Last updated: 10/09/2024
Fund citizen incentives to improve healthier behaviours
Allocate £500 million over five years to fund a programme of financial incentives to improve health behaviours in local authorities (LAs) with the highest obesity rates
- Moderate impact on obesity
A percentage estimate of how much the policy would reduce national obesity rates
- Relative reduction in obesity prevalence: 0.7%
- High evidence quality
A rating of the strength of evidence, accounting for both reliability and validity of the evidence
- Reliability and validity rating: 4/5
- High cost to governments
Cost to UK and devolved governments over 5 years
- Costs to governments over 5 years: £500m
- Benefit to governments per year: £0.3bn
What is the policy?
This policy proposes that the UK, Scottish and Welsh Governments will provide funding to local authorities (LAs) with the highest rates of obesity to design and deliver a range of programmes that use financial interventions to improve health behaviours in the area. Health behaviours could include things like healthy eating and increasing physical exercise.
Recent context
In 2022, the UK Government announced it was piloting an app in Wolverhampton which offers incentives (eg, vouchers for shops, cinema tickets) for people who eat healthily and exercise more. This was announced as part of the UK Government’s obesity strategy, aimed to empower people to make healthier choices. The pilot launched in 2022 and an evaluation of the programme, commissioned by the Office for Health Improvement and Disparities, is currently in progress.
The Welsh Government could explore this policy as public health is devolved in Wales. However, unlike in England where local public health teams are integrated into LAs, local public health teams in Wales are integrated within the Local Health Boards. However there are seven Local Health Boards and 22 LA areas in Wales, meaning that providing the funding to LAs could ensure a more targeted geographical approach. If the Welsh Government wanted to explore this policy, it would need to consider the most effective governance arrangement for the funding.
As public health is devolved in Scotland, financial incentives would likely be delivered through partnership working between LAs and Health Boards. Scotland has previously rolled out schemes offering financial incentives for improved health behaviours. Between 2007 and 2009, NHS Tayside (a Scottish Health Board area) trialled providing grocery vouchers via community pharmacy support to encourage pregnant people who smoked to quit. The scheme ‘Give It Up For Baby’ recorded quit rates at 54% at four weeks, 32% at 12 weeks and 17% at three months postpartum. The scheme found that participants from higher socialeconomic areas were more likely to be successful at quitting. Overall, evaluation of the scheme by Radley et al. (2013) showed that financial incentives can encourage attendance at routine advisory sessions where they are seen to form part of a wider reward structure, but work less well with those on lowest incomes who demonstrate high reliance on the financial reward.
Case studies
HealthyFood Switch Incentive Programme, South Africa
The HealthyFood Switch Incentive Programme provided financial incentives to households in low-income communities for purchasing healthier food items. Participants received a monthly voucher that could be redeemed for discounts on fruits, vegetables, and other nutritious foods at participating retailers.
Research has shown that providing rebates (discounts) on healthy foods can lead to positive changes in people’s food purchasing habits. When a 10% rebate (discount) is offered on healthy foods, people tend to spend 6% more of their total food budget on healthy items and spending on fruits and vegetables specifically goes up by around 5.7%. Additionally, their spending on less healthy, undesirable foods decreases by about 5.6%. With a higher (25%) discount offered on healthy foods, total budget spending increases to 9.3% and spending on fruits and vegetables goes up by 8.5%. Their spending on less healthy, undesirable foods also decreases by about 7.2%.
Considerations for implementation
The Wolverhampton study mentions the use of personalised goals to achieve points. There is a risk that this method could widen inequalities where those with larger health inequalities may be given harder goals and therefore find it harder to earn points. Equally there is a similar risk if all participants have the same goal, where the goal might be harder for some participants than others.
Estimating the population impact
We estimated that this policy would reduce the prevalence of adult UK obesity rates by approximately 0.7%
Estimating the per-person impact
In lieu of published findings of the evaluation of the Wolverhampton pilot study, data for modelling impact was taken from Hulbert et al. (2022). This meta-analysis of 19 trials examined the effectiveness of providing incentives to participants in lifestyle modification programmes to improve obesity-related outcomes. Relative to control groups, people who received an incentive had increased reductions in weight (−1.9kg) and BMI (-0.47 kg/m2). View how we selected the evidence and the findings of the meta-analysis.
Estimating the population reach
In our analytical model, we assumed a maximum of five pounds’ worth of incentives available per week for meeting health behaviours. This results in a total cost of £260 per person per year (this is similar to the cut-off threshold referenced in Hulbert et al. [2022]). We estimated that £100 million per year could reach approximately 450,000 individuals.
We assumed that people experienced the incentive intervention across a one-year period, and then regained weight at a gradual pace, using weight regain estimates from behavioural weight management programmes. We applied the effect to adults living with overweight and obesity. For adults that is people aged 18 and above with a BMI of 25+ (or 23+ for specific ethnic groups). We assumed no effects for children. We also assumed that the funding would be targeted to areas of deprivation and hence selected individuals living in geographical areas with an Index of Multiple Deprivation of four or five.
Changes in the prevalence of people living with obesity
Table 1 shows the percentage reduction of adults moving from BMI ≥30 into a healthier BMI category following introduction of citizen incentives to promote healthier behaviours (five-year follow up).
| Adults (England and Wales) | Children (England and Wales) | Adults (Scotland) | Children (Scotland) |
| 0.7% | Not applicable | 0.4% | Not applicable |
Cost and benefits
Cost over 5 years
We estimated that this policy would cost the governments approximately £500 million over five years
We commissioned HealthLumen to estimate the cost of the policy to both industry and governments over a five-year period. Table 2 below shows a breakdown of costs. The direct costs to the governments are estimated at £500 million. The costs to the industry are not applicable here.
| Group affected | Cost | Horizon | Detail |
| Costs | |||
| Government | £0.5bn | Annual (5 years) | Provision of funds for LAs |
Total annual benefit
We estimated that this policy would have an annual benefit of approximately £0.3 billion
Using analysis conducted by the Tony Blair Institute and Frontier Economics we estimate this policy would result in benefits of approximately £0.3 billion per year. Approximately two-thirds of this saving would benefit individuals (via quality-adjusted life years, and informal social care). The remaining third relates to savings that benefit the state via NHS treatment costs, productivity and formal social care. See our Methods page for more information about the cost breakdowns.
Impact on disease incidence
We commissioned HealthLumen to report disease incidence avoided if the policy were implemented. These estimates do not represent the total health benefits. The specific diseases selected are those where there is good evidence that living with obesity is associated with the development of the disease.
Table 3 presents a summary of disease incidence avoided.
| Disease | Incidence avoided |
| Type 2 diabetes | Not statistically significant |
| Hypertension | Not statistically significant |
| Coronary heart disease | Not statistically significant |
| Colorectal cancer | Not statistically significant |
| Gall bladder disease | 3,377 |
| Ovarian cancer | Not statistically significant |
| Stroke | Not statistically significant |
| Liver cancer | Not statistically significant |
| Depression | Not statistically significant |
| Musculoskeletal disease | Not statistically significant |
Behind the averages: impact on inequalities
This policy could exacerbate inequalities if the personalised goals differ widely and therefore make it harder to achieve the financial rewards. The goals could also vary depending on socioeconomic status or ethnic differences, as research shows wide disparities in the proportion of obesity in different ethnicities.
Rating the strength of evidence
We asked experts working in the fields of obesity, food, and health research to rate the strength of the evidence base for each policy, taking into account both reliability (size and consistency) and validity (quality and content) of the evidence. Policies were rated on a Likert scale of 1–5 (none, limited, medium, strong, and very strong evidence base). The Blueprint Expert Advisory Group rated this policy as having a Strong evidence base.
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