They fall within the purview of our agency. Whether or not we fall ill depends, significantly, on what we do, and whether or not we recover depends, significantly, on what we do. In the light of these facts, calls for us to take responsibility for our health therefore make prima facie sense (see Brown, 2013 Friesen, 2018 for discussion). Moreover, when disease arises, there is usually a great deal we can do to help to manage it, and patients fail surprisingly often to do these things-only about half of all prescribed doses of medication are taken by patients, for instance ( Nieuwlaat et al., 2014). ![]() Lack of sufficient exercise, excessive drinking and smoking all contribute to ill-health. 2 Accordingly, WHO has called for changes in lifestyle to halt this epidemic, as well as to reduce or eliminate other risk factors for early mortality and increased morbidity ( WHO, 2014). We are in the midst of what the World Health Organization (2003) described as an obesity epidemic, and it is widely held that obesity is a risk factor for cancer, heart disease and stroke ( WHO, 2014). Lifestyle factors are very significantly responsible for the global burden of disease: up to 40 per cent of premature deaths are preventable by changes to lifestyle ( Yoon et al., 2014). Rather, early mortality and increases in morbidity are often due at least in important part to our behavior. Should agents be expected to take responsibility for their health? Calls for us to do so have arisen in response to the recognition that ill-health is not something that just happens to us. It is both fairer, and better policy, to address such demands to them, and not to those whose health suffers as a consequence of their own choices. Conversely, there is a large group of individuals who might appropriately be asked to take responsibility for responsibility. While there may be individuals who might appropriately be asked to take responsibility for their health, they form too small a minority, and they are too difficult to identify, for responsibility to be a good basis for policy. Responsibility is not a good basis for public policy, I will suggest, because policies should be formulated in ways that are insensitive to fine-grained differences in the capacities that underlie responsibility. While the considerations I will cite have implications that are broader than exhortations to responsibility in these contexts, it is here that their implications are clearest. It is with responsibility in these kinds of contexts that I am principally concerned. For example, Hungary reportedly uses adherence to dietary recommendations to exclude patients from access to some therapies ( Hazell, 2012). Responsibility is already enshrined in the NHS Constitution for England ( NHS, 2015) and underlies health policy in other countries. In this article, I am concerned with these calls only insofar as they might form a basis for public policy. ![]() They are to be found in the popular press ( Macrae, 2016), in the academic literature ( Callahan, 2013) and in public statements from corporations ( Kent, 2009). ![]() 1 In this light, calls for us to take responsibility for our health are best understood as responsibility-shifting mechanisms: they serve to shift the burden from those who are best equipped to meet it to those who cannot.Ĭalls for us to take responsibility come from multiple sources. I argue that the capacities for responsibility, and the circumstances in which they are exercised, are themselves distributed: typically, agents can effectively take responsibility for their own health by adopting healthier lifestyles only if they are the beneficiaries of distributive mechanisms that allocate life chances. In this article, I argue that these calls are unjustified. While the harshest condemnation comes from the popular press, calls for us to take responsibility come from a variety of sources, including physicians themselves and even governments. Calls for us to take responsibility for our health, and expressions of blame for those become ill, are common.
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