What is healthism?
The term “healthism” was coined in 1980 by Robert Crawford in the International Journal of Health Services: Planning, Administration, and Evaluation. Crawford was concerned about the new health consciousness and interest in wellness and holistic health permeating our society in the 1970s. (1)
He defines healthism as “the preoccupation with personal health as a primary—often the primary—focus for the definition and achievement of well-being; a goal which is to be obtained primarily through the modification of life styles, with or without therapeutic help.” (1)
Although disease is complex and multi-faceted with many different intersecting influences, healthism views health through the lens of personal responsibility and control. Healthism blames the individual’s health on their behavior and choices and shames the individual for not being able to do all the right things when their efforts fail, which they inevitably do. The individual, then, is viewed as a failure and morally inferior. Healthism does not consider the biological, psychological, cultural, and sociological factors influencing physical and mental health, such as: (1)
- Lack of access to care
- Weight stigma
“For the healthist, solution rests within the individual’s determination to resist culture, advertising, institutional and environmental constraints, disease agents, or, simply, lazy or poor personal habits.” (1)
To that end, healthism is a belief or attitude viewing personal health as within that person’s control, entirely attainable, and a moral good. As such, people are judged based on their health. Meanwhile, people who engage in deprivation, such as by dieting, fasting, detoxing, or doing juice cleanses, are often viewed as good and moral.
Healthism is embedded in how we speak
So many of the things we say regarding food consumption and exercise are steeped in healthist attitudes. Here are some examples of healthism in our daily lives:
- Saying “I’m so bad” when we eat dessert or skip the gym
- Having to “earn” your meal by exercising first
- Viewing certain foods as “good,” rather than nutritious or delicious
- Referring to other foods, food groups, or ingredients as “bad,” “junk,” or “unhealthy”
- Choosing foods based on calories, fat content, or carbohydrates
- Referring to desirable foods as a “cheat meal”
- Viewing exercise, fitness, and weight loss through a lens of willpower
- Commenting on other people’s body shapes, sizes, and weights
- Rewarding yourself for restricting or burning a certain number of calories
- Commenting on someone else’s meal or behavior
- Believing that a certain behavior that works for you will work for everyone
- Telling a pregnant person the “healthiest” way to give birth
How healthism harms marginalized people
Healthism is insidious and stigmatizing, harming people living in larger bodies, as well as many other marginalized identities. Fat is a term that has been reclaimed by higher weight individuals. And fat people are subject to weight stigma in many different settings by many different people. These include school, work, healthcare, and even in the home, by family, friends, healthcare providers, teachers, coaches, and colleagues. Fat people are often viewed and labeled as immoral,irresponsible, lacking willpower, lazy, weak, slovenly, unmotivated, undisciplined, unintelligent, and so much more.
And those who judge and stigmatize fat people often defend their judgments by expressing that they’re merely concerned for the person’s health, equating weight and health despite the fact that research has debunked the notion that the two are connected. This is called concern trolling.
Healthism doesn’t just harm people living in larger bodies either—it is used to maintain ableism, racism, transphobia, classism, and more. For example, healthism stigmatizes people struggling with a substance use disorder, or addiction, when we view these individuals as having poor self-control or having chosen to become addicted, instead of acknowledging how various genetic and environmental factors can lead to addiction.
Healthism also becomes apparent when cisgender people focus on the side effects or potential consequences of hormone replacement therapy (HRT) as opposed to its affirming and life-saving qualities. It upholds ableism when people joke about getting diabetes from eating a sugary dish, which implies that this condition is caused by behaviors and decisions a person made, as opposed to systemic issues that hurt those lacking privilege and power.
Pregnant people and new parents also often experience the deleterious effects of healthism, as our society has deemed certain decisions, such as how to give birth or how to feed your child, and certain pursuits, such as losing “baby weight” or getting your pre-pregnancy body back, as “right” or “morally good.”
Healthism views health as a personal responsibility. So, according to those who buy into this damaging attitude, if members of marginalized communities have medical conditions or poor health, then they must be “irresponsible” or “lazy.” As such, healthism can contribute to stereotyping, stigmatization, and discrimination, upheld by those who have power and privilege.
Healthism is a systemic issue
As much as healthism wants to assign personal responsibility to individuals, it is not an individual problem. It is a systemic issue that’s so deeply ingrained in our culture and society that it’s hard to grasp as doing harm. Healthism works to protect the status quo, resisting meaningful social and political change. It promotes victim-blaming, rewards those with privilege, and compounds health inequities.
Before the Affordable Care Act was passed in 2010, U.S. insurance companies were legally allowed to deny insurance to those with “pre-existing conditions.” This meant those who needed the most medical care were unable to receive it. Some of these pre-existing conditions included HIV/AIDS, diabetes, obesity, epilepsy, pregnancy, heart failure, and severe mental health disorders. Millions were underinsured or uninsured because of this horrific policy, only serving to widen the already massive treatment gap.
Those who view healthism through a social justice lens often consider it to be a distraction from more pressing priorities, such as health equity, climate justice, and police violence against Black and Brown people. They also consider it to be a tool to further oppress and marginalize those who don’t fit the healthist ideals, such as those living in larger bodies or those with a chronic illness.
How to challenge your own biases
Much like diet culture and weight stigma, healthism is so prevalent in our society that we likely don’t even realize all the ways in which we perpetuate it. And we’re all guilty of it. But we also don’t have to dwell on the past.
There are ways to unlearn the harmful attitudes we’ve internalized and change our outlook and behaviors. At the end of the day, no matter how we’ve been socialized, it’s up to us to educate ourselves and do better. And we start doing better by challenging our beliefs about other people, their health, and how we treat them.
Here are some questions you can ask yourself in order to challenge your own healthist attitudes:
- How do you feel when you judge another person’s health? Why do you keep doing it?
- How does your perception of someone’s health influence how you treat them? Why?
- Why do you expect to know intimate details about other people’s physical or mental health?
- If you are discussing someone’s health with them, did they ask for your opinion or help? Or are you overstepping a boundary?
Ultimately, challenging your healthist beliefs and behaviors and other implicit biases can help you approach the world from a more compassionate, empathetic, and inclusive place and initiate change. (2) It can also help you to approach other people in your life who promote healthism and perpetuate other harmful beliefs.
However, just as health is not an individual problem, dismantling healthism is not up to individuals. Deconstructing and eradicating healthism requires major structural changes in our culture and society, and individuals working together to achieve those goals. And we can start by doing our individual part.