Changing behavior is difficult – it’s hard for individuals, and even tougher at a population level. Ironically, the greatest obstacle to physical health is cognition – the intellectual flaws that conspire against healthcare consumers' frequent good choices. Patients' desire for instant gratification (having your cake, and eating it, too) and misplaced optimism (It probably won’t happen to me, right?) means healthier choices aren’t necessarily easier choices. The mismatch between long-term benefits of physical activity and perceived short-term costs (time, effort, and pain), means despite best intentions, patients aren't generally as active as they'd like to be.
How Changing Behavior Changes Health Outcomes
Lack of physical activity is a key driver of healthcare costs and mortality, with a recent report by the World Health Organization finding over a quarter of adults don’t get enough exercise. Physical inactivity accounts for 6 percent of deaths globally and $54 billion in direct healthcare costs – a burden felt by all stakeholders.
Not moving enough could be as bad for your health as smoking. Sedentary individuals are faced with increased levels of heart disease, diabetes, cancer, and premature deaths. The ripple effect of not living a healthy lifestyle trickles down to greater society, with employers impacted by productivity losses and growing healthcare expenses, and governments directly burdened by healthcare cost.
New Study: What What We Learned, and Why It Matters
As part of the largest behavior change study on verified physical activity, our newly released study conducted with RAND Europe examined Vitality’s Active Rewards program demonstrates encouraging results for insurance and workplace models that incorporate the behavioral nature of risk, and use the right technology and incentives as a stimulus to effect change. We examined 400,000 people over two years, across three countries, namely the United States, the United Kingdom, and South Africa, to capture verified activity levels for the same cohort of people before and after the introduction of the intervention, while controlling for multiple variables along the way.
Research revealed a dramatic, sustained increase in physical activity levels as a result of reward-based incentives, with a further boost when Apple Watch was introduced through a loss-framed incentive structure. This resulted in a 34 percent increase in activity, which translated to an average of 4.8 more active days per month sustained over a two-year period. The impact was consistent across countries and demographics and, encouragingly, those most at risk saw the largest improvements. US participants with a BMI over 30 doubled their levels of activity over the study period.
Where Employers and Insurers Come Into Play
Both employers and insurers are uniquely positioned to intervene because they, along with the government, can stand to benefit from better health as a healthier, more productive population with less sickness and death translates into better economic results. The response from employers and insurers in recent years has led to the growth of incentivized wellness programs, some of which track behavior via wearable devices. But in many cases, evidence for whether incentives and technology lead to persistent, pervasive, sustained behavior change has been mixed.
The benefits for employers and insurers in these markets were equally significant, demonstrating the “everyone wins” benefits when all stakeholders align to healthier living. In this light, the importance of physical activity cannot be overstated.
What this study shows, most importantly, is that the thoughtful application of behavioral designs, when paired with appealing technology, can have a dramatic, sustained impact on healthy behaviors across broad segments of the population. Positive change is not easy—but it can be done.
Closing the Gap
In addition to advancing behavior change as it pertains to physical activity, applying these innovations more broadly to other health behaviors is a natural progression for Vitality. Stanford Business School Professor Jeffrey Pfeffer, author of “Dying for a Paycheck,” estimates that unhealthy work is the fifth biggest killer in the US – so the need to invest in healthier populations and workplaces is more vital today than ever before. And that is what we plan to do.
In the US, there's been healthy skepticism around some available wellness solutions which promise dramatic overnight reductions in healthcare costs and guaranteed returns. Similarly, many wearable devices flooding the market in recent years have had limited shelf-life and short-term user impacts.
Behavioral insights, personalized programs, and smart incentives create sustained behavior change and help individuals overcome obstacles. This must be a primary focus for the healthcare industry moving forward.