Don't blame the sick

If people can make themselves healthy, should we blame them for getting sick? That is the question raised not only by broadening acceptance of the idea that people should assume some responsibility for their health, but also by the exciting new trend towards patient empowerment.

Of course, the list of "good behaviour" can get tiresome. But the question of personal responsibility is arising more and more. "Don't blame me for being fat!" said Lizmari Collazo at the recent Medicine X conference at Stanford University, where a group of researchers, doctors and caregivers met to discuss the new world of patient-generated health. To his credit, organiser Larry Chu also invited a group of patients.

The conference discussed what is now becoming accepted wisdom. Rather than just reform health care, we should also figure out how people can maintain or regain their own health. They need to eat right, stop smoking, drink less, and exercise and sleep more. And they should avoid too much stress, monitor their vital signs and share bio-data.

Statistically, this works. People who do these things are healthier on average.

And, yes, society's institutions should help them to do this. Schools should provide nutrition education (and healthy lunches). Businesses should encourage their employees to be healthy by providing discounts on insurance, offering team sports, and the like.

But suppose this fails. Suppose that, despite all blandishments, someone gets diabetes through some combination of behaviour and genetics. Should they now be blamed for developing diabetes and raising health-care costs? Or can they blame their parents or the state for their inability to be healthy?