Abstract
Health promotion efforts are commonly directed towards encouraging people to discard ‘unhealthy’ and adopt ‘healthy’ behaviours in order to tackle chronic disease. Typical targets for behaviour change interventions include diet, physical activity, smoking and alcohol consumption, sometimes described as ‘lifestyle behaviours.’ In this paper, I discuss how efforts to raise awareness of the impact of lifestyles on health, in seeking to communicate the (perceived) need for people to change their behaviour, can contribute to a climate of ‘healthism’ and promote the moralisation of people’s lifestyles. I begin by summarising recent trends in health promotion and introducing the notion of healthism, as described by Robert Crawford in the 1980s. One aspect of healthism is moralisation, which I outline (alongside the related term moralism) and suggest is facilitated by efforts to promote health via information provision and educational strategies. I propose that perceived responsibility plays a role in mediating the tendency to moralise about health and behaviour. Since I argue that states ought to avoid direct and indirect moralisation of people’s health-related behaviour, this suggests states must be cautious with regard to the use of responsibility-indicating interventions (including informational and educational campaigns) to promote health.
Highlights
BackgroundA great success of modern healthcare has been the vast improvements in human health and well-being achieved through preventative public health strategies
Public Health and the ‘Behavioural Turn’ in Health PromotionA great success of modern healthcare has been the vast improvements in human health and well-being achieved through preventative public health strategies
We have discussed how health promotion through information provision and education supports the view that people are in control of their behaviour, and further, sufficiently informed about the impact of their lifestyle to adopt healthier habits. We suggest that this effect, in combination with the trends towards healthism discussed earlier, create the conditions for moralisation by indicating that people have moral responsibility for their health-related behaviour, and that they ought to adopt healthy behaviours
Summary
A great success of modern healthcare has been the vast improvements in human health and well-being achieved through preventative public health strategies. The prominence and ordering of different foods can affect what people will buy, so alterations to what Thaler and Sunstein call the ‘choice architecture’ (in this case, the layout of the cafeteria) can impact behaviour Both historical and contemporary ethical criticism of public health interventions have tended to focus on coercive policies, such as mandatory vaccination programs and legal restrictions on the purchase and sale of consumables (Luyten et al 2011; Breton and Sherlaw 2011). Public health promotion which has focused on the provision of health related information and the delivery of educational campaigns to raise awareness of behavioural risk factors has typically been seen as less objectionable These interventions are explicitly presented as efforts to facilitate people in making independent, well-informed choices; to preserve freedom and promote autonomy. Whilst I do not discuss them directly, this criticism suggests that if alternative approaches to health promotion (such as regulation and the use of environmental shaping to influence behaviour) avoid contributing to moralisation, there may be ethical reasons for preferring such approaches to health promotion
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