes after a number of months – is effective in persuading some heavy smokers to drop the habit.

Some policy makers argue that the NHS should use these methods more widely, on grounds that we need to encourage more people to stop smoking, especially in deprived areas.

But others argue that this penalises responsible behaviour. If you don’t smoke or have given up already, in effect, you lose out. ‘Why reward bad behaviour?’, they argue.

Debates like this are going to become more common as the NHS faces tighter budgets and greater public scrutiny for public health measures.

Meanwhile, research shows that people with asthma are at least as likely to smoke as the general public. Persuading them to stop is going to be important in improving their asthma control and reducing unnecessary hospital admissions.

The argument extends from smoking into other areas of behaviour – exercise and diet, for example, are both known to affect our long-term health.

How should we encourage people to act responsibly? What do you think is fair?

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