Behavior Change/Individual Responsibility

Question 1

Wikler, 1987

Who should be blamed for being sick?

Answer 1

Should those w/ unhealthy behs be singled out?

Deserving poor vs. undeserving sick. When has the individual done enough to protect health?

Fundamental + philosophical issues
-Paternalism
-Fairness
-Policy
-Blaming the victim
-Assumptions
-Take a risk? = burden
Can't force others to pay for unhealthy behaviors

Question 2

McKinlay, 1993

The promotion of health through planned sociopolitical change: Challenges for Research + Policy

Answer 2

Modifiable social factors: Change factor, change health/illness

Issues

1. Social system that rewards risk behaviors
2. Blaming the victim
3. Epidemiological

Behaviors do not happen in vacuum

Opp. to effectively + efficiently intervene to _ major inequalities in health

Qualitative work + process evaluation = important

Question 3

McKinlay, 1975

A case for refocusing upstream - the political economy of illness

Answer 3

Downstream (ind) vs. Upstream (env)

“Manufacturers of illness” need to be held accountable

1. Legislative intervention
2. Lobbying
3. Public education

Risk behaviors = culture. Reinforced over time. To avoid risk factors, you become not part of culture.

HeDrs need to be careful not to impose moral code on society.

Culpability of Individuals - Help people do or not do things to stay healthy w/out judgement

Question 4

Minkler, 1989

Health Education, Health Promotion, and the Open Society: A Historical Perspective

Answer 4

HP = Ind. change = Great deal of influence over own health.

Needs to focus on environmental change b/c beh change is more complex than it sounds and has short-term outcomes.

LaLonde Report (74) + Surgeon General Health People (79) = key documents.

American culture = control own destiny

when inds. are unable to respond to beh. change, they won’t. SES was rarely discussed but very imp.

HeDrs need to be coalition building, community diagnosis, and fostering community partnerships.

Question 5

Minkler, 1999

Personal responsibility for health? A review of arguments + evidence at Century’s end

Answer 5

History of Beh Change in U.S. - 1970s focus on ind. resp.

Issues w/ personal responsibility.

• Lack of control linked to unhealthy personal behs, poor health, and SES
• Victim-blaming
• Stigmatize
• Let’s government off the hook
• Limited impact

Issues w/ social responsibility

• Ignores human agency
• Complex, can be overwhelming/too much

Need BALANCED approach - Settings + targets. PRECEDE/PROCEED. WHO. Ottawa Charter.

Reduce inequities b/t low and high income.
Create health environments where positive choices flourish.
Ecological approach.

Question 6

LaLonde Report, 1974

Answer 6

1st to state that medical field needed to partner with prevention in order to be successful.

Determinants of Health

1. Environment
2. Lifestyle
3. Healthcare Org.
4. Biology

All interconnected and have impact.