Thursday 1 December 2011

Individual versus collective responsibilities in health

The British Medical Association has recently proposed to ban smoking in cars. The reasoning behind this proposal is that toxic fumes reach a higher concentration in cars than anywhere else because of the confined space. This may harm children who might travel in the same car.

There has been plenty of debate on this subject since and I will add another sound of outrage or anger. Instead I would like to mention a curious anomaly that often seems to be overlooked in public health debates.

Our health system is tax funded and it is often argued that this injects an element of mutual solidarity or social responsibility into society. In effect, we fund the outcomes of other people's actions that may lead to situations where they either harm themselves or others. Still, there is widespread consensus that this is part of a minimal reciprocal commitment to strangers with whom we live together in this country.

What is interesting to note however is that the main thrust of harm prevention programmes targets activities that are rooted not in social responsibility, but individual responsibility. Public health prevention aims to reduce risky behaviour of individuals, not of societies as a whole. In other words, the impetus of prevention is rooted in an acknowledgement that conduct emerges from individual decisions, which in turn may only be curbed through individual behavioural change.

Where does this lead the reciprocal commitment that is manifested in the foundations of our health system? Does this mean there is a clash of moral principles that animate preventive programmes and those that lie at the heart of our health care system?

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