BIOE 5660 Personal Responsibility for Health in Policy and Practice

Excess body weight is often associated with higher healthcare cost. Should overweight and obese people pay more for health insurance? If we want to encourage people to quit smoking, is it best to give insurance discounts to those who succeed, or impose surcharges on those who do not? Should companies be permitted not to hire smokers? Globally, more than seven in ten deaths are due to chronic diseases, such as stroke, cancer, diabetes or heart disease. In the US, rates are even higher. Good or poor health is typically the result of a number of interacting factors. Genetics, social status, environmental conditions and personal behavior all play a role. In the best case, appeals to personal responsibility can motivate people to achieve oftentimes challenging behavior change. But in the worst case, policies penalize people for factor that are beyond their control. We will critically assess how personal responsibility is conceptualized in law and policy in different countries, and evaluate philosophical, political, economic and health-science related rationales in favor and against personal responsibility for health. Some of the material will be conceptual in nature, but throughout, the discussion will be focused on concrete cases, including obesity, smoking, breast screening, organ donation and medication adherence. We will also discuss controversial new work requirements and other policies aimed at strengthening personal responsibility in Medicaid.