"People Do Have Choices, But They Exercise Them Mainly Under Social Influences"

Dr. Lester Breslow, a pioneer in the field of public health, recently passed away. He was 97. Here's an interview with him from 2003:

An Interview with Dr. Lester Breslow, American Journal of Clinical Nutrition, November 2003

Here he discusses individual responsibility vs. societal responsiblity:

Throughout much of his work, an emphasis on individual initiative in health behavior change is evident. Breslow believes that an overemphasis on individual responsibility instead of societal responsibility leads to “victim blaming.”

"In the report on Health Needs of the Nation for Truman in 1952,” he said, “we delineated the issue quite clearly. People make choices. You and I can decide each day on positive health behavior or negative [health behavior], though most [behaviors] become ingrained in us as habits. Such decisions are not made nor habits developed in a vacuum, but in a social context in which we live. If people live with smokers, smoking is more likely; if people live with exercisers, they tend to exercise. Social factors, advertising, availability, are all determinants of each individual’s choices. As public health workers, we should make it clear that people do have choices, but they exercise them mainly under social influences.”

At the end of his book Health and Ways of Living, Breslow specifies that social action is necessary to influence health-related behavior decisions — social interventions will be more practical and efficient than individual ones. “An example of that,” he said in the interview, “is the successful tobacco smoking control program in California. A great effort of volunteers, public health, and medical people was instrumental in passing legislation as an initiative. A tax of 25 cents per pack is for specific hospital, medical, and other services, with 20% for interventions encouraging people not to smoke. The program involved a very broad network: school, work, health department, state, community organizations, [and] media. Projects spreading the word in neighborhoods, as well as use of mass media, were quite effective. The whole milieu about smoking was being changed, reversing the general tolerance of it. In government offices, smoking was prohibited, in workplaces and in restaurants and bars smoking was also prohibited. So there is progress to making smoking unacceptable.”

Here he addressed whether laws that limit individual freedoms are justified:

In conducting social interventions, there is the potential for conflict between personal autonomy and the common good. Is it right to make laws on personal health choices when such decisions can improve the health of the whole society? Some have referred to this as “health fascism,” an observation that drew laughter from Breslow. “Such laws can appropriately be passed when individual behavior is a hazard to someone else,” he said. “For example, secondhand smoke kills people and causes disease. Laws may be passed to protect people who may be exposed in the workplace, such as flight attendants. Yes, it is appropriate when one’s individual behavior imposes a risk on other people.”

I liked the secondhand smoke example. Can you think of another?
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