{"id":48531,"date":"2020-09-11T12:01:41","date_gmt":"2020-09-11T11:01:41","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=48531"},"modified":"2020-09-11T12:03:02","modified_gmt":"2020-09-11T11:03:02","slug":"natalie-savona-who-is-responsible-for-health-behaviour","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/11\/natalie-savona-who-is-responsible-for-health-behaviour\/","title":{"rendered":"Natalie Savona: Who is responsible for health behaviour?"},"content":{"rendered":"<p><a href=\"https:\/\/twitter.com\/JLPartnersPolls\/status\/1278439359423938563\"><span style=\"font-weight: 400\">A recent poll<\/span><\/a><span style=\"font-weight: 400\"> showed that almost twice as many <\/span><span style=\"font-weight: 400\">people in the United Kingdom would blame the public than the government for a second &#8220;wave&#8221; of covid-19 cases, shining a light on the perceptions of individual vs others&#8217; responsibility for what may ultimately be individual behaviours. N<\/span><span style=\"font-weight: 400\">ow, <\/span><a href=\"https:\/\/www.gov.uk\/government\/publications\/tackling-obesity-government-strategy\/tackling-obesity-empowering-adults-and-children-to-live-healthier-lives\"><span style=\"font-weight: 400\">recent government anti-obesity guidelines\u2014<\/span><\/a><span style=\"font-weight: 400\">driven apparently, by prime minister Boris Johnson\u2019s alarm at the role his body weight may have played in the severity of his coronavirus<a href=\"https:\/\/www.gov.uk\/government\/publications\/tackling-obesity-government-strategy\/tackling-obesity-empowering-adults-and-children-to-live-healthier-lives\">\u2014<\/a>focus on \u201cempowering\u201d people to live healthily. <\/span><span style=\"font-weight: 400\">This is welcome news but contains decades-old, subtle patterns observed in government policy and corporate practices: to divert responsibility away from those with the most power over the drivers of behaviour such as healthy eating or, now, having a family gathering.<\/span><\/p>\n<p><a href=\"https:\/\/researchonline.lshtm.ac.uk\/id\/eprint\/3817563\/\"><span style=\"font-weight: 400\">Research on perceptions of responsibility<\/span><\/a><span style=\"font-weight: 400\"> for healthy eating in the United Kingdom <\/span><span style=\"font-weight: 400\">shows that <\/span><span style=\"font-weight: 400\">individuals are disproportionately burdened with responsibility for healthy eating and other behaviours. Disproportionate because the drivers of such behaviours are complex, often <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2248777\/\"><span style=\"font-weight: 400\">subconscious<\/span><\/a><span style=\"font-weight: 400\"> and if not controlled by others, coloured by their stance on individualism and minimal state interference, or driven by commercial expediency. Expecting individual responsibility is to ignore that many behaviours which affect health\u2014diet, alcohol consumption, smoking, a barbecue with friends\u2014are influenced by commercial practices, geography, biology, culture and other socio-economic or environmental factors, not to mention effects of the covid-19 &#8220;lockdown.&#8221; As one former British senior civil servant <\/span><a href=\"https:\/\/researchonline.lshtm.ac.uk\/id\/eprint\/3817563\/\"><span style=\"font-weight: 400\">said: \u201c<\/span><span style=\"font-weight: 400\">people make their choices but they make their choices only within the prison, the context that they are operating\u201d.<\/span><\/a><\/p>\n<p><span style=\"font-weight: 400\">Responsibility for health behaviours is a subjective, ambiguous concept; given that discourse is socially constructed, i<\/span><span style=\"font-weight: 400\">t is noteworthy then that the emphasis on individual responsibility is now reflected in the <\/span><a href=\"https:\/\/twitter.com\/JLPartnersPolls\/status\/1278439359423938563\"><span style=\"font-weight: 400\">public\u2019s opinions<\/span><\/a><span style=\"font-weight: 400\"> on responsibility for behaviour around covid-19 incidence. G<\/span><span style=\"font-weight: 400\">overnment advice on socialising, distancing, shopping, mask-wearing etc. has been far from clear or timely, leaving individuals to \u201cstay alert\u201d. <\/span><a href=\"https:\/\/www.tandfonline.com\/doi\/abs\/10.1080\/09581596.2020.1755421\"><span style=\"font-weight: 400\">The discursive use of responsibility acts as a smokescreen<\/span><\/a><span style=\"font-weight: 400\"> for the role of government guidance\u2014or lack thereof\u2014on covid-19 and corporate practices in unhealthy eating or other behaviours; and serves to place the responsibility on individuals rather than on government or the companies which sell unhealthy commodities.<\/span><\/p>\n<p><span style=\"font-weight: 400\">It is therefore arguable that the responsibility placed on individuals is inversely proportional to the control they have over factors that influence exercising that responsibility. This discrepancy may be a contributing factor to the flouting of the myriad coronavirus suppression guidelines, as demonstrated by <\/span><a href=\"https:\/\/www.bbc.co.uk\/news\/uk-england-dorset-53607907\"><span style=\"font-weight: 400\">scenes on Brighton and Bournemouth beaches<\/span><\/a><span style=\"font-weight: 400\"> in England. It is also likely to drive &#8220;unhealthy&#8221; food choices and concomitant ill health.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The mismatch between power and responsibility contributes to dysfunctional expectations of public behaviour related to covid-19, diet and other health-related issues. It is difficult to see how public health progress can be made to inspire adherence to covid-19 guidelines or to improve diets while such difference remains. We need <\/span><a href=\"https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(18)32429-2\/fulltext\"><span style=\"font-weight: 400\">policies that are consistent with\u00a0 demands made on individuals to improve health<\/span><\/a><span style=\"font-weight: 400\"> and the <\/span><a href=\"https:\/\/journals.plos.org\/plosone\/article?id=10.1371\/journal.pone.0188872\"><span style=\"font-weight: 400\">unequal abilities<\/span><\/a><span style=\"font-weight: 400\"> of them to do so. <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/19298415\/\"><span style=\"font-weight: 400\">Individuals\u2019 behaviour cannot be segregated<\/span><\/a><span style=\"font-weight: 400\"> from their tacit relationship with the architects of the environment and the complex determinants of choice\u2014food, or going to the beach. Proposals to change the food marketing environment are therefore welcome but the persistent emphasis on health promotion and information provision, <\/span><a href=\"https:\/\/www.gov.uk\/government\/publications\/tackling-obesity-government-strategy\/tackling-obesity-empowering-adults-and-children-to-live-healthier-lives\"><span style=\"font-weight: 400\">as reinforced in the new obesity guidelines<\/span><\/a><span style=\"font-weight: 400\"> highlights how contested responsibility is; the actions create the impression of government (and industry) fulfilling their responsibilities, while burdening individuals, upon whom it is imperative to use the information to make the &#8220;right&#8221; choices.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Regarding unhealthy eating, it has been said, \u201cIt just doesn&#8217;t stack up as an argument that suddenly there&#8217;s this outbreak of irresponsibility and we are just stuffing ourselves stupid.\u201c So it is worth exploring whether there would be a more level playing field on which individuals could make genuine choices (or not) if responsibility were considered in proportion to the power of different actors over determinants of diet or a social gathering. The notion of \u2018proportional responsibility\u2019 offers a theoretical, counterfactual idea that subverts the dominant narrative of \u2018ultimate\u2019 responsibility held by individuals despite their minimal influence in complex food, or other systems.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Proportional responsibility recognises that individual responsibility is not in binary opposition to that of the state or industry, rather that <\/span><a href=\"https:\/\/academic.oup.com\/heapro\/article\/32\/4\/755\/2950993\"><span style=\"font-weight: 400\">responsibility for health behaviour exists along a continuum<\/span><\/a><span style=\"font-weight: 400\">. The concept provides a framework for carrying out, in effect, an &#8220;impact assessment&#8221; on the expectations of responsibility relative to the power any actor(s) has over a given factor. Considering proportional responsibility helps at least challenge the reductionist and opaque characteristics of the covid-19 guidance, and the debate around the role of different actors in diet-related health. By doing so, the normative nature of public health practice, with its expectation of &#8220;responsible&#8221; choice by individuals, is brought into line with the realities in which those choices are made.\u00a0<\/span><\/p>\n<p><i><span style=\"font-weight: 400\"><strong>Natalie Savona<\/strong> is an assistant professor at the London School of Hygiene and Tropical Medicine where she researches health inequalities and diet using a systems approach.\u00a0<\/span><\/i><\/p>\n<p><em><strong>Competing interests<\/strong>: None declared<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A recent poll showed that almost twice as many people in the United Kingdom would blame the public than the government for a second &#8220;wave&#8221; of covid-19 cases, shining a [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/11\/natalie-savona-who-is-responsible-for-health-behaviour\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":48544,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-48531","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Natalie Savona: Who is responsible for health behaviour? 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