The Use of Incentives and the Promotion of Healthy Behaviours: The Case of Unhealthy Food
One issue that has unquestionably raised concern among the public, governments, institutions and international organizations is obesity, and, in particular but not solely, childhood obesity. (World Health Organization [WHO], 2003, 2005; Delisle, 2004; Dériot, 2005). The reasons for this concern are numerous, including the fact that excess weight produces social consequences (The Canadian Medical Association [CMA], 2007, p. 6; Katzmarzyk & Janssen, 2004; National Institute of Health and Medical Research [INSERM], 2005, pp. 49-54) related to economic efficiency (Suhrcke, McKee, Sauto Arce, Tsolova & Mortensen, 2006, cited by AMC, 2007, pp. 5-6; Cusset 2008), health care (for France: Detournay et al., 2000), infrastructure development, etc. While the importance of this issue should not be diminished, there has nevertheless been a sort of catastrophic sensationalism in which obesity is referred to as an epidemic (for an example of this way of presenting the situation, see Faeh, 2006; Alderman, Smith, Fried & Daynard, 2007). Since the problem has resulted from unhealthy eating habits and a modern sedentary lifestyle, it most certainly does not have the characteristics of an epidemic (Epstein, 2005, p. 1367; Botterill, 2006, p. 4). It is thus preferable to view unhealthy eating and its consequences as a problem of collective action in the sense given by Olson (1971), with negative impacts for society as a whole (Marshall, 2000, p. 301; Botterrill, 2006, p. 7) rather than as an epidemiological issue.
In any case, reducing the impact of unhealthy eating – that is, of eating foods rich in saturated fat, salt or sugar – and having people adopt healthy habits (consumption of fruits and vegetables, physical exercise) are legitimate public policy goals. Given this context, the use of incentives is one of the options available for modifying behaviour, as long as a flexible approach is applied (Jacobson & Brownell, 2000; Marshall, 2000; Caraher & Cowburn, 2005; Mytton, Gray, Rayner & Rutter, 2007; Godfrey & Maynard, 1988).
It is necessary to ask two questions. Firstly, what is the moral justification for promoting healthy behaviour? Secondly, what is the moral justification for implementing incentives? These questions will allow us to examine the legitimacy of preventive public policies. We will then review the various types of available incentives, the forms they take, and the secondary moral justifications underpinning them (with examples) and draw out the moral implications of each option. The goal here is to present the main normative reasons for using incentives.