Personal Responsibility Versus Responsible Options: Health Care, Community Health Promotion, and the Battle Against Chronic Disease

Suggested citation for this article: Betancourt JR, Quinlan J. Personal responsibility versus responsible options: health care, community health promotion, and the battle against chronic disease. Prev Chronic Dis [serial online] 2007 Jul [date cited]. Available from: During the past century, the health and life expectancy of U.S. residents have improved substantially, largely because of initiatives in public health, including health promotion and disease prevention efforts. Data now suggest that the United States has undergone an epidemiologic transition, in which the leading causes of death are no longer related to infectious diseases but instead to chronic conditions such as heart disease and diabetes. Although much of the progress in reducing the burden of infectious diseases in the United States can be attributed to environmental principles such as the provision of clean water and sanitation and the establishment of food safety standards, many are seeking to abandon these principles as the United States tackles the new epidemic of chronic disease. In its concern with developing and disseminating new diagnostic and therapeutic modalities — including more effective medications — the U.S. health care system often seems to focus more on treating the disease rather than the patient. The paradigm of personal responsibility for one's health, which includes the responsibility of patients to follow their physician's instructions and adhere to their treatment plan, now carries great weight among health care providers. We've often heard our colleagues say something like, " If we can just get our patients to do what we want them to do, they would be better off. " But to them we say this: as you ask your patients to take personal responsibility for their health care, do the society and the health care system of which you are a part provide your patients with appropriate options? For example, can diabetes patients in fact get the healthy foods we instruct them to eat? Are such foods available and affordable in their com-munity? Can heart disease patients exercise safely in their community? Do they even have a sidewalk where they live? Even if asthma patients take their medications, can they rest assured that the mold and dust in their apartment , or the incinerator one block down, or the diesel bus that passes on their street 30 times a day will not make them acutely short of breath? There is no doubt that social factors often addressed by public health practitioners — …