The Mismarriage of Personal Responsibility and Health

This paper begins with a simple illustration of the choice between individual and population strategies in population health policy. It describes the traditional approach on which the choice is to be made on the relative merits of the two strategies in each case. It continues by identifying two factors-our knowledge of the consequences of the epidemiological transition and the prevalence of responsibility-sensitive theories of distributive justice-that may distort our moral intuitions when we deliberate about the choice of appropriate risk-management strategies in population health. It argues that the confluence of these two factors may lead us to place too much emphasis on personal responsibility in health policy.