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.
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