Individual Will And Social Conditions: Toward An Effective Health Maintenance Policy

Many prominent health experts now assert that major improvements in the health of the American people must come from individual efforts to alter unhealthy per sonal habits and lifestyles rather than through medical services and technology. But it does not necessarily follow that a more ethical and feasible national health policy would focus primarily on exhorting Americans to mobilize their indi vidual willpower to change to more healthful personal habits. In determining the nature of such policy, three main points are essential. First, the "health and individual responsi bility" argument may overestimate the health benefits which will accrue from personal habit changes. Second, that argu ment tends to overlook or misconstrue the nature of societal constraints on individual will. It fails to specify the socio logical conditions under which millions of individuals can change their lives significantly and the role social condi tions play in maintaining unhealthy behavior and attitudes. Finally, the focus on individual decisionmaking deempha sizes the role of collective efforts, of public policy, in securing higher health standards. In essence, then, we suggest that a health policy that promotes curbing unhealthy habits and encourages healthy ones through societal action is more ethical and feasible than one focusing on "health as individual responsibility."