Accountability, Blame and Empowerment

A lot is being made at the moment about the growing patient/consumer empowerment movement. Empowerment and engagement is seen not only as a step to improving the health of individuals but also lowering total health care costs.

It is interesting to see these two contrasting views re-posted on the KevinMD site:

Stop blaming patients for not doing enough to stay health


Make patients more accountable for their health

These views highlight the complexity of empowerment. Yes people should be responsible for their health. At the same time incentives and penalties for taking/not taking responsibility should not be discriminatory.

One way to approach this is to de-emphasise the individual and look more at cultural and societal factors. If we look at the obesity epidemic for example – we’ve got here because of the marketing of myths about diet and metabolism and industries built around encouraging us to eat foods that predispose to insulin dysregulation irrespective of the total caloric intake. To address this needs changes in food policy and re-education. We aren’t going to cause a reversal in the obesity epidemic by penalising people for being fat.

The other thing is empowerment shouldn’t be burdensome. Empowerment should be about creating habits that people don’t have to think about. As I saw on twitter yesterday – what we need is to get people addicted to health.

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