It's no surprise that as individuals, we are much more likely to do something if there is some sort of proximate reward. We might even settle for a distal reward as long as the distance to our reward is somewhere shining on the horizon.
An adage implies that a sign of maturity is delayed gratification. The idea that one is mature when he/she can delay getting a reward for whatever action is immediately being performed. If being comfortable with distal rewards is maturity, then what is it when we don't weigh every action by a reward? Probably altruism or... confusion... Cynicism here is unintentional. Altruism exists, but we cannot deny that individuals make decisions based on how much benefit will be gained or how much pain can be avoided. Our decisions about life, love, work, and health are generally the ladder. I am laying down no judgement here about the decision-making process. It would be silly if a species made decisions based on what hurt more or what was harder. I get it - we are talking about instincts here. Longevity. So how can we use this instinct to guide us towards making better choices?
Where does our action/reward reflex lead us when it comes to making decisions about maintaining our health? Take the case of flossing. Evidently the benefit of flossing every day isn't shiny enough to propel us towards adhering to oral health recommendations for flossing....would I be more likely to do it if I got points or a free cup of tea or a dollar...yeah - probably. Yup. Definitely. I would floss more if I got something more out of the experience than a pat on the back once a year from my dentist and the vague knowledge that I maintained the health of my teeth.
Health maintenance doesn't really fit into the reward system of decision-making. What about a prevention decision that has bigger consequences, like the decision to use a condom during sexual intercourse with a stranger? The "reward" is counter intuitive since many individuals complain that condoms make sex less pleasurable. The fact is that they make sex more safe. So here we have a risk/reward conflict. Let's complicate this conflict further. The consequences of not using condoms can lead to sexually transmitted infections (that range from uncomfortable to deadly) and unintended/unwanted pregnancy. You would think that individuals would be inclined to protect themselves...but immediate and satisfying rewards (proximate) tend to outweigh distal mediocre maintenance "rewards". Sigh, we remain at an impasse Unless we can change the proximate risk/reward conflict and supplement protective behavior with a proximate reward like...money.
Health maintenance doesn't really fit into the reward system of decision-making. What about a prevention decision that has bigger consequences, like the decision to use a condom during sexual intercourse with a stranger? The "reward" is counter intuitive since many individuals complain that condoms make sex less pleasurable. The fact is that they make sex more safe. So here we have a risk/reward conflict. Let's complicate this conflict further. The consequences of not using condoms can lead to sexually transmitted infections (that range from uncomfortable to deadly) and unintended/unwanted pregnancy. You would think that individuals would be inclined to protect themselves...but immediate and satisfying rewards (proximate) tend to outweigh distal mediocre maintenance "rewards". Sigh, we remain at an impasse Unless we can change the proximate risk/reward conflict and supplement protective behavior with a proximate reward like...money.
Cash transfers as behavior change interventions have emerged in the intersection of education and health. Interventions have been designed attempting to keep youth enrolled in school with the intention of ultimately reducing risk behaviors like frequency of unprotected sex. In a conditional cash transfer you must comply with a pre-specified condition (like staying enrolled in school/attending school 80% of the time) in order to be rewarded. If you don't, then no reward. An unconditional cash transfer is when you are given the reward with no specific agreement about what condition is being improved upon.
Surprisingly, whether you say you are rewarding youth for something specific (conditional) or not (unconditional)- they are more likely to have a reduction in health risk behaviors. Girls are a bit better at this than boys. One study showed that youth enrolled in school who were in the conditional or unconditional cash transfer were 64% less likely to have contracted HIV and 76% less likely to have contracted herpes at the end of the 18 month study than those who were not receiving any sort of incentive (Baird, et. al, 2012). Hmmmm. Food for thought. Give youth a little cash for "good behavior" whether you stipulate what it is or not, they are probably more likely to protect themselves. Noted.
There is a growing body of evidence around the effects of cash transfer programs, behavioral economics programs, economic mentorship programs, and we all know about the micro-finance programs. Many of these programs focus on education as a mediating and protective factor for health. It is important to note that while the newer programs like cash transfers and economic mentorship are innovative, they are hard to sustain due to the fact that they are all about giving away money and not about investing for future revenue generating possibilities. One could argue that it is an investment in the health of the workforce, educated population, etc., but from a policy perspective our agendas tend to not be so mature. The policy agenda wants nay needs immediate gratification for the money spent (in order to justify expenditures) and distal rewards or delayed gratification are not a huge part of the process. A healthy educated workforce is often a reward too far off on the horizon. We can and will continue to work on this.
Surprisingly, whether you say you are rewarding youth for something specific (conditional) or not (unconditional)- they are more likely to have a reduction in health risk behaviors. Girls are a bit better at this than boys. One study showed that youth enrolled in school who were in the conditional or unconditional cash transfer were 64% less likely to have contracted HIV and 76% less likely to have contracted herpes at the end of the 18 month study than those who were not receiving any sort of incentive (Baird, et. al, 2012). Hmmmm. Food for thought. Give youth a little cash for "good behavior" whether you stipulate what it is or not, they are probably more likely to protect themselves. Noted.
There is a growing body of evidence around the effects of cash transfer programs, behavioral economics programs, economic mentorship programs, and we all know about the micro-finance programs. Many of these programs focus on education as a mediating and protective factor for health. It is important to note that while the newer programs like cash transfers and economic mentorship are innovative, they are hard to sustain due to the fact that they are all about giving away money and not about investing for future revenue generating possibilities. One could argue that it is an investment in the health of the workforce, educated population, etc., but from a policy perspective our agendas tend to not be so mature. The policy agenda wants nay needs immediate gratification for the money spent (in order to justify expenditures) and distal rewards or delayed gratification are not a huge part of the process. A healthy educated workforce is often a reward too far off on the horizon. We can and will continue to work on this.
-Jasmine Buttolph, MPH
