A debate with a lengthy history involves the degree to which individuals should be held responsible and accountable for misfortunes that occur in their lives versus assigning blame to external forces beyond their personal control. For example, if someone is responsible for personal health, then, all else being equal, that individual should be held accountable for it. Given this line of reasoning, it can be argued that responsibility for health has an important role to play in distributing the benefits and burdens of health care (e.g., charging higher health insurance premiums for those engaged in unhealthy behavior or giving lower priority of care to putatively responsible parties), but some caution is advisable. That health is influenced by social, economic, and environmental factors is a matter of consensus, which leads to a counter argument that in light of social determinants of health, individuals typically are not responsible for their health, rendering inappropriate policies that employ a responsibility-for-health criterion. According to an article published in the January 2021 issue of the journal Bioethics, this debate implicates a number of overlapping concepts and questions that often are difficult to separate. Also, maintaining that social determinants undermine responsibility for health may be latching on to the wrong target.
This perspective holds that social determinants of health are relevant to such policies, but not by globally undermining responsibility. Instead, social determinants are sometimes responsibility-undermining, sometimes responsibility-preserving, and often relevant to whether individuals should be held accountable for their health regardless of their responsibility. A more nuanced appraisal is called for regarding ways in which the social determinants of health are relevant to such policies. After arguing that responsibility is possible amid the social determinants of health, some important ways in which these determinants are directly relevant to individuals’ accountability for their health are surveyed and hurdles are highlighted that any policy holding individuals accountable for their health on the basis of their responsibility must clear. A proposition is advanced that distinguishing responsibility and accountability, and the ways in which social determinants are relevant to each, helps make clear the ways in which the social determinants of health are and are not relevant to policies that employ a responsibility‐for‐health criterion. Thus, it can be maintained that individuals have an obligation to preserve and promote their health, and that they are often responsible for their success or failure to do so, without committing to the thought that they are thereby accountable for their health.
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