Promoting Healthy Behavior: How Much Freedom? Whose Responsibility

The government, the media, HMOs, and individual Americans have all embraced programs to promote disease prevention. Yet obesity is up, exercise is down, teenagers continue to smoke, and sexually transmitted disease is rampant. Why? These intriguing essays examine the ethical and social problems that create subtle obstacles to changing Americans' unhealthy behavior.

The contributors raise profound questions about the role of the state or employers in trying to change health-related behavior, about the actual health and economic benefits of even trying, and about the freedom and responsibility of those of us who, as citizens, will be the target of such efforts. They ask, for instance, whether we are all equally free to live healthy lives or whether social and economic conditions make a difference. Do disease prevention programs actually save money, as is commonly argued? What is the moral legitimacy of using economic and other incentives to change people's behavior, especially when (as with HMOs) the goal is to control costs?

One key issue explored throughout the book is the fundamental ambivalence of traditionally libertarian Americans about health promotion programs: we like the idea of good health, but we do not want government or others posing threats to our personal lifestyle choices. The contributors argue that such programs will continue to prove less than wholly successful without a fuller examination of their place in our national values.

The co-founder and former president of the Hastings Center, Daniel Callahan is currently the director of international programs for the Hastings Center and author of The Troubled Dream of Life: In Search of a Peaceful Death, Setting Limits: Medical Goals in an Aging Society, and What Kind of Life?: The Limits of Medical Progress(Georgetown University Press).