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Eat an Apple, Earn $1: Can We Buy Health?

Posted Nov 03 2008 2:01pm

by Gabrielle Grode

How can financial incentives change the food landscape? Can padding people’s pockets foster behavior changes at industry and individual levels?

In October, the Rudd Center hosted two seminar speakers who both spoke of how they have used monetary rewards to achieve desired outcomes. To be sure, using financial incentives to promote or discourage certain behaviors is nothing new – cities lure businesses by providing tax breaks, transportation officials increase tolls to reduce driving, public health officials raise taxes on cigarettes to decrease smoking. Increasing taxes on junk food has also been discussed. But what we heard from our speakers was slightly different: they both described initiatives that put dollars directly into individuals’ wallets to prompt change.

We first heard from Thomas A. Dziki, LEED® AP, Vice President of Sustainable Development for United Natural Foods, Inc. (UNFI). UNFI, based in Dayville, CT, is the leading independent national distributor of organic and specialty foods in the U.S. and is deeply committed to sustainable and green practices. In an effort to encourage distributors to reduce energy consumption, UNFI created a contest in which the site that decreased its consumption the most would receive money – $5,000 to the top manager and additional rewards for the associated employees. Did it work? Yes, it did, pretty well in fact. UNFI saw a 37% decrease in energy consumption and two years later, consumption had decreased by an additional 7-8%. The changes in policy and practice had become instilled.

Interesting, I thought. I wonder how we could use this idea to encourage change in the industry and in individuals. Would it work with a company like PepsiCo? Maybe we would be better off targeting smaller enterprises, like corner stores, say $2,000 to the store that sells the most produce. What about individuals – could we pay people to eat healthfully? To my surprise, the speaker we heard the very next day also described using money to encourage behavior change.

Robert I. Berkowitz, MD, Psychiatrist-in-Chief at The Children’s Hospital of Philadelphia and Associate Professor of Psychiatry and Pediatrics at the University of Pennsylvania, described an initiative to make pediatricians more aware of childhood obesity and better equipped to treat it. To encourage physicians to include obesity in their assessments, money was given to the physicians who identified overweight in children.

From these two examples, it seems that one effective way to get people to change is simply to pay them! A third example comes from Opportunity NYC, modeled after the successful Progresa, now called Opportunidades. Opportunity NYC seeks to alleviate poverty in the short term by paying families when they meet specific targets in children’s education, family preventive healthcare practices and parents’ workforce efforts, a concept know as Conditional Cash Transfers (CCTs). Families can earn between $4,000 and $6,000 per year depending on multiple factors, including activities completed, which range from superior school attendance to regular dental visits.

What do you think of these initiatives? Are there ethical concerns in paying people to change their behavior? Who should fund programs like this? Most importantly, how can we apply this financial reward concept to our quest to improve how and what people eat? Ten bucks goes to the most creative response!

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