Technology and Economic Incentive: The Way Forward for Health Policy?

By Naomi Norden

The Government has recently announced a new pilot scheme which it hopes will prove a positive force in tackling the high – and increasing – obesity levels across the nation. The scheme will reward those who, for example, increase their step count or eat healthier, in line with personalised hints from a device resembling a Fitbit. On successful response to these recommendations, points will be collected and exchanged for food or clothes vouchers, gym passes, and shop or cinema discounts. £3 million in funding has been unveiled to cover the cost of the rewards, and the pilot will run from January 2022 for six months.

At present, nearly two-thirds of the adult population in England are overweight or obese, and illnesses linked to this excess weight are estimated to cost the NHS a staggering £6bn per year. Coupled with the link between obesity and increased COVID-19 fatality, new policy is indeed needed, so it is encouraging that the Government are exploring this new type of policy.

The contract for developing the app to work in conjunction with the wrist-worn device has been granted to HeadUp Systems, a company specialising in data science and health technology. This marks a significant change in the direction of government health policy. In the words of Sir Keith Mills, the inventor of Air Miles and the Nectar Card and Health Incentive Adviser to the Government, it explores “how government, business and the third sector can work together to deliver a new and engaging way of supporting the public to make healthier choices.” As technology exponentially becomes paramount in all areas of society, it is not unreasonable (in fact, it is arguably a necessity) that public policy keeps pace and harnesses the expertise of companies such as HeadUp Systems. 

Moreover, existing policies in this area lack inventiveness and incentives. Ever-increasing obesity rates indicate that such policies are clearly not working in the way they should be. Consider the ban on advertising foods high in fat, sugar, and salt (HFSS) before the watershed, for example, which research suggests will not make any notable impact on public health. Between 2015 and 2019, chocolate confectionery sales rose by 16.3%, despite government calls for companies to reduce the sugar content of their products. More decisive and impactful policy is vital and, thankfully, it appears that Sajid Javid, the health secretary, has now realised this. 

Yet while the technology-focused direction of policy is important, it comes with its risks and, with this scheme in particular, impracticalities in implementation. The first issue lies in privacy and data collection. Many people, understandably, do not want the Government gathering information on their movement and eating habits, nor should the Government have cause for insisting on this information. 

The pilot scheme itself may be simply implemented, given its small scale. But the coordination behind getting Fitbit-like devices to even a mildly significant part of the population is enormous. Add that to the unfeasibility of ensuring people are wearing them, using the app correctly, putting truthful information in the app – the list goes on – and the Government are left with a logistical nightmare. 

Most importantly, however, the policy will benefit those who do not truly need it. People with the time and money to exercise more and buy and prepare healthier foods are likely already doing so. Those on lower incomes, who are statistically more likely to be overweight and obese, are often forced into eating unhealthier foods because they do not have the time, money, and facilities to foster a healthier lifestyle. If the one of the principal ways to earn rewards from this policy is to eat healthier, such an objective is unachievable for whom these policies should be largely designed. 

The use of economic incentives and cutting-edge technology in health policy is a welcome development in an area that has appeared stagnant for many years. However, this theoretically plausible policy will not work in reality. What the announcement of this pilot scheme does do, nonetheless, is herald a new generation of health policy and reveal a government capable of showing initiative in its pursuit of solutions to the nation’s dire public health situation.