Politics and ethics of chronic disease remediation: A call for 'post-ideological' health policy

This paper examines the ethical and political tensions that often characterize U.S. health policy directed at chronic disease remediation and argues for a “post-ideological” approach. This approach tethers together two values that are often pursued independently from one another: a call for social justice and for individual accountability. Politically liberal-leaning citizens and policy makers often stress the former and neglect the latter; conservatives often do the reverse. I will argue that the most ethically and politically defensible policy responses will often be those that combine these normative commitments in ways that are sensitive to the complex etiologies of chronic disease. Chronic disease brings these ethical and political tensions into high relief precisely because of the significant contribution personal behaviors make to disease development and progression and because these behaviors are socially patterned by socioeconomic status and race/ethnicity. I will use several current and proposed policies as case examples for this investigation and identify the ethical merits of those that redress social structural barriers in ways that aim to foster individual accountability. The policy goal should be, I will argue, to facilitate and normalize healthy behaviors, rather than to stigmatize unhealthy ones. Whether the former can be achieved without causing the latter is an empirical question. But, I will show that there is a strong ethical case to be made for such an approach that appeals to a plurality of values integral to the public health tradition.