Lifestyle Behaviours and Personal Responsibility for Health

Abstract

Abstract Deleterious lifestyle behaviours pose a formidable threat to public health but one for which the solution – modest changes in lifestyle choices is tantalising low cost and nontoxic. Personal responsibility for lifestyle choices, once a government mantra, is increasingly being challenged as the complex relationships between sociocultural and environmental conditions and personal choice are recognised. Individuals make frequent lifestyle choices that affect their health and it is intuitively assumed that these choices are made through free will. However, it is argued that in order for an individual to be considered fully responsible, certain preconditions must ideally be met; their actions must be informed, voluntary, uncoerced, spontaneous and deliberated. These preconditions are problematic when applied to lifestyle behaviours. They fail to acknowledge that health behaviours are influenced by many competing factors: cultural pressures, health literacy, health inequalities, mental capacity, genetic predisposition and in the case of smoking and alcohol, addiction to a substance. Understanding which risk factors are within or outside of the individual's control is necessary when discussing responsibility for health. A balanced opinion would therefore suggest that lifestyle behaviours are influenced by a complex interplay of intrapersonal and extrapersonal factors. And responsibility varies for individuals along a continuum. Key Concepts: Individual personal responsibility for lifestyle choices lies on a continuum between complete free will and no choice. Individual personal responsibility for health is dependent on cultural pressures, health literacy, health inequalities, mental capacity, genetic predisposition and in the case of smoking and alcohol, addiction to a substance. Health behaviour is determined in part by perceptions of control over performance of the behaviour which will vary from individual to individual. Advances in our understanding of the genetic aetiology of so‐called lifestyle diseases and their associated behaviours present new challenges for determining those risk factors that are under a person's control and those that are outside of it. Providing people with genetic risk information may induce a sense of ‘fatalism’, the belief that little can be done to reduce the risk. Fatalism may be particularly relevant to perceptions of responsibility and control now that many diseases are thought to have a genetic aetiology. Habit and addiction introduce an additional layer of complexity when debating personal responsibility for health. The very nature of dependency suggests that the individual is unable to control their use of a substance which is usually damaging to health. Determining the precise degree by which an individual is responsible for lifestyle‐related health outcomes is complex and problematic.