Commentary: Be wary we don’t go too far even as we pursue healthier living

THE RISK OF “HEALTHISM”

This ethical tension comes to the forefront within two central components of the Healthier SG framework: Health plans for residents and the rewards-based health points system.

The health plan is an innovative and formalised process of documenting planned lifestyle adjustments and regular health screenings. Health plans are to be discussed between doctor and patient and then reviewed on an annual basis.

The spectre in the background here is what is sometimes referred to as “healthism”. This happens when people are judged through the prism of their health status, facing subtle forms of discrimination for their failure to take responsibility over their own health and to practice socially desirable health behaviours.

Healthist attitudes can be particularly dangerous if they infiltrate into the doctor-patient relationship. This is because patients are liable to feel guilt or blame if they fail to meet health targets or expectations, even if these are not set out by the doctor explicitly.

Healthism can subtly change the patient’s expectations about the healing role of the doctor – or even undermine the doctor-patient relationship entirely, potentially reducing patients’ willingness to attend clinic at all.

Addressing this ethical tension will require careful attention to be paid to the implementation of health plans on the ground. It will be important to ensure that the patient is willing to commit to this health goal-orientated way of approaching their interactions with the doctor. Just as importantly, health plans should be co-created with patients, with goals specified in light of the patient’s own health-related value commitments.

For these reasons, a one-size-fits-all, or standardised approach, is unlikely to be viable. Instead, health planning will need to be a dynamic process. Doctors should be open to health plans taking multiple forms, tailored to the patient’s own preferences and responsive to continual changes in the patient’s circumstances or life plans.