We ourself our responsible for our ill health in modern time. composition in about 350-400 words.
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Abstract
What does it take for an individual to be personally responsible for behaviors that lead to increased risk of disease? We examine three approaches to responsibility that cover the most important aspects of the discussion of responsibility and spell out what it takes, according to each of them, to be responsible for behaviors leading to increased risk of disease. We show that only what we call the causal approach can adequately accommodate widely shared intuitions to the effect that certain causal influences—such as genetic make-up or certain social circumstances—diminish, or undermine personal responsibility. However, accepting the causal approach most likely makes personal responsibility impossible. We therefore need either to reject these widely shared intuitions about what counts as responsibility-softening or undermining or to accept that personal responsibility for behaviors leading to increased risk of disease rests on premises so shaky that personal responsibility is probably impossible.
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 community? 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 — such as people's level of education or socioeconomic status, the condition of their housing, the healthfulness of their physical environment, and how they are affected by stress and racism — contribute to health outcomes (1-7). The effect of these "social determinants of health," however, should be the concern of the entire health care community, not just public health practitioners. Anyone who provides health care to people with diabetes, asthma, or heart disease, for example, rapidly realizes the link between their patients' social context and their patients' ability to control their chronic condition. The negative effect of certain social factors on people's health is especially pronounced among some minority groups, and the health disparities that these groups have experienced are now garnering greater attention (8). For example, researchers have shown that three of the five largest landfills in the United States are located in African American or Latino communities and that rates of pediatric asthma near these landfills are among the highest in the country (9). Addressing such racial and ethnic health disparities needs to be a key part of the U.S. health care agenda.