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Financial prescribing: A potential cure to the global inactivity pandemic?



Health Tech World hears from the CEO of the world’s most downloaded health and fitness app,  Sweatcoin, about the implications of rising inactivity and how technology and financial incentives can help get people active.

This year, the NHS and Sweatcoin formed a new partnership to roll out a diabetes prevention programme which seeks to tackle what is estimated to be a £10 billion per year problem.

The app tracks physical activity – notably walking and running – and converts steps into a digital currency called Sweatcoins which can be redeemed for various rewards and products.

The aim is to incentivise people to engage in regular physical exercise, especially those who have issues with motivation.

NICE estimates that more than 5 million people in the UK will be diagnosed with diabetes by 2025, while the World Obesity Federation predicts that more than half of the world’s population will be overweight or obese by 2035.

The NHS has identified it as a key priority, however, England’s waiting lists for illnesses relating to cardiology are currently 13.3 weeks long while over 350,000 people wait – almost double what it was in April 2018.

People across the South West of London are being prescribed rewards per step as part of what’s called the ‘Prevention Decathlon’.

The approach is referred to as financial prescribing, an emerging sub-category of social prescribing which aims to boost people’s health by incentivising them with tangible goods or rewards.

The programme has initially launched in targeted areas of Richmond and Wandsworth following a successful trial of 70 patients which saw people lose 3kg in weight on average.

Sweatcoin CEO, Anton Derlyatka spoke on the ‘global inactivity pandemic’, the shortcomings of traditional fitness apps in motivating inactive people and what technology can bring to the preventative care space.

Experts have described physical inactivity as a global pandemic. Can you elaborate?

               Anton Derlyatka

If you look around on one hand, you see lots of people engaging in all sorts of physical activities.

You tend to think the reality is that the world is slowly getting better and better in terms of people being more physically active, but the numbers show a completely different picture.

There are people who have an intrinsic motivation to be physically active, and there’s quite a significant proportion of the world population who are like that.

These are the people you see in the streets. These are the people to go to the gym. And these are the people you see fit.

But not everybody is lucky. Not everybody’s got that privilege of being able to find that intrinsic motivation.

The vast majority of the human race, in fact, does not have it; about 70 per cent of the world population does not really want to be physically active or they do not have the power or strength to do so.

The huge wellness and fitness industry that’s made incredible progress over the past 50 years in terms of helping us become more physically active, only caters to about 30 per cent of the world population.

What are the implications of this widespread lack of movement?

[It] creates further health inequalities because people who are physically active are healthier, they are more productive and they are richer.

Whereas people who are less physically active, they tend to be, obviously, less healthy.

That leads to complications, from diabetes to cardiovascular to cancers to mental health issues.

As a result of that, they are relatively less happy, they’re relatively less productive and they’re relatively less wealthy.

Physical activity per se can not be the only cure for obesity but, in combination with other things, it is a determinant for general [wellbeing].

You move more and you walk outside, which improves your cardiovascular health, your metabolic health and that improves your mental health.

Can walking alone cure cancer? No, but it can increase your chances of recovering or treating any sort of condition to a very large extent.

What are the reasons for this decline in physical activity?

People are getting more and more obese and there is a range of different reasons [for that].

It’s consuming more calories because calories have become cheaper and cheaper. Some calories are actually worse than others, so people are consuming lots of bad cheap calories.

The other part of the reason is that we have become more and more sedentary. And why?

It’s very interesting. We are not actually created to be active. We are created to be lazy. We’re created to preserve whatever calories we can obtain.

Originally, when calories were so hard to get, you weren’t incentivised to be more physically active or to burn more calories.

In terms of evolutionary biology, it’s a different story with things like procreation for example.

From the get-go, we were incentivised to procreate. Orgasm exists to make the human being want to procreate.

With physical activity, it is different. We were not designed to be active.

Now, things have changed, things have evolved. The calories are cheap and almost everyone can get those calories. So it’s no wonder that we do not want to move.

Modern technology makes our life more convenient. You’ve probably seen the film WALL-E where in the future we’ll just walk around in capsules and stuff like that.

That’s pretty much in essence what’s happening right now because we don’t have a reason to be physically active.

What kind of incentives do other fitness apps use and what is Sweatcoin doing differently?

To some people, things like social pressure or being competitive really helps to develop that ritual. At the end of the day, physical activity requires building a daily habit.

The wellness industry, in the past 50 years, has been largely focused on building that intrinsic motivation by explaining why it’s good for you and building that motivational element.

Sometimes it uses something more manipulative such as guilt trips.

We thought there was room for something different.

Sometimes the traditional approach is basically, ‘alright, you’re a couch potato, you don’t move at all’ and then somebody like Nike comes in and they say, ‘Just do it. Why don’t you just stand up and do 5k three times a week?’

Well, that’s a huge leap and not everybody is capable of doing this.

[Other platforms] do something less stringent, something a little bit more subtle, creating tiny behavioural nudges, which on aggregate can help you develop a new habit. The likes of Strava, for example.

These guys actually cater to what I call amateur athletes, or people who are already active. And actually, they don’t have a problem with health as much.

Whereas we are on the exact opposite side of the spectrum.

We’re a consumer app for everyone and our target audience is people who struggle with being physically active. People who have problems with creating that motivation.

Can you tell us more about your current partnership with the NHS?

Diabetes is a big, big problem in the UK [and] a big problem for the NHS. About 10 per cent of the total budget goes into treating complications from diabetes.

Now, there are ways to pull people from the edge and prevent them from developing diabetes.

The NHS is using what they call a Diabetes Prevention Programme, which is a programme that helps people change their lifestyle by starting to be more active and eating better.

The problem with the existing approach is that the existing Diabetes Prevention Programme suffers from very low completion rates.

Only 20 per cent of pre-diabetic patients actually end up completing the programme, which means that 80 per cent of those patients have a very high chance of developing diabetes.

What we’ve built is a product that powers the existing Diabetes Prevention Programme.

When Sweatcoin is at play, then completion rate goes up from 20 per cent to 90 per cent.

And we know that in our past successful trials, users demonstrated the loss of weight of about 6 per cent of the body weight and they would become 40 per cent more active.

It’s a combination of a digital product and the real life meetings and lectures that the Diabetes Prevention Programme [runs].

So it’s not like we’ve come up with something completely new. We came up with a technology that strengthened the existing proposition.

What is Sweatcoin bringing to the preventative care space that previous technologies have failed to bring? Is this part of a general push from Sweatcoin to enter the healthcare industry?

Yes, we are very keen to deliver this approach […] and make the population in this country and around the world healthier.

Financial prescribing is a relatively knowable concept. Part of the reason why technology hasn’t been successful in the preventive care space is that it never closed the loop on measuring the impact.

There has been lots of marketing-driven campaigns and positive propaganda around healthy lifestyle.

But the problem is that when you cannot really track the return on investment, it’s hard to build a strong case for the government to continue to invest in certain areas.

With Sweatcoin, we’ve built a product that can track progress in real-time.

You take a certain segment of the population, you apply certain incentives and you can see how that changes people’s behaviour, literally on a daily basis,

Most importantly, it’s built for the user.

Often, the approach is different. Somebody gets a big contract from the NHS, they already have the money, they go out and start building something for the user, at least in the way they think the user needs it.

The reality may be different because people [want] something different. We took a completely different approach.

We’re not going top-down, we’re going bottom-up. We build the product for the user, we know the user loves it.

And then we approach the [NHS] saying, ‘Guys, we already deliver a certain level of behaviour change. If you’re interested in making it even stronger, let’s work together’.

If financial prescribing is adopted on a larger scale by healthcare systems and governments, what could the impact be on public health and the economy?

Going forward with [this] financial prescribing approach I think can be a wonderful way for the government to make targeted interventions or targeted investments into the healthcare system and achieve very clear, tangible and measurable results.

I believe this is important because this way, taxpayers will see exactly where their money is going and what kind of result they are actually achieving.

At the very high level, what we’re trying to do is change behaviour. But we also want to change the mindset of people.

The fundamental underlying concept that we have is that your physical activity is actually valuable.

It’s valuable to you, valuable to your family, your employer, to your insurer, to your health care provider, like the NHS, and ultimately your government.

And that is something because right now, physical activity, by many, is considered to be a bit of a nuisance. At best, it’s neutral and at worst, it’s actually quite annoying.

We want to [see] a fundamental shift in people’s psyche; for them to understand, ‘my physical activity is valuable’.

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