Public Health Ethics - Global Cases, Practice, and Context, 2016a

5 Chronic Disease Prevention and Health Promotion
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Fig. 5.1 Factors determining health and chronic diseases (Originally published in Dahlgren and
Whitehead ( 1991 ). Reproduced from Acheson ( 1998 ). Reproduced with permission)
And finally—although Knowles acknowledges elsewhere in his essay the role of
taxes and other measures to improve health and eradicate poverty—he concludes by
stating “the costs of individual irresponsibility in health have now become prohibitive.
The choice is individual responsibility or social failure ” (Knowles 1977 ). The
policy interventions he mentions aim for broader recognition of personal responsibility
and therefore focus on education and information campaigns to empower
people to behave responsibly. But this analysis is shortsighted. It fails to consider
the responsibility of those who produce, market, and sell products (e.g., unhealthy
foods, drinks, or tobacco ) and of those who regulate markets or set business standards
(e.g., trade groups or national or regional policy makers). His point could best
be made if all people lived in similar environments and conditions, had sufficient
disposable income, had ready access to healthy and affordable food, had equal
opportunity to exercise, and experienced other health-conducive conditions. But
this is not the case. People live in vastly different contexts, and many different factors
determine health (Fig. 5.1 ).
Although Fig. 5.1 provides a useful overview of many factors that affect health,
the concept of “ lifestyle ,” commonly encountered in the broader debate around
chronic diseases is problematic. It can suggest that people choose, for example,
smoking or heavy drinking as others might decide between taking up golf or tennis
as a hobby. The point is that “ lifestyle ” implies degrees of freedom and the possibility
of genuine opportunity and choice. But assume that you grew up in an inner-city