Incentives for Health
TL;DR: Incentives to help make healthy choices the easy choices for individuals, operating at the levels of the individual, producers and service providers, and governments are discussed.
Abstract: This article discusses incentives to help make healthy choices the easy choices for individuals, operating at the levels of the individual, producers and service providers, and governments. Whereas paying individuals directly to be healthier seems to have a limited effect, offering financial incentives through health insurance improves health. Changing the environment to make healthier choices more accessible acts as an incentive to improve health. Employers can provide incentives to improve the health of their employees. Producers and service providers can take voluntary action to make their products less harmful, and they can be nudged into marketing healthier products within a regulatory environment. International agreements and monitoring systems can incentivize governments to do more for health. Lessons from climate change adaptation suggest that multilevel governance and policy integration are greater obstacles to policy change and implementation than knowing what has to be done. Policy change and implementation are triggered by many drivers, many of which are side effects of other policy pressures rather than of the direct policy goal itself. Effective action to reduce noncommunicable diseases will require leveraging social networks into a new ways of thinking about health; making better health prestigious and aspirational, and giving health and wellness a brand that encourages positive behavior change.
Citations
More filters
Book•
18 Jun 2012
TL;DR: This report presents the latest literature overview of effective alcohol policies, and includes data from the European Union, Norway and Switzerland in the areas of alcohol consumption, harm and policy approaches.
Abstract: Alcohol is one of the world’s top three priority areas in public health. Even though only half the global population drinks alcohol, it is the world’s third leading cause of ill health and premature death, after low birth weight and unsafe sex, and greater than tobacco. In Europe, alcohol is also the third leading risk factor for disease and mortality after tobacco and high blood pressure. This report presents the latest literature overview of effective alcohol policies, and includes data from the European Union, Norway and Switzerland in the areas of alcohol consumption, harm and policy approaches. The data presented were collected from a survey in 2011.
278 citations
TL;DR: In this paper, it was argued that by the end of the next century the world will be a flood-and storm-prone hothouse, and the suggestion by a British member of parliament in the nineteenth century that London would be waste-high in horse excrement by the 1950s could have been seen as a call for crippling taxes on Hansom cabs, pushing cabbies out of trade while still leaving us choking on exhaust fumes.
Abstract: Legislating for the present on the basis of predictions for the future can never be other than a dicey business. The suggestion by a British member of parliament in the nineteenth century that London would be waste-high in horse excrement by the 1950s could have been seen as a call for crippling taxes on Hansom cabs, pushing cabbies out of trade while still leaving us choking on exhaust fumes. So should we now be legislating against those exhaust fumes, in fear that by the end of the next century the world will be a flood- and storm-prone hothouse?
255 citations
Posted Content•
01 Jan 2004TL;DR: In this article, the authors investigate the possible effects of thin subsidies, consumption subsidies for healthier foods, and calculate the potential health benefits of subsidies on certain classes of fruits and vegetables.
Abstract: "Fat taxes" have been proposed as a way of addressing food-related health concerns. In this paper, we investigate the possible effects of "thin subsidies," consumption subsidies for healthier foods. Empirical simulations, based on data from the Continuing Study of Food Intake by Individuals, are used to calculate the potential health benefits of subsidies on certain classes of fruits and vegetables. Estimates of the cost per statistical life saved through such subsidies compare favorably with existing U.S. government programs.
124 citations
Journal Article•
TL;DR: Moderate reductions in dietary salt could substantially reduce cardiovascular events and medical costs and should be a public health target.
Abstract: BACKGROUND
The U.S. diet is high in salt, with the majority coming from processed foods. Reducing dietary salt is a potentially important target for the improvement of public health.
METHODS
We used the Coronary Heart Disease (CHD) Policy Model to quantify the benefits of potentially achievable, population-wide reductions in dietary salt of up to 3 g per day (1200 mg of sodium per day). We estimated the rates and costs of cardiovascular disease in subgroups defined by age, sex, and race; compared the effects of salt reduction with those of other interventions intended to reduce the risk of cardiovascular disease; and determined the cost-effectiveness of salt reduction as compared with the treatment of hypertension with medications.
RESULTS
Reducing dietary salt by 3 g per day is projected to reduce the annual number of new cases of CHD by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. All segments of the population would benefit, with blacks benefiting proportionately more, women benefiting particularly from stroke reduction, older adults from reductions in CHD events, and younger adults from lower mortality rates. The cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels. A regulatory intervention designed to achieve a reduction in salt intake of 3 g per day would save 194,000 to 392,000 quality-adjusted life-years and $10 billion to $24 billion in health care costs annually. Such an intervention would be cost-saving even if only a modest reduction of 1 g per day were achieved gradually between 2010 and 2019 and would be more cost-effective than using medications to lower blood pressure in all persons with hypertension.
CONCLUSIONS
Modest reductions in dietary salt could substantially reduce cardiovascular events and medical costs and should be a public health target.
112 citations
TL;DR: This paper starts from the premise that population health improvement is conditional on a health-promoting societal context, and emphasises three mechanisms: maximisation of the value of health and incentives for healthy behaviour; promotion of healthy choices as default; and minimisation of factors that create a culture and environment which promote unhealthy behaviour.
82 citations
References
More filters
TL;DR: Network phenomena appear to be relevant to the biologic and behavioral trait of obesity, and obesity appears to spread through social ties, which has implications for clinical and public health interventions.
Abstract: Background The prevalence of obesity has increased substantially over the past 30 years. We performed a quantitative analysis of the nature and extent of the person-to-person spread of obesity as a possible factor contributing to the obesity epidemic. Methods We evaluated a densely interconnected social network of 12,067 people assessed repeatedly from 1971 to 2003 as part of the Framingham Heart Study. The bodymass index was available for all subjects. We used longitudinal statistical models to examine whether weight gain in one person was associated with weight gain in his or her friends, siblings, spouse, and neighbors. Results Discernible clusters of obese persons (body-mass index [the weight in kilograms divided by the square of the height in meters], ≥30) were present in the network at all time points, and the clusters extended to three degrees of separation. These clusters did not appear to be solely attributable to the selective formation of social ties among obese persons. A person’s chances of becoming obese increased by 57% (95% confidence interval [CI], 6 to 123) if he or she had a friend who became obese in a given interval. Among pairs of adult siblings, if one sibling became obese, the chance that the other would become obese increased by 40% (95% CI, 21 to 60). If one spouse became obese, the likelihood that the other spouse would become obese increased by 37% (95% CI, 7 to 73). These effects were not seen among neighbors in the immediate geographic location. Persons of the same sex had relatively greater influence on each other than those of the opposite sex. The spread of smoking cessation did not account for the spread of obesity in the network. Conclusions Network phenomena appear to be relevant to the biologic and behavioral trait of obesity, and obesity appears to spread through social ties. These findings have implications for clinical and public health interventions.
4,783 citations
Additional excerpts
...…health-related behaviors such as tobacco use (Christakis & Fowler, 2008), alcohol intake (Rosenquist, Murabito, Fowler, & Christakis, 2010) obesity (Christakis & Fowler, 2007), and loneliness (Cacioppo, Fowler, & Christakis, 2009) and promote happiness (Fowler & Christakis, 2008), and cooperative…...
[...]
TL;DR: This paper examined the effectiveness of signs requesting hotel guests' participation in an environmental conservation program and found that normative appeals were more effective when describing group behavior that occurred in the setting that most closely matched individuals' immediate situational circumstances, referred to as provincial norms.
Abstract: Two field experiments examined the effectiveness of signs requesting hotel guests’ participation in an environmental conservation program. Appeals employing descriptive norms (e.g., “the majority of guests reuse their towels”) proved superior to a traditional appeal widely used by hotels that focused solely on environmental protection. Moreover, normative appeals were most effective when describing group behavior that occurred in the setting that most closely matched individuals’ immediate situational circumstances (e.g., “the majority of guests in this room reuse their towels”), which we refer to as provincial norms. Theoretical and practical implications for managing proenvironmental efforts are discussed.
2,514 citations
TL;DR: In this article, neighborhood environment characteristics proposed to be relevant to walking/cycling for transport are defined, including population density, connectivity, and land use mix, with evidence suggesting that residents from communities with higher density, greater connectivity and more land-use mix report higher rates of walking and cycling for utilitarian purposes than low-density, poorly connected, and single land use neighborhoods.
Abstract: Research in transportation, urban design, and planning has examined associations between physical environment variables and individuals' walking and cycling for transport. Constructs, methods, and findings from these fields can be applied by physical activity and health researchers to improve understanding of environmental influences on physical activity. In this review, neighborhood environment characteristics proposed to be relevant to walking/cycling for transport are defined, including population density, connectivity, and land use mix. Neighborhood comparison and correlational studies with nonmotorized transport outcomes are considered, with evidence suggesting that residents from communities with higher density, greater connectivity, and more land use mix report higher rates of walking/cycling for utilitarian purposes than low-density, poorly connected, and single land use neighborhoods. Environmental variables appear to add to variance accounted for beyond sociodemographic predictors of walking/cycling for transport. Implications of the transportation literature for physical activity and related research are outlined. Future research directions are detailed for physical activity research to further examine the impact of neighborhood and other physical environment factors on physical activity and the potential interactive effects of psychosocial and environmental variables. The transportation, urban design, and planning literatures provide a valuable starting point for multidisciplinary research on environmental contributions to physical activity levels in the population.
2,218 citations
"Incentives for Health" refers background in this paper
...A number of systematic reviews have analyzed strategies to promote walking and cycling (Forsyth & Krizek, 2010; Ogilvie et al., 2007; Pucher, Dill, & Handy, 2009; Saelens et al., 2003; Yang, Sahlqvust, McMinn, Griffin, & Ogilvie, 2010)....
[...]
TL;DR: Despite the decrease in smoking in the overall population, the size of the clusters of smokers remained the same across time, suggesting that whole groups of people were quitting in concert.
Abstract: BACKGROUND The prevalence of smoking has decreased substantially in the United States over the past 30 years. We examined the extent of the person-to-person spread of smoking behavior and the extent to which groups of widely connected people quit together. METHODS We studied a densely interconnected social network of 12,067 people assessed repeatedly from 1971 to 2003 as part of the Framingham Heart Study. We used network analytic methods and longitudinal statistical models. RESULTS Discernible clusters of smokers and nonsmokers were present in the network, and the clusters extended to three degrees of separation. Despite the decrease in smoking in the overall population, the size of the clusters of smokers remained the same across time, suggesting that whole groups of people were quitting in concert. Smokers were also progressively found in the periphery of the social network. Smoking cessation by a spouse decreased a person's chances of smoking by 67% (95% confidence interval [CI], 59 to 73). Smoking cessation by a sibling decreased the chances by 25% (95% CI, 14 to 35). Smoking cessation by a friend decreased the chances by 36% (95% CI, 12 to 55 ). Among persons working in small firms, smoking cessation by a coworker decreased the chances by 34% (95% CI, 5 to 56). Friends with more education influenced one another more than those with less education. These effects were not seen among neighbors in the immediate geographic area. CONCLUSIONS Network phenomena appear to be relevant to smoking cessation. Smoking behavior spreads through close and distant social ties, groups of interconnected people stop smoking in concert, and smokers are increasingly marginalized socially. These findings have implications for clinical and public health interventions to reduce and prevent smoking.
2,165 citations
"Incentives for Health" refers background in this paper
...Data from the Framingham Heart Study demonstrated that social networks determine many health-related behaviors such as tobacco use (Christakis & Fowler, 2008), alcohol intake (Rosenquist, Murabito, Fowler, & Christakis, 2010) obesity (Christakis & Fowler, 2007), and loneliness (Cacioppo, Fowler, &…...
[...]
TL;DR: People’s happiness depends on the happiness of others with whom they are connected, providing further justification for seeing happiness, like health, as a collective phenomenon.
Abstract: Objectives To evaluate whether happiness can spread from person to person and whether niches of happiness form within social networks. Design Longitudinal social network analysis. Setting Framingham Heart Study social network. Participants 4739 individuals followed from 1983 to 2003. Main outcome measures Happiness measured with validated four item scale; broad array of attributes of social networks and diverse social ties. ResultsClustersofhappyand unhappypeoplearevisible in the network, and the relationship between people ’s happiness extends up to three degrees of separation (for example, to the friends of one’s friends’ friends). People whoaresurroundedbymanyhappypeopleandthosewho arecentralinthenetworkaremorelikelytobecomehappy in the future. Longitudinal statistical models suggest that clustersofhappinessresultfromthespreadofhappiness and not just a tendency for people to associate with similarindividuals.Afriendwholiveswithinamile(about 1.6km)andwhobecomeshappyincreasestheprobability that a person is happy by 25% (95% confidence interval 1% to 57%). Similar effects are seen in coresident spouses (8%, 0.2% to 16%), siblings who live within a mile (14%, 1% to 28%), and next door neighbours (34%, 7% to 70%). Effects are not seen between coworkers. The
1,714 citations
Additional excerpts
...…(Christakis & Fowler, 2008), alcohol intake (Rosenquist, Murabito, Fowler, & Christakis, 2010) obesity (Christakis & Fowler, 2007), and loneliness (Cacioppo, Fowler, & Christakis, 2009) and promote happiness (Fowler & Christakis, 2008), and cooperative social behavior (Fowler & Christakis, 2010)....
[...]