Nannying, nudging, rewarding? A discussion on the constraints and the degree of control over health status

Public health policies typically assume that there are characteristics and constraints over health that an individual cannot control and that there are choices that an individual could change if he is nudged or provided with incentives. We consider that health is determined by a range of personal, social, economic and environmental factors and we discuss to what extent an individual can control those factors. In particular, we assume that observed health status is the result of individual control and constraints to change that an individual faces. We suggest three different constraints: budget, time and psychological constraints and position various determinants of health according to increasing levels of constraint and increasing degrees of individual control. We finally discuss public health policies such as nannying, nudging, and rewarding within this new framework and show that the level of constraints and the degree of individual control over health status are essential dimensions to consider when designing and implementing public health policies.