Sunday, November 20, 2016

Public Health Strategies Part 2: Personal Responsibility

If you find one of the ideas in these posts on public health strategies objectionable consider waiting before jumping to conclusions because I may address your concerns in a later post

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

It’s tempting to blame what’s called the obesogenic environment (which is a decent point I'll discuss later) and ‘evil corporations’ for the rise in obesity and other chronic diseases across the globe.  Similarly, because free will cannot exist, one could justify playing the victim, that they are not personally responsible for the bad things that happen in their life including their poor health behaviours and health status, that they are a victim of being born to the wrong parents and living in an obesogenic environment

As discussed in the previous post, even though free will does not exist there is value to society and us as individuals to emphasise a belief in personal responsibility.  We have plenty of options to make healthy or unhealthy lifestyle choices; 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.  The blaming of business is not really appropriate (except when they distort science and engage doctors/dieticians for hire) as businesses cannot force us to purchase their products (unlike government), but instead they are reacting to what consumers want when they decide to open more stores and make more products (supply and demand).  In addition, there should come a time when people realise that although playing the victim may give you an excuse and sympathy in the short-term, but in the long term others will become desensitised to the strategy such that it no longer has the same effect, and is ultimately unproductive as your problem will remain until you take active steps to fix it.  In this respect, holding yourself and others personally responsible is more empowering than wallowing in self-pity

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, social norms against personal responsibility and a pessimistic attitude towards ageing and chronic disease.  So the strategy of personal responsibility should be coupled with: (1) a major change in universal healthcare, or at least the addition of a mechanism 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, vitamin K2 for osteoporosis, and higher protein diets for fat loss and sarcopenia) and there will almost certainly be more options available that no one knows yet until more research is done

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