Who is responsible for keeping me healthy?

In 2011 Paul Mason, formerly the Britain’s fattest man, threatened to sue the NHS for not giving him the right medical advice. Before receiving gastric surgery in 2009, he claimed his GP told him to “ride your bike more”.

Matthew Sinclair, director of the TaxPayer’s Alliance said at the time, “Taxpayers will be outraged that someone who allowed himself to get that fat is taking so little responsibility and blaming others for his failure to stop eating”.

In 2012, NHS Hertfordshire (among others) began asking obese patients to lose weight before they could be listed for routine surgery. They said the decision was based on clinical evidence that obese patients are at higher risk of complications.

Douglas Carswell, Tory MP for Clacton, said then, “We can’t have is the state withdrawing treatment because it disapproves of the ways people live. They are still tax-paying citizens and they deserve services.”

So was Paul Mason right to threaten the NHS or did Matthew Sinclair have a point about the cost to taxpayers? Was NHS Hertfordshire acting in the interest of their patients or were they being discriminatory as Douglas Carswell implies?

The question of responsibility – the act of of being accountable for something within one’s power, control or management – comes up a lot when discussing behaviour change.

Rightly so, it is a question fraught with political ideology and personal opinion.

One reason is that it goes hand in hand with questions of capability and control.

If our behaviours are the product of individual attributes, our environment and economic status, the result is huge variation in the lives people lead.

Some people highly value their health, live next to a park and are eligible for free gym membership. Others pay little attention to what they eat, walk to work and flinch at the cost of fruit. The iterations in between are infinite but there is a gradient of how capable people are of change.

Not how willing they are to change, but how the individual, environmental and economic factors are realised as a set of actions that lead to better or worse health. There is large gap – the value-action gap – between what people say they would do and what they actually do.

If the potential for change is not a level playing field, then how much control do we have over our health? Sendhil Mullainathan, an economist at Harvard, recently discussed the role of biology versus behaviour in the rise of obesity, in particular how the composition of our gut bacteria correlates with body fat.

The interaction between biology and behaviour is an area in need of more research and development but the implication is that some people have more control over their weight than others.

This could be both liberating and frightening.

Accepting inequalities in capability and control – and responsibility – could lead to a reduction in stigma and more radical ways of guiding and supporting people in leading a healthy life. On the flip side, it could lead to individual apathy or discrimination against those who are deemed more in control.

There is no general answer to the question of responsibility so maybe it’s a mute point.

Our projects always start by understanding reality – what people on a personal or professional level experience, why this reality exists, and how we can create ideas that benefit everyone involved.

The best ideas combine a real world understanding with scientific insight and creative thinking.

The question of responsibility becomes insignificant when everyone’s in it together.

This article first appeared on the Behavioural Design Lab website


Edward Gardiner
Behavioural Design Lead