Healthy incentives for the disadvantaged?

Of course, the fact that in some of the most deprived parts of the country life expectancy is 15 years less than in the most affluent areas suggests the message is still not getting through to everyone. But what can we do about this? Is it the responsibility of health and social care agencies to engage those who drink excessively, eat too much or smoke if they don't want to be engaged? What is the balance between personal responsibility and that of the state?

This is a complex debate and one that will probably rage for many years to come as the public health and care system increasingly creaks under the strain of an ageing population. But it's interesting to see that one primary care trust in Essex has come to the conclusion that concern about one's personal health is simply not enough of an incentive to get their hard-to-reach patients to come and see them - it believes that a monetary inducement will be more effective.

The PCT is to run a pilot scheme that will reward people from disadvantaged backgrounds - the unemployed, in social housing, children in care - with money and vouchers for just attending the GP surgery to have a health check-up. I can understand the logic: the small outlay for getting people to see a GP and tackling lifestyle problems who otherwise wouldn't could be paid for many times over if it reduces chronic illness and improves health.

But is it morally right? Some would argue that who cares about morals if such a scheme tackles the entrenched and dispicable gulf in life expectancy between the haves and have nots. However, I can also see the other side of the fence - is it really right for the state to be putting a monetary value on people's health? And why should only those who don't take their health seriously be the only ones to benefit? Either way, it's a pretty sad state of affairs when you have to bribe someone with £20 to see their GP.