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The Mismarriage of Personal Responsibility and Health

Published online by Cambridge University Press:  11 March 2020

GREG BOGNAR
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Abstract

This paper begins with a simple illustration of the choice between individual and population strategies in population health policy. It describes the traditional approach on which the choice is to be made on the relative merits of the two strategies in each case. It continues by identifying two factors—our knowledge of the consequences of the epidemiological transition and the prevalence of responsibility-sensitive theories of distributive justice—that may distort our moral intuitions when we deliberate about the choice of appropriate risk-management strategies in population health. It argues that the confluence of these two factors may lead us to place too much emphasis on personal responsibility in health policy.

Keywords

personal responsibilityindividual risk management strategy of public healthpopulation risk management strategy of public healthepidemiological transitionjustice in health careluck egalitarianismresponsibility-sensitivity
Type
Special Section: Causality and Moral Responsibility
Information
Cambridge Quarterly of Healthcare Ethics , Volume 29 , Issue 2 , April 2020 , pp. 196 - 204
Copyright
© Cambridge University Press 2020

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Footnotes

Acknowledgments: I would like to thank participants at a VR/FORTE Person Centred Care workshop in Linköping, Sweden. Financial support from the Swedish Research Council and from the Swedish Research Council for Health, Working Life and Welfare is gratefully acknowledged (2014–4024).

References

Notes

1. See Rose, G, Khaw, K-T, Marmot, M. Rose’s Strategy of Preventive Medicine. Oxford: Oxford University Press; 2008 CrossRefGoogle Scholar.

2. Sometimes, of course, only one of these strategies may be available. More often, a mixture of the two approaches may be the most appropriate. For simplicity, I set more complex cases aside. One of the most relevant examples is that of preventing and managing STDs, including HIV/AIDS, in the case of which the choice between individual and population strategies have also been politically controversial. For discussion, see Aral, SO, Holmes, KK, Padian, NS, Cates, W Jr. Overview: Individual and population approaches to the epidemiology and prevention of sexually transmitted diseases and Human Immunodeficiency Virus infection. The Journal of Infectious Diseases 1996;174(Suppl.2):8127–33CrossRefGoogle Scholar, and the references therein.

3. Wolff, J, de-Shalit, A. Disadvantage. Oxford: Oxford University Press; 2007:3 CrossRefGoogle Scholar, their emphasis.

4. GBD 2013 DALYs and HALE Collaborators. Global, Regional, and National Disability-Adjusted Life Years (DALYs) for 306 Diseases and Injuries and Healthy Life Expectancy (HALE) for 188 Countries, 1990–2013: Quantifying the Epidemiological Transition. The Lancet 2015;386(10009):2145–91.

5. Rawls, J. A Theory of Justice. Cambridge, MA: Harvard University Press; 1971 CrossRefGoogle Scholar.

6. Dworkin, R. Sovereign Virtue: The Theory and Practice of Equality. Cambridge, MA: Harvard University Press; 2000 Google Scholar; Arneson, RJ. Equality and equal opportunity for welfare. In: Pojman, L, Westmoreland, R, eds. Equality: Selected Readings. Oxford: Oxford University Press; 1997:229–42Google Scholar; Cohen, GA. On the currency of egalitarian justice. Ethics 1989;99:906–94CrossRefGoogle Scholar; Temkin, L. Inequality. Oxford: Oxford University Press; 1993 CrossRefGoogle Scholar; Roemer, JE. Theories of Distributive Justice. Cambridge, MA: Harvard University Press; 1996 Google Scholar.

7. Arneson, RJ. Luck egalitarianism and prioritarianism. Ethics 2000;110:339–49CrossRefGoogle Scholar.

8. The increased focus on personal responsibility has had a massive impact on public policy. For an account of its emergence, see Mounk, Y. The Age of Responsibility: Luck, Choice, and the Welfare State. Cambridge, MA: Harvard University Press; 2017 CrossRefGoogle Scholar.

9. Thaler, RH, Sunstein, CR. Nudge: Improving Decisions about Health, Wealth, and Happiness. New Haven, CT: Yale University Press; 2008 Google Scholar.

10. Marmot, M, Wilkinson, RG. Social Determinants of Health, Second Edition. Oxford: Oxford University Press; 2005 CrossRefGoogle Scholar.

11. Segall, S. Health, Luck, and Justice. Princeton, NJ: Princeton University Press; 2010:20 Google Scholar.

12. Roemer, JE. A pragmatic theory of responsibility for the egalitarian planner. Philosophy and Public Affairs 1993;22:146–66Google Scholar.

13. OECD. Obesity Update 2017; available at https://www.oecd.org/health/obesity-update.htm (last accessed 16 Aug 2019).

14. See, for instance, Gard, M, Wright, J. The Obesity Epidemic: Science, Morality, and Ideology. New York: Routledge; 2005 CrossRefGoogle Scholar.

15. Anomaly, J. Is obesity a public health problem? Public Health Ethics 2012;5:216–21CrossRefGoogle Scholar.

16. Brownell, KD, Kersh, R, Ludwig, DS, Post, RC, Puhl, RM, Schwartz, MB, et al. Personal responsibility and obesity: A constructive approach to a controversial issue. Health Affairs 2010;29:379–87CrossRefGoogle ScholarPubMed.