Responsibility for Personal Health: A Historical Perspective

Abstract

Reflections about the role of human choice in determining personal health occur in the writings of practitioners and laymen throughout history. THe Greek and Roman writers emphasized the effect of life's activities. During the Middle Ages and Renaissance, disease continued to be seen as a consequence of disorder of the bodily humors, which were under the individual's control. THe rise of the paternalistic national regimes in Europe produced the view that society had the responsibility to maintain health. Jacksonian egalitarianism led to a reaction against the aggressive therapies of established professional experts, a view furthered by the Thomsonian belief that people should wrist control of their health away from orthodox physicians. Among the twentieth century reactions was the movement to urge people to have doctors evaluate laypersons' health. By the 1970s a movement emerged emphasizing again personal responsibility, which, in turn, produced a concern that this was merely "victim-blaming". Views on the role of lay people in determining personal health are heavily influenced by prevailing social, political, and moral climates.

Co-Responsibility: a New Horizon for Today’s Health Care?

“…By the beginning of nineteenth century, as Reiser carefully describes, medical and social events produced again an emphasis on individual responsibility for health [42]. However, when the knowledge about the relation between diseases and social conditions increased, not only personal but also society's responsibility was at the forefront.…”

“…Reiser mentions the Ladies Physiological Institute of Boston and Vicinity, founded in 1848 in the USA, as an example of an institute devoted to instructing women on hygiene and the prevention and cure of disease [42].…”

“…In this article, Knowles wrote: ''The solution to the problems of ill health in modern American society involves individual responsibility, in the first instance, and social responsibility through public legislative and private voluntary efforts, in the second instance'' [24]. This being written at that time-the seventies of the twentieth century-is perhaps no coincidence, because during these seventies, a renewed debate over the issue of responsibility for getting ill, was certainly the case, as Reiser points out in 'Responsibility for Personal Health' [42].…”

“…In his historical review of the evolution of personal health responsibility, also Stanley Reiser confirms that despite the diverse meanings personal responsibility had and still has today, a dominant meaning for personal responsibility has been noted throughout our history: the emphasis on personal control and self-sufficiency [40,42,44,53]. On top of that, the shift from a more socialist perspective in the sixties when first of the all the 'system' was to blame, to a more liberal focus, results almost naturally into an increasing focus at the individual [7,11].…”

“…The a priori choice to limit our scope to individual autonomy and responsibility not only narrows in advance the horizon of the discussion, it leads to a debate which necessary will get stuck in its own binary logic: this or that, me or the other. Despite the recent emphasis on community or social responsibility [8], Reiser and others have argued that, since the seventies, the idea is put forward that, since we as individuals are personally responsible for our lifestyle and therefore lifestyle diseases, the consequences of so called 'risk behavior' are on our individual account [40,42].…”