Personal and Social Responsibility for Health (Special Section‪)‬

AS we come to understand the multiple determinants of health, the list of agents whose actions have a role in its maintenance and restoration grows long--ranging from international organizations to states, communities, employers, insurers, and the health professions. The ethics of health policy consists in part in determining the appropriate role for each: who is responsible for health? This essay addresses the responsibility of individuals for their own health. At the population level, it is increasingly clear that individual choices--"healthy lifestyles"--are at least as significant in achieving good health outcomes as costly medical interventions, and that providing information and encouragement is an essential function of health systems. But what should happen when an individual fails to take advantage of these resources? Placing responsibility on the individual could mean holding people accountable for what they do and do not do to remain healthy--an idea with far-reaching implications for health policy. While acknowledging its appeal, this essay argues that personal responsibility for health deserves but a peripheral role in health policy.