Legal and Policy Measures to Promote Healthy Behaviour: Using Incentives and Disincentives to Control Obesity

This article examines incentives as a health policy option to encourage healthier behaviours and considers the emerging body of literature that evaluates the effectiveness and impact of incentives as public health policy tools. Incentives - including rewards and penalties - vary widely in their force, from indirect (or mild) to direct (or strong) incentives. At one end of the incentive spectrum are strategies that invite healthier behaviour, such as urban planning measures to encourage walking and cycling. In the middle of the incentive spectrum are measures such as tax credits for those who participate in sports and fitness programs or "fat taxes" on high-calorie, low-nutrition foods. These strategies target individuals' pocketbooks and thus may have a stronger influence on behaviour change. The most direct incentives are governmental or private sector schemes that use monetary payments or penalties to induce behaviour change. While this article focuses on incentives targeted at individuals, it briefly discusses several examples of incentives aimed at businesses, particularly food retailers. The use of incentives as a health policy tool has several key legal dimensions. First, governments rely on legal powers, such as taxation laws and zoning regulations, to implement certain kinds of incentives. Second, in their operation and impact, incentives may infringe on legally protected rights. In particular, the use of "sticks" rather than "carrots" may be criticized on the grounds that they are coercive, discriminate unfairly, and promote individual blame. Third, public health law is concerned with the use of legal and policy measures to create conditions in which people may be healthy. It is important, therefore, to evaluate incentive programs to determine their effectiveness in ameliorating obesogenic environments and creating conditions for improved dietary and physical activity behaviours