Responsibility for health

Health is, on one hand, a highly personal responsibility and, on the other hand, a major public concern. It involves the collective efforts of the entire social fabric, namely the individual, the community, and the state, to protect and promote health.

1. Individual/family responsibility

Although health is now recognized as a fundamental human right, it is essentially an individual responsibility. It is not a commodity that one individual can impose on another. No community or state program of health services can guarantee health. In large measure, it has to be earned and maintained by the individual who must accept a broad spectrum of responsibilities now known as “self-care.” Self-care refers to the activities individuals undertake to promote their own health, prevent their own disease, limit their own illness, and restore their own health. Self-care activities comprise adherence to simple rules of behavior related to diet, sleep, exercise, weight, alcohol, smoking, and drugs. Others include attention to personal hygiene, cultivation of healthful habits and lifestyle, undergoing selective medical examinations and screenings, accepting immunization, and carrying out other specific disease prevention measures. It also involves promptly reporting when sick, accepting treatment, and undertaking measures to prevent relapse or the spread of the disease to others. Additionally, family planning is essentially an individual responsibility.

2. Community responsibility

Health can never be adequately protected by health services without the active understanding and involvement of communities whose health is at stake. Until quite recently, throughout the world, people were neglected as a health resource: they were merely looked upon as sources of pathology or victims of pathology and consequently as a “target” for preventive and therapeutic services. This negative view of people’s role in health has changed because of the realization that there are many things which the individual cannot do for himself except through united community effort. The individual and community responsibility are complementary, not antithetical. The current trend is to “demedicalize” health and involve the communities in a meaningful way. This implies a more active involvement of families and communities in health matters, including planning, implementation, utilization, operation, and evaluation of health services. In other words, the emphasis has shifted from health care for the people to health care by the people. The concept of primary health care centers around people’s participation in their own activities.

There are three ways in which a community can participate:

i. The community can provide facilities, manpower, logistic support, and possibly funds.

ii. It also means the community can be actively involved in planning, management, and evaluation.

iii. An equally important contribution that people can make is by joining in and using the health services, particularly in preventive and protective measures. No standard pattern of community participation can be recommended, as there is a wide range of economic and social problems, as well as political and cultural traits among and within communities.

3. State/National responsibility

The responsibility for health does not end with individual and community efforts. In all civilized societies, the State assumes responsibility for the health and welfare of its citizens. The State shall, in particular, direct policies towards securing that:

a. The health and strength of workers, men and women, and the tender age of children are not abused, and that citizens are not forced by economic necessity to enter avocations unsuited to their age or strength.

b. Childhood and youth are protected against exploitation and moral and material abandonment.

c. The State shall, within the limits of its economic capacity and development, make effective provision for securing the right to work, education, and public assistance in cases of unemployment, old age, sickness, and disablement, and in other cases of undeserved want.

d. The State shall make provisions for securing just and humane conditions of work and maternity relief.

e. The State shall regard the raising of the level of nutrition and standard of living of its people and the improvement of public health as among its primary duties.

4. International responsibility

The health of mankind requires the cooperation of governments, the people, national and international organizations both within and outside the United Nations system in achieving health goals. This cooperation covers subjects such as the exchange of experts, provision of drugs and supplies, border meetings regarding the control of communicable diseases, and the achievement of “Health for All” through primary health care. The TCDC (Technical Cooperation in Developing Countries), ASEAN (Association of South East Asian Nations), and the recently established SAARC (South Asia Association for Regional Cooperation) are important regional mechanisms for such cooperation. The eradication of smallpox, the pursuit of “Health for All,” and the campaigns against smoking and AIDS are a few recent examples of international responsibility for disease control and health promotion. Today, more than ever before, there is a wider international understanding of matters relating to health and “social injustices” in the distribution of health services. The WHO is a major factor in fostering international cooperation in health. In keeping with its constitutional mandate, WHO acts as a directing and coordinating authority on international health work.

Sources: Park, K. (2021). Park’s Textbook of Preventive and Social Medicine (26th ed.). Bhanot Publishers.

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