Responsibility ascriptions and public health problems Who is responsible for obesity and lung cancer?

Discussions about who is responsible for public health problems such as obesity and smoking-related diseases are often heated. A central question concerns the extent to which individuals are responsible for the consequences of their health-impairing behaviour and whether the State and the food and tobacco industries can justifiably be said to be responsible, too. The controversy may be partly due to the two aims of responsibility ascriptions: that they should be morally justified and that they should be efficient. The primary aim of this article is to achieve more clarity in the analysis of this issue. The method used in the article is conceptual analysis in the tradition of moral philosophy. There are two major perspectives on responsibility ascriptions. First, there is the merit-based idea that responsibility should be ascribed to someone who deserves to be held accountable, e.g. because he or she voluntarily and knowingly brought about his or her own health impairment. Second, there is the consequentialist view that responsibility should be ascribed in ways that have as good effects as possible. There are two values at stake here: responsibility ascriptions in public health should satisfy criteria of moral norms or fairness as well as of efficiency. It is argued that both perspectives should be taken into account in public health policymaking. It is concluded that it is important to be aware of the two views of responsibility ascriptions in public health discussions and the policymaking process and to aim at striking a balance between the two.