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.
Table of Contents
Preface
Introduction
Daniel Callahan
Personal Responsibility for Health: Contexts and Controversies
Meredith Minkler
Health Promotion and Civil Liberties: The Price of Freedoms and the Price of Health
Beverly Ovrebo
The Credibility of Claims for the Economic Benefits of Health Promotion
Helen Halpin Shauffler
Sticks and Carrots and Baseball Bats: Economic and Other Incentives to Modify Health Behavior
E. Haavi Morreim
Health Promotion and the Common Good: Reflections on the Politics of Need
Ann Robertson
Health Promotion and the Common Good: Toward a Politics of Practice
Ronald Labonte
The Promise of Molecular Medicine in Preventing Disease: Examining the Burden of Genetic Risk
Barbara Koenig and Alan Stockdale
Freedom, Healthism, and Health Promotion: Rinding the Right Balance
Daniel Callahan
Promoting Health and Preventing Disease: Ethical Demands and Social Challenges
Daniel Callahan, Barbara Koenig, and Meredith Minkler
Contributors
Index
Reviews
"Insightful . . . provide[s] fascinating analyses. . . . A must-read for all involved with health promotion and disease prevention programs and concerned about their social and ethical implications."—Choice
"A scintillating collection of essays"—Revue Canadienne de Sante Publique
About the Author
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).
