Innovative strategies targeting obesity and non-communicable diseases in South Africa: what can we learn from the private healthcare sector?
Article first published online: 23 OCT 2013
© 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Special Issue: Program and Policy Options for Preventing Obesity in the Low, Middle, and Transitional Income Countries
Volume 14, Issue Supplement S2, pages 141–149, November 2013
How to Cite
Lambert, E. V. and Kolbe-Alexander, T. L. (2013), Innovative strategies targeting obesity and non-communicable diseases in South Africa: what can we learn from the private healthcare sector?. Obesity Reviews, 14: 141–149. doi: 10.1111/obr.12094
- Issue published online: 23 OCT 2013
- Article first published online: 23 OCT 2013
- Accepted manuscript online: 9 SEP 2013 06:46AM EST
- Manuscript Accepted: 14 AUG 2013
- Manuscript Received: 13 AUG 2013
- Rockefeller Foundation's Bellagio Center
- University of North Carolina Nutrition Transition Program
- International Development Research Center, Canada
- Financial incentives;
- health insurance;
- lower- and middle-income countries;
- wellness programmes
Over 50% of South African adult women and 30% of adult men are either overweight or obese, and nearly half of all adults are insufficiently active, with major increases in obesity-associated healthcare expenditures since 1980, a high proportion of which are paid by private health insurance. In this paper, we describe the Vitality programme, an incentivized health promotion programme from South Africa's largest private health insurer, Discovery Health, with over 2.5 million beneficiaries. Wellness activities of the programme include health risk assessments, subsidized gym memberships and smoking cessation or weight loss programmes with many incentives, including cash back on purchases of healthy foods. This incentive-based programme has shown a significant relationship between levels of engagement in wellness activities, in particular increasing participation in fitness-related activities, with lower healthcare expenditure and an increase in the overall ratio of healthy foods to total food purchases. This programme demonstrates that incentives may reduce the barriers for entry into care, increase preventive screening and increase engagement in healthy behaviours for prevention and management of obesity. This ‘carrots versus sticks’ approach may have implications for public health policy even in lower- and middle-income settings and underserved communities.