Wednesday, March 31, 2010

Healthcare And Individual Responsibility

BL sent this article from the New York Times yesterday. BL knows how to fire me up.

No Matter What, We Pay For Others’ Bad Habits

Who wrote this? Sandeep Jauhar? Major props!

The person in the article who said, "I’m tired of paying for everyone else’s stupidity," doesn't understand that we are already paying for other people's health problems in the form of higher health insurance premiums and higher medical costs.

About that "stupidity" part ... The person who said this also doesn't understand that you can't judge an individual apart from their environment. If what we see is stupidity, it is more a reflection of our country's stupidity, the stupidity of the choices of the population as a whole, than it is the conscious choices of a particular individual. This focus on the individual is simplistic, short-sighted, and deflects responsibility away from the person who thinks it.

Here are excerpts of the article that I whimpered joyfully when I read:
"When people advocate the need for personal accountability, they presuppose more control over health and sickness than really exists."

"Unhealthy habits are one factor in disease, but so are social status, income, family dynamics, education and genetics."

" "It’s the context of people’s lives that determines their health,” said a World Health Organization report on health disparities. “So blaming individuals for poor health or crediting them for good health is inappropriate.” "
"The context of people's lives." Whoever said this gets it. I'll admit, it took years of public health education and working for me to get it. I used to think ... "This person is overweight because they choose to eat too much." Of course I believe that an individual bears responsibility for their health. Of course I do. But I've come to understand that the wider context - a person's social, cultural, economic, religious, political, historical setting is more influential. You cannot ignore these effects.

My favorite analogy is ... if you pluck an overweight someone from a rich suburb in 21st century US and place him in 1960 rural China or in areas of Sudan and Chad right now, he will likely lose weight. Conversely if you move an underweight someone from war-torn Sudan and place him in a rich suburb here, he will likely gain weight. Changes in a person's health - both detrimental and advantageous - when they relocate to places unlike their origins have been documented.

Before you can blame an individual for their choices, you have to make sure they have the same choices as everyone else.

The conversation is ongoing at the NYTs Well blog: Paying For The Bad Habits Of Others
Photo: Bix


Bix said...

I forgot to mention TV. I don't know how I overlooked that. I think it's one of the most powerful forces that shape our behavior.

When you feed a child junk food, beginning in the womb and throughout infancy and childhood, at school and other public affairs, when you reinforce the eating of junk food on TV and other media, when all your friends eat junk food, when restaurants and grocery stores sell junk food, you establish neural pathways that are very hard to re-establish later in life.

virginia said...

"Before you can blame an individual for their choices, you have to make sure they have the same choices as everyone else."

I just might steal this for my header - credited to you, of course.

Bix said...

Thanks, virginia.

By the way, I was reminded of you... I was looking around the place from where you sent this link:

How To Feed The World?
(Politically bold conclusion, there.)

And I saw this:

Does TV Make You Fat?

I don't have the opportunity to see what's being taught to children these days, but if this is representative, it bodes well for our future.

virginia said...

unfortunately, i think it bodes well for european children's futures - not that they don't have their issues.

i think maybe TV chefs bringing veggies, cameras and fame to school cafeterias and kitchens, will appeal to our kids.

saw a really entertaining one, recently. actually think it was british, and he killed a chicken on camera. don't think that would go over here, though.

Bix said...

The TV chefs ... would that be Jamie Oliver? I haven't been paying attention.