“Personal Responsibility” Is A Meaningless Term

How our health choices are shaped by forces outside of our control

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I walk a lot. Every day, in fact. Last time I used a step counter, I did an average of 15,000 steps a day, and it usually works out to be a bit over 6 kilometers — or 4 miles for the US — every day.

It’s not as much as a professional athlete, but it’s roughly 2.5x as much as the average person.

At this point, you are probably wondering why I am telling you about my walking habits. Is it because my ego requires daily adulation regarding my excellent exercise regime? Perhaps.

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Maybe I’m boasting about how much better I have gotten at walking in the last 25 years or so

Or maybe it’s to make a point. Because, you see, I don’t walk a lot to be healthy. I walk because the quickest and easiest way for me to get to and from work is by train, and catching the train requires a fair bit of walking.

I am healthy partially because my environment has forced me to be so.

The shocking truth?

It’s the same for everyone.

We all like to think that we can control our lives. What we eat, who we hang out with, even what brands we buy.

Unfortunately, we have much less control than we think.

And when it comes to health, we may have none at all.

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Would a guy who was in control be wearing that hat?

It’s time to introduce you to a public health term. Try not to be terrified.

The basic idea of the social determinants of health is that there are things in society that influence health over which individuals have basically no control. My walking to the train is a great example; if my work wasn’t on a train line, I’d have to drive. Then I wouldn’t walk much, if ever.

Another easy example is the area that I work in: diabetes. Some of my colleagues have done research showing that not only are there areas where you are much more likely to get diabetes, but that you can predict the likelihood of people getting diabetes in a suburb in part based on the number of parks there are and the distance to healthy food stores. To put it another way, whether you get diabetes has a great deal to do with whether you live in a nice wealthy suburb with lots of parks and fresh food or a low-income area that’s paved over and only has fast-food joints.

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Red = More Diabetes. I’ll give you one guess as to which suburbs have the worst healthy food environment

It’s terrifying to contemplate that we might not be as in control as we thought*.

That brings us nicely back to personal responsibility. The idea of personal responsibility is a common theme among libertarian arguments, because it sounds so logical. If people control their own health, then why should anyone else pay for their healthcare? That guy with diabetes — he could’ve just eaten better food and he wouldn’t be in this mess!

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Just “vet” a job, guys. It’s easy!

It’s funny, because things like this are usually said by the most privileged people imaginable. It’s easy to see why a guy who’s been able to easily afford a gym and fresh food his entire life would assume that anyone not exercising and eating well was making an intentionally unhealthy choice.

These arguments completely ignore the role that society plays in determining our health. When we know that children of incarcerated parents are significantly more likely to commit crimes themselves — and we do nothing to prevent this — how can we blame them when they do?

Society’s relationship with health is complex, but one thing is clear. Personal responsibility is only an argument for people who completely misunderstand health.

Stop blaming poor people for being unhealthy.

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*This isn’t to say that anyone is powerless, mind you. The actions you take can have a massive impact on your health and wellbeing. It just means that, as a society, we can’t blame people for their poor health.

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