"Evil Habits" and "Personal Choices": Assigning Responsibility for Health in the 20th Century

Abstract

The 20th century began and ended with much of the nation's more affluent and better-educated citizens in a near-frenzied pursuit of better health through lifestyle modification, and with many of the nation's health policymakers and opinion shapers blaming individuals for their own ill health. Despite this common theme, assumptions about the character, causes, and consequences of personal irresponsibility in health matters differed in important respects. In particular were differences in the degree to which Americans at the start and end of the last century were free to choose healthier lifestyles, in the role of science and medicine in debates promoting health, in the alleged negative externalities of personal irresponsibility, and in the moral authority on which these debates were based.