Non-adherence to exercise programmes and guidelines continues to be a massive public health challenge. As few as 5% of American adults achieve the current recommendation of 30 minutes a day of physical activity. The reasons for such widespread low activity levels are complex, but the prospects of a longer life expectancy and higher quality of life don’t seem to be enough to get a lot of people exercising.
Money makes the world go around, so the saying goes… but can it also get the scales to go down as well? The costs associated with obesity related illness are mind-boggling. A recent report by McKinsey Global Institute estimated the global economic burden of obesity to be around US$2 trillion a year, equivalent to 2.8% of global GDP, and nearly as costly as smoking, or armed violence, war and terrorism. If the costs of paying people to be active is less than the costs of an inactive lifestyle, then such a program would pay for itself.
There is good evidence to suggest that a modest financial incentive is effective in increasing exercise session attendance and decreasing weight in monitored short term (1-4 month) exercise interventions. However, it seems that financial incentives do not create lasting positive habits – once financial incentives are withdrawn, the positive effects all but disappear in 3 months. There is little research into whether good exercise habits are maintained for longer periods of time if financial incentives are maintained.
Financial incentives are useful in some for small groups in the clinic, but what about as a public health policy to change the behaviour of large populations? Earlier this week, the winners of the Dubai municipality’s lucrative annual weight loss competition were announced, where participants lost weight in exchange for gold. In Mexico City and Moscow performing squats in front of a motion detecting machine can get you a free subway ticket. These are interesting ideas, but do they promote lasting positive lifestyle changes?
Whether these types of measures are just gimmicks or whether they have genuine long term public health and economic benefits is so far unknown. One concern might also be that there may be potential for people to exploit such measures, for example by putting on weight in order to lose it in exchange for gold, or tricking a motion sensing machine instead of actually doing squats.
Measures encourage cycling and walking are likely to have a significant effect on activity levels. For example a daily payment of £2 per day to cyclists was predicted to almost double the number of cyclists in Britain from 5.8% to 10.9% of commuters. Less popular, but possibly more effective are financial disincentives to drive. Right here in Trondheim, the removal of toll stations in 2005 led to an 11.5% increase in car use during business hours in 2006 at the expense of cycling, walking and public transport. While we may grumble about the expansion of the toll system in the past couple of years, try and remember that toll roads are good for public health! And until the day squats for bus tickets becomes a reality in Trondheim, consider this: 20 days at work is 40 bus trips costing approximately 1200kr each month. After paying for petrol, road tolls and parking, driving is no cheaper than the bus. The snow has melted and your bike/walking shoes are crying out for some action. Your financial incentive for exercising is just waiting to be collected!