Behaviours that pose risks for an individual's health and that also represent important threats for public health, such as drug use, smoking, alcohol, unhealthy eating causing obesity, and unsafe sex, are highly prevalent in low income countries, even though they are traditionally associated with richer countries. Individual choices are an important part of the risky behaviours. Risking Your Health: Causes, Consequences, and Interventions to Prevent Risky Behaviors explore how those choices are formed and what are their consequences. Why do people engage in risky behaviours? Many different explanations have been proposed by psychology, sociology, economics or public health. One trait common to all these behaviours is that there is a disconnect - a function of both delay and uncertainty - between the pleasure or satisfaction provided by them and their consequences. Another characteristic of risky behaviours is that they rarely occur in isolation. Peer-pressure, parental influences, networks and social norms often play an important role in initiating, continuing, or quitting those behaviours. Even if they might often be the first to suffer, the consequences of risky behaviours are also rarely limited to the individuals engaging in them. In certain cases, such as second-hand smoking or HIV transmission, the link is direct. In other cases, the link is less direct but not necessarily less real: the long term health consequences of many of these behaviours are costly to treat and could stretch households' finances and worsen poverty. Finally, these risky behaviours have consequences for society as a whole since they often trigger a non-trivial amount of public health expenditures and lead to declines in aggregate productivity through premature death and morbidity. Changing behaviours is tricky -- public health interventions via legislation with strong enforcement mechanisms can be more effective than simple communication campaigns informing consumers about the risks associated with certain behaviours, since translating knowledge into concrete changes in behaviour seems to be hard to achieve. Economic mechanisms such as taxes (especially on alcohol and tobacco products), subsidies (such as free condoms), and conditional/unconditional cash transfers are also used to reduce risky behaviours (for example in HIV prevention). Of great interest to policy makers, academics and practitioners, this book assesses the efficiency of those interventions designed to reduce the prevalence of behaviours that endanger health.

This Policy Research Report examines one specific policy approach to improving effective coverage: financial incentives in the form of performance-based financing (PBF) or financial incentives to health workers on the front lines.