Behavior Change or Empowerment: On the Ethics of Health-Promotion Goals

Abstract

Behavior Change or Empowerment 2 individual's, or population's, quality of life, it is not worth trying to achieve it. Thus, we should only try to promote health if it is expected to lead (directly or indirectly) to increased quality of life, that is, if the specific health increase either constitutes quality of life, or causally contributes to it.2 Most increases in health do, however, contribute to quality of life, even if sometimes only minutely, and some health increases, mainly in (health-related) wellbeing, constitute increases in quality of life [80]. 3But quality-of-life-related health promotion is not all there is to the goals of public health.First of all, most ill health is caused by disease and injury [52; 81-82]. Therefore preventing such states will also be important goals for public health. 4 Second, as will be clear later, since very little is directly done to individuals or populations, health-wise, we also have to consider the 'opportunities' to stay healthy, e.g., promoting those environmental and social factors that contribute to increased or sustained health, especially since public-health work mainly targets the healthy population [20; 23]. Furthermore, the average aggregated health status in a population, and its increase (or decrease), is important, but it is not all that should concern us.It is also of importance how health is distributed in a population [13, p. 41 ff.; 87]. Thus, health inequalities between groups have to be taken into account when evaluating the health status of a population [13, pp. 43-44; 21; 93]. Kinds of interventions and some contemporary health problemsInterventions can be initiated on various levels in society. There are 'top-down' measures, such as fiscal policy, macro environment changes, health campaigns, or legislation, and most 2 There is no room to develop a theory of quality of life here, but a few remarks need to be made. It seems to me that what best explains what makes a life go well for a person (her quality of life) is that her (final) desires are fulfilled. It follows that it is not sufficient that the desires are only believed to be fulfilled (an idea that would permit also false beliefs to contribute to a person's quality of life), which is the case in some happiness theories of quality of life. It also seems plausible that the desires that count most (in evaluating the good life) are the ones that are authentic, i.e., that are autonomous and informed. Brülde, who has argued for the above position [12; see also 72], adds a hedonistic dimension to his theory of quality of life. The best life is one where one's (authentic)desires are fulfilled and one experiences well-being, and does not suffer. I will assume here that this dimension is not necessary, since to experience well-being, and be free from suffering, are (in most cases) covered by a person's (authentic) desires.3 In a public health-context we differentiate between individuals and populations. What might constitute a relevant and important health-promotive activity on the individual level, ...

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