Words: Joan Costa-Font
Pics: Getty Images
Financial incentives have a long history in high-income countries as a tool to encourage healthier lifestyles. Programmes such as Singapore’s, the UK’s Vitality Active Rewards, and a range of US employer wellness schemes reviewed by the RAND Corporation rewarded physical activity, weight loss, or other healthy behaviours. Similar incentive-based interventions have also been tested for smoking cessation in randomised trials, including in a landmark study.
In January 2027, building on this tradition by using loyalty-style rewards to promote everyday walking at population scale, NHS England will launch Movement 26.2 – a walking-rewards scheme fronted by Sir Brendan Foster and Keith Mills.
The scheme will encourage people to log 20–30 minutes of walking a day (a “marathon a month”) in exchange for digital badges and retailer vouchers, tracked through an app or wearable device. NHS chief executive Jim Mackey has tied it to the government’s 10-Year Health Plan, pitching it as a way to make movement “part of everyday life” without demanding gym memberships.
It’s a genuinely interesting moment – not because the scheme itself is revolutionary, but because of what it reveals about how hard it is to design incentives that actually change behaviour.
A big moment for what it signals
The details of Movement 26.2 are still thin, and that’s worth saying plainly.
What’s promising is the framing: this is a prevention-focused intervention, not another treatment pathway bolted onto an already-stretched NHS. But several structural questions remain open.
Is the scheme NHS-funded, retailer-funded, or some hybrid – and does that funding model hold up over years, not just a launch cycle? Will it be genuinely universal, or effectively opt-in for people who are already digitally engaged?
And critically: is there a baked-in evaluation plan, ideally something close to a randomised trial, to establish whether the scheme actually shifts activity levels – or is this a launch with no mechanism to ever answer that question?
None of this makes the scheme a bad idea. It just means the interesting part hasn’t happened yet.
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Designing incentives that work: cue, routine, reward
The behavioural science on habit formation is fairly consistent, and it starts with a simple loop: cue, routine, reward. Digital nudges anchored to a specific, prespecified trigger – a set time of day, for instance – tend to outperform open-ended targets, because they help build automatic routines rather than relying on people to remember on their own.
The behavioural science on habit formation is fairly consistent, and it starts with a simple loop: cue, routine, reward.
This is sometimes called the “habit loop” and it’s worth noting that the loop works identically whether the habit being reinforced is healthy or not – which means good scheme design has to deliberately engineer the cue and the routine, not simply dangle a prize at the end.
Examples include Singapore’s and the UK’s, which has been associated with substantial increases in physical activity.
How 5,000 steps could save the NHS billions
Two other design principles matter more than people tend to assume.
First, frequency and immediacy of feedback often matter more than the size of the reward. Evidence suggests that small, frequent incentives tied closely to behaviour can be more effective than large, delayed payments.
Second, and often overlooked, is what happens when the incentive stops. A scheme that only works while rewards are flowing has not necessarily built a habit. Reviews of financial incentive programmes find that effects often fade once incentives are withdrawn.
Bigger isn’t better: what the evidence says about incentive design
There’s a persistent assumption that more money means more behaviour change. The evidence doesn’t really back that up.
A US trial found that financial incentives of equivalent value did not increase colorectal cancer screening uptake compared with no incentive, while a comparable UK trial found that offering a financial incentive failed to increase NHS Health Check attendance.
The presence of a reward often matters more than its size –