Paying the piper: additional considerations of the theoretical, ethical and moral basis of financial incentives for health behaviour change.

Lynagh, Sanson-Fisher and Bonevski's article entitled "What's good for the goose is good for the gander. Guiding principles for the use of financial incentives in health behaviour change" (Int J Behav Med 20:114-120, 2012) reviews evidence for the use of financial incentives for encouraging health behaviour change. Their discussion of the practical and moral issues involved is a timely contribution which will encourage consideration of the implications of such interventions. In this response to their paper, I suggest that there are also broader aspects that we must consider before developing principles for public policy intervention. First, we must include good theories that explain in a great deal more depth what we mean by health-related behaviours, and secondly, we need to understand the location of these behaviours in social life and within structural inequalities. To ignore these fundamental aspects of health is to risk increasing social injustice and worsening health inequalities, a facet of the morality of health promotion activities which is not touched upon by the Lynagh et al. paper.