Here’s why paying people for healthy behaviors is a really bad idea

Humans are rationale, right?

Give someone a wad of cash to do something, let’s say exercise daily, and they’ll do it. We have a behavior (i.e. exercise) and a corresponding reward (i.e. money). We want to increase this behavior, and so we simply increase the reward to “motivate” people to engage in the behavior. Increase the reward, and we should see an increase in the desired behavior.

Oh, wait, humans aren’t always rationale? You’re telling me they don’t behave in a predictably rationale way all the time?

As author Daniel Pink describes in his book Drive: The Surprising Truth About What Motivates Us this carrot/stick approach is a perfectly accurate way to describe a lot of animal behavior. Unfortunately, though, this isn’t at all what really motivates humans.

In his book and his wildly popular 2009 TED talk, Pink brings this to light by explaining the classic candle problem experiment, which was originally conducted way back in 1945 and has been replicated over and over in social science research.

Here’s how it goes.

The researcher leads participants into a room. They receive a candle, some thumbtacks and a box of matches.The task: to attach the candle to the wall so the wax doesn’t drip onto the table.

What do you do?

Well, after a few minutes of trying different approaches, most participants stumble on the solution: you tack the box to the wall and place the candle inside the box, which now operates as a a platform to hold the candle and catch the wax.

Now let’s make things more interesting. Let’s suppose that we want people to solve this little problem even faster. We want more of a desired behavior. Okay, easy, right? Let’s give them a financial reward. Let’s give $5 to the top 25% fastest times, you get five dollars. And if you’re the fastest of everyone, you get $20.

What happens? Compared to a group without any of these financial incentives, this money-enticed group should perform faster, right?

WRONG.

On average, the group with the financial incentives took 3.5 minutes longer to perform the task.

How does this apply to health?

It’s now more common than ever to see these gentle and not so gentle nudges being used to try and motivate people to make healthier decisions. The rewarding people for exercise thing I mentioned in the first paragraph. That’s actually happening! There’s the $70 gift card for taking 10,000 steps each day. There’s the $500 annual reward that Aetna is using to encourage employees to sleep seven hours each night. Now there’s the new reward scheme by life insurance company John Hancock that gives discounts, cash back, and reduced premiums in return for purchasing nutritious food at the grocery store.

Let’s step back and break this down. There are two kinds of rewards or motivation: intrinsic and extrinsic.

  • Intrinsic motivation is based on internal rewards, like a personal drive to master a particular skill or subject matter.
  • Extrinsic motivation is based on external rewards, similar to a carrot/stick approach. One example would be paying someone $20 to walk 10,000 steps a day. Another would be offering your child an ice cream cone if they eat all of their vegetables at dinner.

Now, when it comes to extrinsic rewards, like the ones I talked about above (the $70 gift card, and the cash back for buy nutritious foods), there are 3 big cautions (among other reasons why we should reconsider the traditional carrot/stick approach to motivation — read Pink’s book Drive).

First, offer this type of reward and it will come to be expected over time. So, instead of an ice cream cone being a treat, it’s now the only thing that will “motivate” your child to eat vegetables at dinner.

Second, extrinsic rewards are often effective in the short-term, but usually fail in the long run.

Most importantly, extrinsic rewards dampen intrinsic motivation, which is the very thing that drives us in the long-term.

Incentives can be used to achieve short-term health goals. We’ve seen that in the weight loss world. But habits are only beneficial if they can be sustained. And thus far, across social science research, money simply doesn’t do this.

So while money might be a great enticement to try and get people to walk 10,000 steps or buy 5 servings of fruits of veggies in a day, it’s not the determining factor that will motivate people to sustain these habits. In fact, and the thing I fear most, is that all of this focus on incentivizing healthy behaviors will have the opposite effect in the long-term. People will come to expect a reward for making healthy choices instead of finding their own intrinsic reason for valuing health. By turning health behaviors into a giant if-then scheme (i.e. if you do this, then you get that) we’re actually slowing sucking away any possible intrinsic motivation for engaging in such behaviors.

Continue to rely on financial incentives to motivate people and we all just might become that little kid who won’t eat their vegetables unless they get an ice cream cone.

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