Sunday, November 20, 2016

Public Health Strategies Part 2: Personal Responsibility

In an earlier post I mentioned a few different commonly proposed public health strategies, and how most of them fit quite nicely into the political spectrum characterised by an authoritarian-libertarian axis and a left-right axis.  In this post I’ll discuss the strategy of personal responsibility, which I thought fits nicely into the libertarian right quadrant.  This is because personal responsibility is a key value of the political right, and because personal responsibility is a strategy that maximises individual freedom and ultimately limits the influence of government and others

I discussed in previous posts that I doubt free will exists, and that I believe the absence of free will is not just an academic issue but that it has some very important implications.  One of these is that the absence of free will is a valid argument against morally blaming people for their health behaviours and health outcomes, as these are a product of their genes and environment.  Ultimately, we can’t choose our personality traits such as conscientiousness, the environment that we grow up in, and our genetic susceptibility to health and disease and so shouldn’t be blamed for that

However, there’s also the risk that this line of thinking goes too far in the other direction.  With the absence of free will, it can be tempting to play the victim and blame your genes, your upbringing and the obesogenic environment.  While this has an element of truth, this mindset is ultimately unproductive.  If your health is impairing your quality of life, what good would it do to ruminate in self-pity that your poor health (or other problem) isn’t your fault and not do anything about it.  While playing the victim may yield some sympathy in the short term, the problem won’t go away and will likely get worse until you take active steps to fix it.  In this respect, holding yourself and others personally responsible is more empowering than fatalism and self-pity

While you can’t change your genes, can’t change the past and have a limited ability to change the broader environment, you can change the way you engage with the broader environment and set up your own microenvironment to support good habits.  We all know the basics of what to do to improve our health (that whole foods are on average healthier than highly processed foods and that getting enough exercise and sleep are important) and no one has a gun to our heads forcing us to make the wrong choices.  Ultimately, your health is in your hands

The efficacy of personal responsibility as a public health strategy is difficult to assess.  Some people may argue that it’s the status quo and so is failing as a public health strategy.  However, I don’t think this is completely true

1) Taking personal responsibility for your health isn’t as incentivised as it could be.  Most Western countries have some degree of universal healthcare, health insurance, subsidised pharmaceutical drugs, and government funding into the basic sciences that can lead to drug development.  These policies and institutions mean that individuals and not completely financially responsible for the costs of poor health resulting from poor lifestyle choices, and the financial costs are instead shouldered by others to varying degrees in the form of more taxes, or from funding being taken away from other public services.  Under such conditions it would be expected that individuals would be less motivated to prevent and treat diet and lifestyle diseases themselves by improving their diet and lifestyle

2) Our society’s narrative on ageing and chronic disease is one that emphasises an inevitability of chronic disease and the role of bad luck, rather than personal responsibility.  I think some of this narrative is to protect against blaming and shaming when people are at their most vulnerable, but it has the unintended consequence of fostering a belief that humans are broken and creating a sense of hopelessness

So the potential of personal responsibility as a public health strategy is not likely to be realised in a society that has universal healthcare or health insurance, social norms against personal responsibility (a victimhood vs. dignity culture) and a pessimistic attitude towards ageing and chronic disease.  So the strategy of personal responsibility should be coupled with: (1) the addition of a mechanism in healthcare that incentivises people not getting lifestyle diseases/adopting good health choices (focus of the next post I have planned); and (2) a change in society’s narrative of chronic disease to one that empowers people 

The second point illustrates a weakness with personal responsibility as a public health strategy.  Which is that it requires that people either know or have readily available access to the knowledge that will allow them to make the healthy lifestyle choices that will dramatically reduce their risk of chronic disease or in other cases treat or reverse existing diseases.  Some of this knowledge is already widely known, but most people don’t know about even well supported interventions (such as very low calorie diets for type 2 diabetes and vitamin K2 for osteoporosis) and there will almost certainly be more options available that no one knows yet until more research is done

Sunday, November 13, 2016

Implications of not having Free Will

In the previous post I briefly challenged the idea of free will.  In philosophy, hard determinism states that current events are determined by previous events and therefore free will cannot exist.  That any thoughts or actions we take are the result of the interaction between earlier environmental factors and our genetics.  And those earlier environmental factors in turn are the result of the interaction between even earlier environmental factors and our genetics.  You can ultimately go back with this chain of causality (infinite regression) to a point where we have not yet been born.

Hard determinism is very difficult to argue against, but some philosophers argue that even though current events are determined by previous events (determinism), the fact that we have choice on a practical level means that free will exists.  This position is called soft determinism or compatibilism and can only work by changing the definition of free will.  You could describe this version of free will as functional or practical free will, as opposed to what could be called ultimate free will that is the topic of this post

The case against free will has been made stronger from recent neuroscience research, showing that our conscious awareness of having made a decision occurs after our brain unconsciously makes the decisions [1] [2].  So in a sense, both conscious decision making and free will are illusions

Rather than being an academic point, I think the absence of free will has several important implications.  In the previous post I used the absence of free will to question whether it was appropriate to blame someone for their behaviours and health status, but there are more important issues than this.  This content is going to be quite different to my usual blog posts, but I think these are ideas worth mentioning regardless

Personal Responsibility

In the strictest sense, a not having free will means that we cannot be personally responsible for our actions and so any praise and criticism is not deserved.  However, it’s still important for the functioning of society to emphasise personal responsibility and praise and criticise the behaviours of others as if they were personally responsible.  This is purely because of the positive consequences of doing so, the negative consequences of not doing so, and the fact that none of us have a gun to our head forcing us to act in a certain way (functional or practical free will)

Imagine the following scenarios:

  • Someone does poorly on their job and when questioned about it states that they are not responsible for their poor performance
  • A driver runs over a pedestrian with their car, and in court claim they are not personally responsible for running the pedestrian over
  • A student studies hard for a test and does well on it.  The student receives no praise from the teacher who decides the student is privileged for being white/Asian and being middle/upper class
  • An entrepreneur finds a gap in the market, takes risks and works hard to start and build their business, and they end up making a lot of money.  Despite selling people products they want and increasing jobs, an angry mob claims conflates inequity with inequality and demands 90% of the entrepreneur’s income

In each scenario the person cannot strictly be held personally responsible for their actions, but each scenario demonstrates the importance of: (1) emphasising personal responsibility regardless of its truth; and (2) using praise and criticism to encourage good behaviour and discourage bad behaviour, even if life isn’t fair, the world isn’t a true meritocracy, and the praise and criticism isn’t deserved.  You would want other people to hold themselves personally responsible for their actions, other people would want it of you, and you would want society to be based on it and the encouragement of good behaviour and discouragement of bad behaviour

The alternative is a bleak world, but one that is close to the utopia of social justice warriors.  It would be a socialist world where people would have little incentive to work hard or create value.  The opposite would be true as people would be incentivised to take as much as possible from society while doing as little work as possible, claiming that their unique set of genes and environmental factors resulted in them having great needs and little ability*.  The perceived merits of each person and the criminal justice system would be perverted by what Thomas Sowell calls cosmic justice.  The purpose of the criminal justice system will no longer be to deter crime and prevent repeat offences to protect the innocent.  Instead it will focus on the criminal and apply the law unequally to people from groups with current or historical privileges or oppressions to the detriment of the public.  This will raise tensions between races/sexes/etc because the ‘privileged’ group will be resentful of the special treatment of the 'oppressed' group, while the ‘oppressed’ group will be fed a false narrative of victimhood at the hands of the privileged.  People who disagree with this ideology won’t receive the same concessions.  They will uniquely be held personally responsible, labelled as evil, and silenced in the name of progress because the end always justifies the means

* Capitalism is been criticised as a system based on based on greed.  I agree, but capitalism incentivises co-operation and creating value for others, whereas socialism is a system based on sharing, but one that actually incentivises greed

Divine Justice

For this section just an FYI, I’m an atheist

This brings me to what I think is the most important implication of not having free will by far.  Many religions have a concept of an afterlife and that pleasantness or unpleasantness of which is determined by your actions while you’re alive.  This is judged by an omniscient deity in the Abrahamic religions (Judaism, Christianity, Islam) or by karma in Eastern religions such as Hinduism and Buddhism.  I’ll call this divine justice

Many aspects of religion can be interpreted to have had functions that provided a net benefit to society in some way at some stage.  For example, the Abrahamic religions have a very strong emphasis on hygiene and cleanliness and this was likely a cultural adaptation against infectious disease at a time before the germ theory of disease.  Similarly, the belief in an afterlife and in divine justice could have been a cultural mechanism to strongly encourage or discourage certain behaviour and provide consolation for the suffering experienced in life.  This could be cynically interpreted as a means to keep the general population complacent with authoritarian regimes and the massive inequalities in those ancient societies

Belief in an afterlife and divine justice may have been helpful earlier, but I think that these beliefs are ultimately responsible for some of the major problems in the world at the moment, which is why I’m writing this section

The Abrahamic religions have a belief in the same deity, who is believed to be omniscient, just, and merciful (they believe this deity possesses many other qualities, but these are ones relevant to the topic).  They also all include a belief in free will, an afterlife and divine justice.  Belief in free will is a necessary premise for belief in divine justice, and in the absence of free will, the belief that their deity possesses those qualities contradicts the belief that divine justice will affect the quality of the afterlife

Since free will cannot exist, therefore we cannot strictly be personally responsible for our actions.  An omniscient, just, and merciful deity could not possibly condemn someone to purgatory or hell based on the actions they made in life as these actions are a product of the genetic and environmental cards they were dealt.  For such a deity, divine justice would be an infinite regression back to the first cause – the big bang (or whatever came before that) or the deity creating the universe – and everyone would have to be judged as neither good nor evil and deserving no different treatment regardless of whether they were a sociopath or a saint.  It would take an exceptionally unjust, unmerciful and sadistic deity to condemn someone to an eternity of suffering for the crime of being born to the wrong parents, in the wrong place, at the wrong time

Therefore not having of free will - combined with a belief in an omniscient, just, and merciful deity - undermines the religious beliefs and practices (but not faith in a deity) one would ordinarily not partake in, but does so to appease their deity and increase their chances of a better afterlife.  Knowing this would have the effect of freeing people from any religious practices that don’t improve your life or the lives of others (because you don’t need religion to be a good person).  Most importantly, not having free will undermines a basis for religiously motivated violence/terrorism outside sectarianism (whether it’s holy war, delivering gays from sin, just killing infidels, etc) and the politicisation of religion, all because it cannot matter in the eyes of an omniscient, just, and merciful deity