How can we balance citizens’ healthcare rights and responsibilities to adopt healthy lifestyles?

Despite advances in our understanding of management and prevention, chronic diseases are still on the rise. By 2030, estimates point that an additional 52 million people will die from chronic diseases. Public healthcare systems are under strain, and their budgets are getting smaller.

How can we reverse the chronic disease epidemic?

First and foremost, citizens can help themselves. According to the World Health Organisation (WHO), citizens can reduce new cases of heart disease, stroke, and type 2 diabetes by up to 80% if they avoid the risk factors of tobacco, alcohol, and junk food, while doing 30 minutes of exercise per day.

But how can citizens be encouraged to make these healthier lifestyle choices? The idea of linking healthcare benefits and services to ‘healthy behaviours’ has been fiercely debated, and dropped by policy makers in the past.

Evaluating ‘healthy behaviour’ is far from straightforward. Even if we accept self-reporting, how can we differentiate between causes – are urban and social environments taken into account? Are individuals’ socio-economic backgrounds taken into account? Is there a risk of stigmatising people who don’t make the ‘right’ choices? And if we don’t accept self-reporting, then how can peoples’ lifestyle behaviour be monitored? Isn’t this an invasion of privacy and personal freedom? Or should people be more accountable for their lifestyle choices?

Government’s impulse

Some governments in Europe have already tried to encourage healthier lifestyle choices by introducing public smoking bans; heavy tax duties on tobacco and alcohol products; and nutritional information on processed food packaging. Austria, Hungary, Iceland, Norway and Switzerland followed the example of Denmark, which in 2003 was the first country in the world to ban transfats--one of the ingredients linked to cardiovascular diseases–from the food market through regulation.

Is promoting healthy lifestyles authoritarian? Or is a government that fails to do so guilty of neglect?

Governments and corporations alike are increasingly borrowing from behavioural economics to ‘nudge’ citizens into healthier lifestyle choices. For example, in Iceland a “LazyTown” television programme and mobile app was created in 1996, in which the healthy superhero “Sportacus” motivates children to eat healthy food and be more active, while parents reward this sort of behaviour with small prizes. The programme successfully reduced child obesity rates. In addition, 27-42% of pre-school children perceived LazyTown’s branded health food to be tastier than identical non-branded alternatives.

As the spread of big data makes citizens’ and employees’ behaviour and habits increasingly transparent for both the private and public sector, opportunities to influence their choices to increase their wellbeing are multiplying. However, moral implications with reference to privacy and freedom are far from clear while there appears to be a fine line between “nudging” and “manipulating”.

Partnerships

Clearly, citizens can’t do it alone.

Multi-stakeholder partnerships between public, private and third sector actors are needed to co-create healthier societies and tackle big societal issues. These include: environmental pollutants such as insecticides, pesticides, and fertilisers; artificial additives used in the food processing industry such as refined sugar and trans-unsaturated fatty acids; and air pollution, which is responsible for 400,000 premature deaths in Europe every year, and has become the world’s top environmental cause of premature mortality ahead of dirty water and lack of sanitation. These partnerships are also tasked with developing and delivering healthcare products and services.

Further action is required by citizens, policy makers, healthcare providers, businesses, and other stakeholders to better manage and prevent chronic non-communicable diseases. However, key questions and points about how these actions could or should affect citizen’s rights and responsibilities remain unanswered. Should citizens be nudged or forced into certain lifestyle changes to reduce chronic non-communicable diseases? Should access to free healthcare be linked to healthy lifestyles? Should citizens who abuse alcohol, smoke, or eat foods with high sugar, salt, and transfat have to pay more for healthcare? What would this mean for personal choice, privacy, monitoring and proving your lifestyle was ‘healthy’? Would such an intervention have a disproportionate burden on socio-economically disadvantaged citizens who are most at risk? Are governments and businesses doing enough to inform citizens about chronic non-communicable disease risk factors, or protect citizens from these risks?

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