This discussion was March 27, 2025, in Cupples Hall I, Room 207, on the Danforth Campus.
The problem of bad behavior
At some instinctive level we all understand that health emerges from some combination of personal agency and choice, biology and genetic determinism, and the world we live in. And yet, this observation makes us, in public health, a bit uncomfortable. Public health is about building health through shaping the world around us. We are acutely aware that life circumstance imposes on us limited choices, or at least shapes our choices. That where we are born shapes our opportunities and, hence, our health trajectories, and that the constraints of policy and context are deeply determinative of our health. And yet, so is individual behavior. It is undoubtedly true that we may smoke because we are deeply influenced by our upbringing and our social networks. But it is also true that when we smoke we are choosing to pick up a cigarette and smoke. Denying individual agency in the work of public health neglects the central role that autonomy should play in our vision of the world. But how do we account for the role that personal choices — particularly, bad choices — play in shaping health, while also accepting the role that context may play? How do we engage individuals to guide them to better choices? Can we point out health-harming behavior without attributing blame or stigma? When is it reasonable, and when is it not, to stigmatize particular “bad” behaviors?
To help ground the discussion:
“The problem of bad behavior” from The Healthiest Goldfish
“Behavioral economics, explained” by Max Witynski
“I Fought the Law” by Christopher Hichens
President Ronald Reagan’s Call for Responsible Driving on New Year’s Day, Jan. 1, 1983