Can Incentives Change Health Outcomes in South Africa?

From reduced gym membership fees to discounts on healthy foods to exclusive travel deals, financial incentives can be an attractive motivator for making healthy choices. But the most successful incentivized health programs don’t focus on monetary reward alone; they also embrace positive reinforcement, shared goals and the spirit of community.


“Changing behavior, particularly deeply ingrained behaviors such as unhealthy eating and a lack of physical activity, requires more than information and prescription,” says Anne Till, RD (SA). “It requires meaningful environmental or structural changes.”

In Till’s home country of South Africa — where 37 percent of deaths are due to such noncommunicable diseases as heart disease, stroke, cancer, chronic respiratory diseases and diabetes — a wellness program developed by Discovery, the nation’s largest health insurance company, incorporates evidence-based interventions from medicine, dietetics, sports science, epidemiology, psychology and the emerging discipline of behavioral economics.

The Discovery Vitality program uses a status-based model in which participants who achieve milestones, which may range from submitting an online assessment to regularly going to the gym, automatically accumulate points and rise from Blue level status to Bronze, Silver, Gold and Diamond levels.

The goal-gradient concept (celebrating small achievements that lead to overall lifestyle improvements) encourages engagement; status-based wellness programs are effective in discouraging a loss of status. “Psychologically, individuals are more troubled by loss than they are satisfied by an equivalent gain, a concept known as ‘loss aversion,’” says Till, who served as primary nutrition consultant for Discovery Health from 2004 until she relocated to North Carolina last year. “What we found was that people not only enjoy receiving Gold- and Diamond-level benefits, but they are proud of having achieved those levels and are inspired, and inspire others, to maintain them.”

In addition to one-on-one consultations with health professionals such as dietitians and exercise specialists, incentives and opportunities to earn points are integrated throughout participants’ everyday lives, from grocery store savings and reduced gym fees to movie passes, airline discounts and magazine subscriptions.

Discovery Vitality’s HealthyFood™ benefit, for which Till served as an expert panel member, provides discounts of up to 25 percent on healthier food choices: fresh fruit and vegetables, fat-free dairy products, eggs, fish, trimmed poultry and whole grains.

Since Discovery Vitality’s launch in 1997, the program has expanded to the United Kingdom, the United States and China, and backs its success with extensive reporting, peer-reviewed outcomes and published studies showing reduced medical expenses and shorter hospital stays. But the real success, Till says, belongs to the participants who lead healthier, happier lives. “There is a great sense of community with this program, because whether they are shopping, at the gym or at an organized event like a walk or a marathon, they are all part of this huge, supportive group,” says Till. “A positive, sustainable program isn’t about punishing people for making less healthy choices, but rewarding the healthy decisions we do make.”

Liz Spittler
Liz Spittler is the executive editor of Food & Nutrition Magazine and creative media director at the Academy of Nutrition and Dietetics.