Carrots and Sticks to Promote Healthy Behaviors: A Policy Update (Essays‪)‬

Whether and to what extent people should be held personally responsible for their health has been a subject of debate in the United States for at least three decades. (1) In the last few years, however, a new crop of proposals to promote healthy behaviors has been testing both our collective tolerance for such policies and our public health values. These proposals take two basic forms. One waves carrots; the other wields sticks. Most proposals use some form of incentive to reward individuals for adopting behaviors that protect against disease and promote health. Others, thus far in the minority, take a more punitive tack. In these cases, people who do not adopt the specified behaviors or meet the specified health criteria may forfeit benefits, pay more for them, or even lose their jobs (and so their benefits).