Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.
J Public Health (Oxf). 2019 Sep 30;41(3):561-565. doi: 10.1093/pubmed/fdy113.
This article considers the role of responsibility in public health promotion. Efforts to tackle non-communicable diseases which focus on changing individual behaviour and reducing risk factor exposure sometimes invoke individual responsibility for adopting healthy lifestyles. We provide a critical discussion of this tendency. First, we outline some key distinctions in the philosophical literature on responsibility, and indicate how responsibility is incorporated into health promotion policies in the UK. We argue that the use of some forms of responsibility in health promotion is inappropriate. We present an alternative approach to understanding how individuals can 'take responsibility' for their health, based on the concept of prudence (i.e. acting in one's interests). In this discussion, we do not prescribe or proscribe specific health promotion policies. Rather, we encourage public health professionals to consider how underlying assumptions (in this case, relating to responsibility) can shape health promotion policy, and how alternative framings (such as a shift from encouraging individual responsibility to facilitating prudence) may justify different kinds of action, for instance, shaping environments to make healthy behaviours easier, rather than using education as a tool to encourage responsible behaviour.
本文探讨了责任在公共卫生促进中的作用。为了应对非传染性疾病，我们努力改变个人行为，减少风险因素的暴露，有时会呼吁个人为采取健康的生活方式负责。我们对这种趋势进行了批判性的讨论。首先，我们概述了哲学文献中关于责任的一些关键区别，并指出了责任是如何被纳入英国健康促进政策中的。我们认为，在健康促进中使用某些形式的责任是不恰当的。我们提出了一种替代方法来理解个人如何为自己的健康“负责”，这种方法基于谨慎的概念（即按照自己的利益行事）。在这一讨论中，我们并未规定或禁止特定的健康促进政策。相反，我们鼓励公共卫生专业人员考虑基本假设（在这种情况下，与责任有关）如何影响健康促进政策，以及替代框架（例如，从鼓励个人责任转变为促进谨慎）如何证明不同类型的行动是合理的，例如，塑造环境使健康行为更容易，而不是将教育作为鼓励负责任行为的工具。
