Políticas tutelares asimétricas: conciliando preferencias individuales y sociales en salud pública

Abstract

Behavior is a major determinant of health, but changes in individual conduct are difficult, and health promotion lacks effectiveness. State intervention in the last century, rooted in the modernist movement, went far beyond dealing with externalities and built the framework of the welfare state. The crisis of the welfare state and post modernity after the 1970s led to a weakness of ideologies and values, narcissistic individualism, and lack of trust in institutions, all of which hampered the ability of society′s perspective to influence individual behavior. A review of health economics (especially merit goods) and public health (ethics and values of health promotion and prevention) may be useful to understand certain dilemmas in the balance between public intervention and individual autonomy. Given that many unhealthy decisions come from biased or irrational individual preferences, a promising new field in public health interventions is being developed, known as «asymmetric paternalism», or, more appropriately, as «asymmetric policies for merit-goods», which allow society to selectively influence those individuals whose decision biases lead to self-harming behavior, without constraining the autonomy of well informed autonomous individuals (even though their preferences may not coincide with society′s recommended preferences).