Responsibility for Health

Abstract
This essay will address the degree to which the viewpoint that health is ultimately the responsibility of the individual is correct and sound. It will touch on both sides of the argument highlighting that although health problems associated with poor lifestyle choices such as an unhealthy diet or lack of physical exercise have taken an unquestionable toll on free health care resources and finances, the reality can be far more complex.
Introduction

The question of whether health is the responsibility of either the individual or society is almost philosophical in nature. Free will and the ability to make our own choices about the way we live is a basic human right. However, the lifestyle choices that some individuals make can place a burden not only on free healthcare, but also on society as a whole. Although on the surface it may appear that choices such as a poor diet, lack of exercise or substance abuse are self-inflicted, this essay will explore that the reality is often far more complex.
Body
A review by Scarborough et al. (2011) reported that between 2006 and 2007, health problems caused by poor diet cost the UK’s National Health Service (NHS) ?5.8 billion pounds, smoking and alcohol related illness cost ?3.3 billion and the cost of obesity was just over ?5 billion. This equated to 46% of total NHS costs accounted for by diseases related to self inflicted activities such as a lack of physical activity, poor diet, smoking, alcohol consumption and obesity. Governments have certainly made moves to try and tackle the burden that self-inflicted health problems are bringing. Since 2011, countries such as Denmark, France and Hungary have introduced a ‘fat tax’ on food items such as sweetened drinks and junk food to try and limit unhealthy food choices. In most countries, the purchase and consumption of alcohol and cigarettes, two substances known to have negative health effects, are both regulated by the law. Although such measures provide guidance regarding how to live healthily, the fact that items such as cigarettes and alcohol are freely available once individuals are 18 and an adult in the eyes of the law suggests that it is the individual who is ultimately responsible for making either healthy or unhealthy lifestyle choices. As a result, it could be argued that they should also be responsible for the consequences of such choices. This argument could be particularly relevant to the case of obesity for which it is hard to argue for the existence of excuses other than poor choice and lack of self-discipline. Not only does obesity take a large toll on NHS finances, but is has been estimated to cost the wider economy ?16 billion, which could rise to ?50 billion by the year of 2050 if it’s aggressive impact is not checked (http://www.bis.gov.uk).
On the surface, the burden of lifestyle related diseases certainly provides a strong argument for the individual to not only be responsible for their health but also financially responsible (see Cappelen and Norheim, 2005). However, such a view is an ethical minefield and definition of a lifestyle related health problem is not as clean cut as it might first appear. If it is expected that patients who have health problems stemming from poor lifestyle choices must pay for their own healthcare, then it could be argued that those individuals who develop health problems as a result of participating in activities such as extreme sports, should also pay for their own healthcare. Furthermore, the viewpoint that individuals choose to live either healthily or unhealthily may be grossly oversimplified. For example, unhealthy choices may be the result of a co-morbid mental health problem or the result of a past trauma that the individual has been unable to come to terms with. Vulnerable groups of individuals such as the homeless may be more likely to be abuse alcohol and drugs as a coping strategy and individuals in supported housing may have no choice in the food that is provided for them. The World Health Organisation (WHO, 2004) have found that price has a significant impact on people’s diet choices and coupled with the relatively low cost of unhealthy foods compared to organic, whole-food choices, a poor diet may be almost unavoidable for individuals with a low income. Therefore, establishing whether lifestyle choices are based on personal choice or forced through personal circumstance can often become difficult. Although governments have introduced measures designed to aid the public in making positive health choices, there is in fact little solid evidence that taxes on items that cause poor health, such as unhealthy foods, have a positive impact on public health. Two American based studies (Kim and Kawachi, 2006; Powell, Chriqui and Chaloupka, 2009) failed to find a significant association between taxes and the prevalence of obesity. A study by Powell and Chaloupka (2009) found that the small price change caused by taxes or subsidies are unlikely to cause notable changes in levels of obesity. In a recent article in the British Medical Journal, Mytton, Clarke and Rayner (2012) argued that taxes on unhealthy items could have the power to make a change to public health but they would need to be set at least 20%.
Conclusion
The viewpoint that health is ultimately the responsibility of the individual will always be a controversial one. For most of society, the responsibility for health should lie with the individual. However, it is clear that for many individuals there are far more causes behind poor lifestyle choices than just bad decision making on their behalf. These could include social status, income, education, environment and genetic factors. Scarborough et al. (2011) have highlighted that the burden of diet-related diseases such as type 2 diabetes is greater than can be attributed solely to lifestyle factors such as obesity. Nevertheless, governments must also be held accountable for ensuring that information regarding positive health choices is made widely available through a number of different mediums so that individuals can make informed decisions. Furthermore, any future measures dictating that individuals who are deemed to have self-inflicted health problems must pay out for their own health care, must first try and be avoided by providing more preventative and educational measures for improving overall public health.
References
Cappelen, A.W. and Norheim, O.F. (2005) Responsibility in health care: a liberal egalitarian approach. Journal of Medical Ethics, 31, pp. 476-480.
Department for Business, Innovation and Skills (2007) Tacking Obesity: Future Choices [WWW]. Available from: http://www.bis.gov.uk/foresight/our-work/projects/published-projects/tackling-obesities [Accessed 02/12/12].
Kim, D. and Kawachi, I. (2006) Food taxation and pricing strategies to “thin out” the obesity epidemic. American Journal of Preventive Medicine, 30, pp. 430-437.
Mytton, O.T., Clarke, D. and Rayner, M. (2012) Taxing unhealthy food and drinks to improve health. British Medical Journal, 344, e2931.
Powell, L.M. and Chaloupka, F.J. (2009) Food prices and obesity: evidence and policy implications of taxes and subsidies. Milbank Quarterly, 87, pp. 229-257.
Powell, L.M., Chriqui, J. and Chaloupka, F.J. (2009) Associations between state-level soda taxes and adolescent body mass index. Journal of Adolescent Health, 45, S57-63.
Scarborough, P., Bhatnagar, P., Wickramasinghe, K.K., Allender, S., Foster, C. and Rayner, M. (2011) The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs. Journal of Public Health, 33, pp. 527-535.
World Health Assembly (2004) Global strategy on diet and physical activity. Geneva: World Health Organization.