Virtue, Wellness, Health, and Obesity after the ACA

Seven years of efforts to repeal and replace the Affordable Care Act (ACA) seem to be taking a rest for now. Perhaps the moral outrage on both sides of this debate can take a rest, too. But will we ever get a rest from health and wellness as a tool for signaling virtue?

The Epithet of Virtue Signaling

This catchphrase is quietly taking hold as a tool for calling out hypocrisy. It seems especially popular on the right of the political spectrum, but targets are easy to find on all sides. Virtue signaling is a derisive label for conspicuous displays of moral values. The implication of that label is that those values are unsupported by any real action or convictions.

Hypocrisy is a human failing that’s all too easy to find.

Wellness as Virtue

Unfortunately, people have long taken wellness and good health to be  signals of virtue. Biblical disciples asked “who sinned, this man or his parents, that he was born blind?” Many religions establish elaborate rules for dietary behavior, spurning “unclean” foods.

In a classic 1994 paper, sociologist Peter Conrad explained:

Wellness seekers engage in a profoundly moral discourse around health promotion, constructing a moral world of goods, bads and shoulds. Although there are some gender differences in particular wellness goals, engaging in wellness activities, independent of results, becomes seen as a good in itself. Thus, even apart from any health outcomes, the pursuit of virtue and a moral life is fundamentally an aspect of the pursuit of wellness.

And so, these assumptions about health as a virtue creep into our dialogues about health policy. The treatment a person receives becomes dependent, at times, on perceived virtue.

Stigmatized conditions – such as drug dependence, depression, lung cancer, and obesity – leave a person vulnerable. Those conditions lead to terrible outcomes. They seldom improve without good care. But in seeking care, people find providers sometimes questioning how deserving they are.

Drug dependence is one of those essential health benefits that was nearly cut out of the requirements for health insurance in the ACA repeal debate. Obesity care is a hit or miss proposition.

Meanwhile, people who enjoy the benefits of fit and trim bodies can signal their virtue to the world. Others can purge sugar from their diets – or at least proclaim that they have.

But the truth is that health is a journey of a lifetime. Bodies don’t always cooperate with our good intentions. And every one of us will experience disease and death. Quiet compassion will serve us well.

Click here for advice on how to signal your virtue by giving up sugar and here for Peter Conrad’s paper in Culture, Medicine, and Psychiatry.

Overarching Virtues, photograph © Fr Lawrence Lew, O.P. / flickr

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.

March 26, 2016