December 14, 2013
Should We Be Paid To Be Healthy?
The UK’s Department of Health is to fund a pilot research scheme in which mothers will be paid to breastfeed their babies. This has brought about much discussion in the media about the ethics and rationale of rewarding people financially for adopting “healthy” habits or lifestyle changes.
The reasoning behind the scheme is that it should bring about a two-fold benefit. There are the simple but very real health benefits for the child and mother but one suspects that one of the main drivers of this policy is financial. It has been estimated that breastfeeding costs the National Health Service up to £40 million (around $64 million) a year by reducing the incidence of gastro-intestinal infections and respiratory problems in babies. Research has also suggested that mothers who breastfeed are less likely to develop breast cancer and it has long been believed by many that breastfed babies can pick up immunities to several diseases from the mother. Britain has a comparatively low rate of breastfeeding with only around 34 percent of mothers breastfeeding up to six months and only one percent of babies being exclusively breastfed at that age.
There will be around 130 women taking part in the initial trial which will take place in South Yorkshire and Derbyshire in the north of England. The specific areas for the feasibility study have been chosen apparently because they are among the more economically deprived parts of the country and have some of the lowest rates of breastfeeding. They will be paid £200 ($320) in the form of shopping vouchers to be spent as they wish in some of the UK’s larger chain stores like Matalan, Mothercare, Poundland, Tesco, and John Lewis. The first payment of £120 will be paid if the babies are breastfed up to six weeks old with a further £80 being paid if they are still being breastfed at six months.
Critics of the plan say that it in effect penalizes those mothers who, for whatever reason, physically cannot breastfeed their children. Others claim that the system is open to abuse, as it is not going to be strictly monitored. The mother and the midwife involved will simply sign to say that they are taking part in the scheme. While it is clearly possible that mothers could claim the payment without actually breastfeeding this should not really be a reason not to go ahead. If everything we do in society was judged on the fact that someone might cheat the system there would not be many policy choices left.
The NHS has tried similar “payment” for health schemes before with mixed results. There have always been criticisms that such schemes reward people for doing what they should be doing anyway. In 2009 a trial in Kent paid people up to £425 to lose weight but there was a high drop-out rate and less than half of the participants lost significant weight so the scheme was deemed inconclusive. On the other hand a scheme in Dundee in which people were paid weekly to stop smoking saw more than a third of those in the trial stopping smoking and was considered a success compared to other “stop-smoking” schemes. So only time will tell if this new initiative will work and therefore if it stands a chance of being rolled-out nationally.
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