Clarissa

Responsibility for health

Clarissa, 24, is highly motivated. She has just completed her daily virtual training program with the help of her fitness app. She lives by a saying she thinks Bill Gates once said:

“It’s not your fault to be born poor, but it’s your fault to die poor.”

She firmly believes that willpower, motivation and overcoming the inner self are also the most important keys to health and fitness. The app also has a social media function. She therefore now has a large number of friends from all over the world with whom she is in regular contact. Clarissa thinks it’s great to have someone to chat to day or night to share her experiences about the training, the challenges and successes. The exchange on social media has even improved her English. In the chats with the others and through the daily motivational app-exercises, it is increasingly clear to Clarissa that she wants to make more of her life. She works as a nurse and is bored by her colleagues who complain about exhaustion and whose greatest adventures seem to be happening in the series they stream after their shifts. The startup team of the app is looking for employees to market the app via social media. Clarissa feels that it would be her greatest passion to work in this area and contacts the team. She thinks it’s great to live in a time when mobile technologies and social media make it possible for her to be healthy and athletic and to get closer to realising her own dreams.

Health apps, individual responsibility for health and social justice

Individual responsibility for health plays an important role in the marketing of fitness apps. The ability to decide freely how to stay healthy and “to take one’s own health into one’s own hands” are presented good things that are worth striving for. According to Clarissa’s life motto, it is not only one’s own responsibility to behave in a healthy way, but also one’s own fault if one does not do so.

Responsibility and guilt are morally relevant concepts: in general it is morally recommendable (and perhaps morally required) to bear responsibility. Clarissa believes that it would be right to use fitness apps in order to take responsibility for a healthy lifestyle, and morally wrong to do otherwise.

This case addresses the issue of personal responsibility for health. But not everyone would see it the way Clarissa does. In fact, it is not clear who should bear responsibility for health, whether everyone can and should bear this responsibility, and if so to what degree. And can one really speak of “guilt” if one does not manage to achieve certain health goals?

Many people consider health to be fundamentally desirable in order to be able to lead a good and flourishing life.

On the one hand, responsibility for one’s own health is a good thing. Those who take responsibility for it can contribute to reducing pain and illness, to an increased level of health and fitness, and to an overall flourishing and good life. Physical exercise and a certain sensitivity for the body and its warning signs are especially important for the prevention of cardiovascular diseases, but also other illnesses. If many individuals behave in a healthy way, this can also have an impact on public health: the frequency of certain illnesses can decrease, as well as the cost of their treatment.

On the other hand, taking responsibility does not mean that one can do and achieve everything. For example, not everyone is born with the same genetic make-up that enables a healthy life. In addition, there are circumstances in life that one can hardly influence. For example, there is a connection between poverty and health. This connection is complex and is not only related to one’s own decisions and behaviour. Imagine Nadine, a single mother who has an insecure and underpaid job where she is treated badly and disrespectfully. Child care is difficult because she sometimes has to work during the evenings. She also has parents in need of care who she tries to see regularly. So for Nadine it is neither a priority to follow the instructions of her fitness app, nor is it even possible for her to do so. Whether one has the opportunity to eat healthy food, find good working conditions, clean air or a good stress balance depends, among other things, on one’s socio-economic status and on the circumstances one lives in. Many people cannot change these structurally conditioned living conditions even with willpower and motivation, even with the help of a health app that is supposed to support willpower and motivation. So it is also a problem of social justice if the emphasis is placed one-sidedly on individual responsibility and hardly on living conditions. Chances to be and stay healthy are not equally distributed.

Another problem of an overemphasis on individual responsibility for health are feelings and experiences of guilt and stigma. If you assume that you are responsible for your fitness and health, you might blame yourself if it doesn’t work out. Social media functions of the apps might add to these feelings of guilt, blame and stigma. This is not conducive to a successful life or mental health. As we have just shown, it is also not always in the hands of the individual whether they can achieve certain health goals just as easily as others. Feelings of guilt and stigma can thus aggravate the situation of an already disadvantaged individuals.

In addition, some point to the danger of decreasing solidarity. Universal health systems are often based on the principle of solidarity. Medical treatment and medication for individual patients are reimbursed through the collectively generated funds. If, however, the idea that everyone is responsible for his or her own health becomes established, and reinforced through the use of health apps, the attitude of solidarity towards one another may decrease. Why should one pay for someone who has not helped himself? After all, Clarissa is convinced that there are apps and a social media community that make it so easy to stay healthy and fit. But here, too, the question of responsibility for health depends, among other things, on how good the chances are and how fairly distributed they are to be able to take care of one’s own health at all.