The role of energy balance in cancer prevention

Personal responsibility matters for both rationing and resource allocation. If people were healthier, there would be less competition for absolutely scarce resources such as organs or limited ICU beds. If fewer people were overweight, obese, or smokers, dilemmas arising from relative scarcity could be attenuated, as there would be reduced need for providing (and funding) interventions for conditions such as diabetes, heart disease, stroke, some cancers, or hip or knee-replacements. Yet, how to implement reasonable personal responsibility policies is far from straightforward. In the best case, the stars are aligned and programs empower people’s health literacy and agency, reduce overall healthcare spending, alleviate rationing and resource allocation dilemmas, and lead to healthier and more productive workforces. But the devil is often in the detail: a focus on controlling or reducing cost can also lead to an inequitable distribution of benefits from incentive programs, and penalize people for health risk factors that are beyond their control. This article reviews the different motivations that can underlie and drive personal responsibility policies; sets out a proposal for how to decide on the reasonableness of personal responsibility policies given the constraints of the realpolitik of health policy and the normative issues that are at stake; and provides an overview of central ethical issues raised by incentive programs, the dominant policy tool to promote personal responsibility.