With the advent of behavioral economics and studies, governments have found new methods, both positive and negative, to attempt to control, or at least influence, the behavior of citizens. Those attempts have found fertile ground in the public health arena, where a variety of “unhealthy” choices have been targeted. An article in Health Affairs discusses the effectiveness and issues surrounding fear-based public health campaigns, focussing on some of New York City’s efforts. (HA Article) Smoking, HIV and other sexually transmitted diseases, obesity and drug use have all been the subject of public advertising campaigns which trumpeted negative consequences, all part of a larger effort spearheaded by ex-Mayor Bloomberg to force citizens to behave in what he and his advisors deemed to be healthy ways. (A separate issue is that often what is said to be unhealthy at one point in time is later found by new research to not have high health risks.) The article highlights the concerns about stigmatization and marginalization of people who engage in the targeted behavior, as well as uncertainty about their actual effectiveness.
The effectiveness of efforts to influence citizens to be healthy, whether fear-based or through positive incentives or by outright bans on or mandating of certain behaviors is one issue, but a broader question is in a free society, what is the right philosophy for addressing individual behavior. In a free society, individuals generally should be able to engage in whatever behavior they wish, so long as it does not unduly intrude on others. But individuals should also be held responsible for the consequences, however unpleasant, of their choices. The problem in health care is that we too often allow people to engage in unhealthy behaviors, but then remove the financial consequence by having other people, i.e., taxpayers, pick up the bill for the costs of treatment resulting from that behavior. If citizens understand that this isn’t going to happen, that might be the most effective method of ensuring that people think about their health choices.