Are your health resolutions really a free choice?

Are your health resolutions really a free choice?
Modern citizenship in the West increasingly involves a duty to care for ourselves – to eat healthily, exercise enough and even screen ourselves for disease – to minimize our health-care costs to the state. Credit: Shutterstock

"I really should be taking better care of myself."

Who hasn't thought that at least once in the past year? And maybe you've made a few health resolutions for 2018 —to cut back on the junk food, up the daily exercise, start meditating or get more sleep?

In 2014, the Canadian Community Health Survey (CCHS) found that 72 per cent of respondents thought they should do something to live more healthily —an increase of 13.9 per cent since 2001.

Seventy-seven per cent planned to actually do something to improve their health, such as reducing stress, changing their eating habits or getting more sleep and exercise —another increase of 9.5 per cent since 2001. And 59 per cent had already made some improvements.

It's clear from these statistics that "healthism" —an elevated consciousness about health, lifestyle and related practices of risk and disease prevention —is on the rise.

On the surface, this might seem like a positive cultural development. Who can argue with trying to be healthy? But healthism has another side —a tendency to locate responsibility for health and well-being squarely on the shoulders of individuals.

Or, to put it another way, it lets the state off the hook for looking after its citizenry. (Remember the good old days, when Ottawa used to pay 50 per cent of the provinces' expenditures on health care?)

Health is now a moral duty

The fact is, we've progressively been "responsibilized" in recent decades to look after ourselves, with less and less support from our provincial and federal governments. The pursuit of "wellness" has become a kind of moral imperative that cannot be separated from the state's broader political and economic objectives.

With recent efforts in the United States to repeal the Affordable Care Act (also known as Obamacare), the link between individual health responsibility and the state's agenda has become starker than ever.

As Canadians, we enjoy the benefits of a socialized health-care system, but even so, this imperative of individual responsibility to the rest of Canadian society consistently figures in, say, health promotion and popular lifestyle rhetoric.

For example, a recent health column in a Canadian women's magazine declared it possible to "retrain your brain," claiming that unhealthy habits can be fixed simply by "changing your perspective."

If your bad habit is that you "often put off exercise," you just need to "choose more positive online influences." If your bad habit is an inability to stick to healthy eating goals, then you just need to "predict your feelings about food" before you begin eating.

Exhorting individual readers to become entrepreneurial self-managers and take responsibility for their well-being, this magazine column goes on to list a series of other personal weaknesses and their quick fixes, all of which boil down to the reader's good and bad choices and their ability (read: obligation) to conduct their lives more responsibly for the good of everyone.

Citizenship is a biological project

And this is where the idea of "biocitizenship" comes in.

Through engaging in practices of self-care—that is, making the "right" kinds of lifestyle and medical choices—modern citizenship in the West has become a kind of biological project. It depends on individuals fulfilling their responsibility to the rest of society by accepting and carrying out the duty to care for themselves.

From relaxing baths to kale smoothies, self-care is definitely "on trend." Increasingly, though, we find ourselves morally and socially obligated to be proactive about our health risks, whether it be eating right, exercising more, quitting smoking or even screening for genetic disease potential.

That moral obligation has even evolved into a kind of entitlement.

In my recent book on the history of Tay-Sachs disease, I show how some parents of children born with this fatal disease have sued for "wrongful birth" and "wrongful life." They claimed their right to be responsible biocitizens —by terminating their pregnancies —was denied when their doctors, genetic counsellors and the like failed to test for Tay-Sachs or did not inform them properly of the results when they did.

Welcome to your 'unfreedom'

The point is that responsible biocitizens engage in self-care for the good of all.

Good biocitizens are healthy citizens who do not use up too many health-care dollars by having costly health problems they could have prevented if only they'd looked after themselves better.

And, as I am finding in some preliminary new research explorations, this message comes to us from all over —from our workplaces in the form of Employee Assistance Programs, from campus medical services in the form of "wellness promotion" and even from shopping malls in the form of "mall walking programs" designed to help people exercise more.

As a fairly recent development since Thatcher and Reagan were in power, the neoliberal trend is towards greater privatization, financialization and declining state responsibility for social welfare. As part of this, there has been a transformation of "patients" into "consumers" and a shift from "care and social entitlements" to the individual's "ethical duty" to be well.

All this reflects how individual freedom figures in this context as a kind of "unfreedom."

Unfreedom is the capacity, or even the duty, to act that —given its moral undertones —is not really very free at all.

Don't get me wrong, I'm not saying we shouldn't aim for quality of life and try to be as healthy as we can. But choosing quinoa over cannoli is much more than a matter of personal preference. I think it's important to reflect on our self-care choices in their political, economic and socio-cultural context.

So, will you strive to become a better biocitizen in 2018? Or can you count on your government to do more of what it used to do —and look after you too?

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