Worshiping a False God of Healthy Choices

Who can possibly argue with the virtue of healthy choices? And yet, that’s precisely what Anita Sreedhar and Anand Gopal are doing in a provocative commentary about the root of our problems in coping with a public health emergency. Much of the world has fallen into a trap: walking away from the common good of public health and instead worshiping the ideal of healthy personal choices above all else.

It is well worth the effort to think about how we got here.

My Body, My Choice

Personal autonomy and freedom is important to everyone. But humans are indeed social animals. If you had any doubts about that, look at the profound impact that constraints on socialization have had on all of us during the pandemic. To be cut off from others hurts us in more ways than we can count.

So with social interactions come constraints to personal freedom and autonomy. Social order compels us to behave within certain boundaries. To stop short of behavior that will harm others. In the midst of a pandemic, that means we should not behave in ways that make us a dangerous vector for an infectious disease that is killing thousands of our neighbors, friends, and loved ones every day.

And yet, here we are, facing angry debates and sloganeering about “my body, my choice” from people who resist wearing masks or taking a vaccine.

Healthy Choices

Sreedhar and Gopal explain that Americans have come to think more about personal responsibility for health. Thus, we place less value on public health. This has consequences, they say:

“Of course, there’s a lot of good that comes from viewing health care decisions as personal choices. No one wants to be subjected to procedures against their wishes.

“But there are problems with reducing public health to a matter of choice. It gives the impression that individuals are wholly responsible for their own health. This is despite growing evidence that health is deeply influenced by factors outside our control; public health experts now talk about the ‘social determinants of health,’ the idea that personal health is never simply just a reflection of individual lifestyle choices, but also the class people are born into, the neighborhood they grew up in and the race they belong to.”

Four decades of promoting healthy choices as the answer for rising obesity rates has brought us ever more harm to health from obesity, along with a heaping helping of stigma.

Too Much of a Good Thing

Four centuries ago, Shakespeare gave us a clue that too much of a good thing is a bad thing. So it is with personal autonomy and appeals to personal choice. Cayce Hook and Hazel Rose Markus write that narratives about free choice and personal responsibility are making us sick:

“These narratives contribute to ill health in the United States. They encourage stress and worry over health, blame and stigmatization of the unhealthy, widened health disparities, and the failure to adopt policies that could save lives.”

Healthy personal choices have become an excuse for neglecting responsibilities to each other for a healthy community. While we have been worshiping a false god of healthy choices, disparities have grown. Trust has withered. People who feel betrayed by their leaders are in no mood to pay attention to public health guidance. Stark disparities in health, social, and economic status fuel distrust among people who feel abandoned. An Amazon truck driver describes the situation:

“When you’re in a high tax bracket, the government protects you. So why wouldn’t you trust a government that protects you?”

He and his friends don’t believe that the government really cares about them when it pushes vaccination.

The Luxury of a Healthy Lifestyle

So here we are. People with the luxury of healthy lifestyles can feel good about their freedom to make healthy choices. Others live more constrained lives. But the pandemic is showing us that none of us are safe from this virus unless all of us are safe.

Click here for the essay from Sreedhar and Gopal, here for the paper by Hook and Markus.

Hermaphrodite Idol, painting by Carlo Carra / WikiArt

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December 5, 2021