Health and the Usual Disclaimers

What Will you DefendWhen I discuss the concept of health on this blog I include some version of the following:

Health is not an obligation, barometer of worthiness, completely within our control, or guaranteed under any circumstance.

Recently reader Deborah asked me to talk more about this so I thought I would do that today, taking it piece by piece

Health is not an obligation

Health is a complicated concept, it can be a moving target and different people have different definitions.  When I say that health is not an obligation, I’m saying that nobody owes anybody else “health” or “healthy” behaviors by any definition. People are allowed to make choices that not only don’t prioritize their “health” based on whatever definition, but that actively put their health, up to and including their lives, in danger.

People are allowed to play sports even though they lead to sports injuries in the short term and can lead to chronic issues. People are allowed to go mountain climbing even though only people who climb mountains fall off of them and get injured or die. People are allowed to spend tons of time outside even though it vastly increases the risk of skin cancer.  People are allowed to be sedentary and eat fast food.   People are allowed to participate in extreme sports with huge risk. People are allowed to be cast members of Jackass. People are allowed to be rockstars and not get any sleep. People are allowed to be professional football players and put their bodies at tremendous risk.  People of all sizes get to make choices about their bodies and health, and there are no obligations as to what those choices have to be. (Those who want to make a “but my tax dollars!” argument can check out this post.)

Otherwise it becomes a slippery slope – if there is evidence that eating a raw foods diet and practicing hot yoga are “healthier” than other choices do we all have to do that?  Do we all have to eat cashew cheez between downward dog in 120 degree studios?  If there’s evidence that going paleo and long distance running is”healthier” do we all have to eat a ton of meat while ultra marathons?  Do we end sports because there are activities people can do that have the same health benefits but are less risky?

People use this idea of “fat people not prioritizing our health” as a justification for their bigotry and poor treatment of us while being completely fine with thin people who behave in the same ways that they believe fat people do.  In order to refrain from sizeism and healthism, we need to stop acting like other people’s bodies and choices are our business. So unless the people discussing other people’s behaviors and health are excited about being told what they are allowed to do by the newly elected Overlord of Health, it’s time to stop making this argument.

Health is not a barometer of worthiness

It is completely, totally, wildly, inappropriate to use health as a way to judge people.   People who have health issues should be given accessible treatment options that have their decisions respected.  They should not be judged or asked to prove that their health issue is not somehow “their fault” because that is absolutely horrifying.  This is another area where sizeism and healthism intersect

It does not matter what size someone is, or the reason for their health status, or what their habits are, everyone deserves to be treated with basic human respect, and to have care options based on their own values and choices.  The only appropriate healthcare treatment is blame free, shame free, and future-oriented. There is no health issue, personal health choice, or health status that should cause someone to lose the rights to basic human respect and life, liberty, and the pursuit of happiness.

Health is not completely within our control

Health is multifaceted and includes genetics, environment, stress level, access to healthcare, behaviors (food, movement, sleep, etc.) Nobody is completely in control of all of these factors, and increasingly experts suggest that we are overestimating the amount of control we have over our health outcomes.  The number factors that each of us has control over varies depending on factors like socioeconomic status, ability to access care, social oppression like racism, ageism, transphobia, homophobia, fatphobia etc., effects of things that happened in our past and more.  The job of public health should be to remove barriers to health and fight the things that get into the way of health, the current model of public health wherein people try to make the individual’s health the public’s business is ineffectual and just plain lazy.

Health is not guaranteed under any circumstance

An extension of the fact that health is not completely within our control – no behaviors guarantee a specific health outcome, people get all kinds of illnesses regardless of their behaviors or body size. Thin people get all the same diseases that are correlated with being fat, so being thin cannot be a sure preventative or a sure cure.

When it comes to discussions of health and fat people I think it’s very important to make a distinction between the civil rights movement of Size Acceptance, and the healthcare paradigm of Health at Every Size.  I also think it’s important to speak out against the bullshit Good Fatty/Bad Fatty dichotomy, and to discuss the ways that healthism and ableism are used as tools to oppress fat people.

And I think it’s important to remember that health is not an obligation, barometer of worthiness, completely within our control, or guaranteed under any circumstance.

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14 thoughts on “Health and the Usual Disclaimers

  1. I applaud every time Ragen points these things out, especially that health is NOT entirely under our control and NOT guaranteed. As someone living with chronic illnesses, I get SO TIRED of people assuming that I must be engaging in unhealthy behaviors. As I’ve posted here before, I cook most of my own food, from fresh ingredients, watch my sodium and sugar intakes rigorously (because of my particular health issues), and walk 35 to 45 minutes at least 5 and usually 7 times a week. In other words, I’m already doing everything that the health police tell me to do, and that people assume would “fix” me. I’m already doing those things, but I don’t lose weight and my health issues don’t go away. That’s okay; health isn’t guaranteed and isn’t under my control, and I accept that. I just wish all the nosy busybodies would accept it too!

  2. Does this imply that the government shouldn’t oppose smoking? It might limit people’s exposure to secondhand smoke, but possibly not put sin taxes on cigarettes. we might have a better world (more understanding of biology) if there’d been a decades long effort to make smoking safer.

    As for taxes and sports, consider the extent to which stadiums are subsidized.

    1. Not to go all wackobird libertarian, but I really don’t like the laws about smoking in public/in restaurants. I don’t like people smoking near me when I eat (well, or any other time, really), but I also think it should be the proprietor’s business who they want to cater to and when and why. And then I have the option not to go there. Underpants rule all ’round.

      1. I consider those laws part of public safety – in terms of the fact that my right to punch ends at the tip of someone else’s nose. So while I’m allowed to do shots, I’m not allowed to make everyone within 40 feet of me do shots. Similarly, if people were able to smoke without making everyone around them participate in their personal choice then that would be fine, but they can’t. So just like there are plenty of laws on the books that private business have to follow (restaurants aren’t allowed to make up their own food safety rules with the assumption that if people don’t like food poisoning they have the option not to go there etc.) smoking in public isn’t just a personal choice.


        1. Someone should invent some kind of self-contained system so that people who want to smoke can do so without any of the smoke escaping and affecting others.

          1. They have – e-cigarettes. They deliver nicotine to the “smoker” along with the mouth feel of a cigarette, but only release water vapor into the air.

  3. One thing about health too is that we all prioritize in different ways. We can’t do all things all the time, and that means making some sacrifices when it comes to health. Each of us prioritize that in different ways. One thing that gets me all the time is the folks who preach “health” and talk about getting less sleep to get their workouts in- which is a find choice for any person to make. Just the same as deciding that getting enough sleep is more important is a fine choice for any person to make. But the reality is, if you are not getting enough sleep that you are fully rested in order to get in your workouts, you are compromising one area of health in favor of another, which imo means you have no right to judge other people who make a different choice on their health trade offs than you, because the truth is we all make health trade offs.
    Another example I would use is drinking. Especially from a personal level, alcoholism runs in my family, so I could certainly make a choice to not drink on health grounds and I know many people with the same background who do make that choice. Yet on the other hand drinking around 1 drink a day has been correlated in research with reduced risk of developing Alzheimer’s, which also runs in my family. I like alcoholic beverages and prioritize anything that reduces my risk of Alzheimer’s over the health risks of drinking. But either choose to drink or not to drink can be a health one, yet there is no way I could possibly do both.

    Though this also goes to your comment about health not being guaranteed. I’m always trying to stay up on research around Alzheimer’s and trying to do whatever I can that *might* make me less likely to end up with it. But I can’t guarantee I won’t get it, can’t even guarantee I’ll live long enough for that to be an issue.
    And I have some family members who get even more upset than me when they hear that people should do X to prevent Alzheimer’s because my grandmother had it and they see it as an implication that she had it only because she didn’t do the right things. Exercise has been correlated with reduced risk of Alzheimer’s and anecdotally in my family many people point to my grandmother’s sister walking everyday as why she doesn’t have Alzheimer’s (which is unusual on that side of the family. Almost everyone who has lived past their early 60s has developed it.) The thing is, my grandmother used to walk daily too until she was to ill to anymore. I also just saw an article saying that there was a finding that grandparents who babysat were less likely to have Alzheimer’s- my grandmother more than just babysat, her and my grandfather were like parents to me and my siblings. And she babysat my younger cousins when they were young, and babysat for other people she knew, and worked in a nursery- her whole life was always about kids. So to use a non-fat related example of this- you can do the things you are supposed to do for health or to prevent some disease, but you never get a guarantee of such things.

    1. I’m sorry about your grandmother’s Alzheimer’s.

      I just want to say that your last sentence here absolutely nailed it. People forget that even when there seems to be a proven association between certain behaviors and certain health outcomes, those outcomes are *likelihoods* across large groups of people. You can NEVER predict on the level of the individual whether a particular behavior will lead to a particular outcome. Smoking and lung cancer are the classic example here–many smokers don’t get lung cancer and some non-smokers do. The association, clear as it is, means that smokers are more *likely* to get cancer; it doesn’t, can’t ever, mean that any individual smoker inevitably will or that any individual non-smoker definitely won’t.

      But so many people seem to forget–or never to understand in the first place–that however you prioritize your health, your choices can only make the outcome you want somewhat more likely, they can’t make it a certainty.

  4. This is full of interesting points- particularly the idea that health is not an obligation. I’d never thought of it exactly like that but I’ve often felt pressured personally to always make the “right” choices because my health and it’s interesting to think that this is perhaps where some people are coming from when they pressure others to make certain choices.

  5. I love your perspective on this. I have to admit, I struggle with this sometimes regarding my husband’s smoking…the truth is, his decision to treat his body poorly (in the case of smoking, we have PLENTY of evidence for making a declarative statement that it is bad for a person’s health on many levels) DOES affect me in an immediate sense…right now, in financial costs (especially regarding his dental troubles that are at least partially a direct result of his addiction) and worry; later, possibly, in emphysema, lung cancer, or heart disease…etc, etc. His choices could mean I wind up a caretaker/sole breadwinner in my middle age, for reasons that probably both of us will always wonder if they were preventable had he made wiser choices. All that said…one, I’ve always maintained (even when I worry about him) that allowing someone complete bodily autonomy is absolutely an essential part of putting feet to any claim to respect them as an equally human being as yourself.
    Secondly, and perhaps more to the point of your piece above, I do feel that Americans in general (regardless of where their own weight falls in the spectrum) have a tendency to speak with great authority and self-righteousness on what other people “should” do regarding their health, IF said person is visibly “overweight” (a word I don’t even like using these days, with its connotation of “too much, clearly!”), despite the fact that most of those same people lean towards neutrality or complete acceptance on a myriad of other potential health issues-including those that can be treated more definitively as harmful. What is it about jiggly bits on another person that make so many people feel that person is fair game for mockery? I think the worst part is how many people sincerely have a blind spot to realizing that it IS demeaning to treat this one health factor (one that’s easily spotted at first glance) as somehow okay to consider your business, whether or not you know a thing about the person or their habits…and again, perhaps even more importantly, as though THEIR HABITS COULD POSSIBLY BE ANY OF YOUR BUSINESS! Drives me bonkers! But I think perhaps my favorite bit of what you wrote was the mention of correlation vs causation. As a scientist (neuroscience) myself, and firmly in the body-positive camp for years (I taught yoga and dance while in college, and was blessed by a pair of students who opened my eyes to my previous level of ignorance and prejudice regarding, shall we say, non-traditionally athletic bodies), I have always been profoundly annoyed by every article I read (or comment by someone spouting off online) wherein this essential research cornerstone is ignored because of a biased, predetermined point of view. Grrrrr…but again, great job. I just discovered your site today, but I’m already a huge fan based on the couple of pieces I’ve read thus far! You are an incredible inspiration, lady! 🙂

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