Presenteeism among resident physicians.

individuals for leading healthy lifestyles is currently the subject of policy experiments in Europe. The Dutch Council for Public Health, like the British National Health Service and the GermanStatutoryHealth Insurance, is experimentingwith incentives to encourage healthy lifestyles in health insurance. What can be learned from these European policy experiments? First, it is questionable whether prevention programs and incentives work at the individual level. There is a great deal of evidence that these policies fail to change people’s lifestyles in the long run because unhealthy living habits are strongly predicted by a person’s socioeconomic position and social circumstances. Certain social contexts make it harder for people to make the “right” individual choices with regard to exercise, diet, and other health habits. In some cases, what seems like a personal choice to adopt an unhealthy lifestyle might not be; the choice may be driven by the fact that realistic options do not exist. Second, there is a danger that focusing on individual responsibility reinforces existing socioeconomic health inequalities. By rewarding healthy lifestyles and punishing unhealthy behaviors, the initial advantage of the well educated and well paid may tend to beget further advantage, and disadvantage those most in need of health improvements, creating widening gaps between haves and have-nots. Strikingafairbalanceinhealthcareismorecomplicatedthan moralizingriskybehavior.For individuals tobeable to take individual responsibility for their health, they first and foremost need adequate opportunities to achieve good health, such as affordableandaccessiblehealthcare—nottheotherwayround.