The best public health stratagems are often the least overt ones.
Consider New York mayor Michael Bloomberg’s recent campaigns to cap the size of soft drinks and keep cigarettes out of view of young customers. Instead of picking up a sledgehammer—publicly shaming the industries’ heavyweights, or declaring an outright war on soda and tobacco—Bloomberg went for the ball-peen: he sought to redefine in New Yorkers’ minds the size of a “regular” Coke, from 16 to eight ounces, and to remove the visual cues that encourage us to make impulse buys, whether Marlboros or Reese’s Pieces, at the register.
Alas, no good public health scheme goes unpunished in the United States, and deep-pocketed corporate interests being what they are, Nanny Bloomberg’s initiatives seem destined for messy legal battles. In other corners of the world, meanwhile, governments are busy trying to do what the American one seems unable to: save people from themselves.
In South Africa, a three-year campaign by the country’s largest health insurer has demonstrated that customers who are given rebates on fruits, vegetables, and other nutritionist-approved foods quickly change their dietary habits. Healthful eating? It just makes good cents.
The HealthyFood program, sponsored by insurer Discovery, offers its beneficiaries a 10 to 25 percent rebate on produce and other smart selections—some 6,000 items total, including canned veggies and non-fat dairy products—at hundreds of Pick n Pay supermarkets around the country. Using scanner data, researchers from the Rand Corporation were able to track the grocery purchases of 169,000 Discovery clients, 100,000 of whom were enrolled in HealthyFood; the remaining 69,000 were not.
Published online this week in the American Journal of Preventative Medicine, the results show that among HealthyFood enrollees receiving a 10 percent rebate for good supermarket behavior, the ratio of healthful food to total food purchased increased 6 percent, while the ratio of unhealthful food—products high in trans fats, sugar, salt, and refined starches—decreased by nearly the same amount. When the rebate was bumped to 25 percent, customers bought even more fruits and vegetables; their healthful expenditures increased close to 10 percent, while their unhealthful expenditures fell 7 percent.
Of course, a healthy diet has to do with more than how you stock your pantry. Sedentary office life, a culture of snacking, and too-generous portion sizes are as much to blame for our obesity epidemic as poor supermarket choices. Indeed, we’d be better off if more Americans simply had the luxury of shopping at greengrocers and farmers’ markets, rather than corner stores.
But if the “psychology of saving” and knocking a few pennies off the cost of carrots and kohlrabi can motivate Safeway shoppers to buy fewer Ding Dongs, well, that’s an appetizing approach, too.