To Mask or Not: Is Your Health Only Up to You?

New research on appeals to choice and responsibility is discussed.

Posted Jul 29, 2020

Source: pixabay/drfuenteshernandez

During the COVID-19 pandemic, we have been getting a lot of messages that are variations of, “Your health is up to you.” Similar messages have been communicated to us in the past about preventing various health conditions, such as preventable diseases. So we are used to them.

But could such messages, which are appeals to personal responsibility and choice, have negative consequences? Yes, according to an article published in the May issue of Perspectives on Psychological Science, by Stanford University researchers.1

Most deaths in the US are related to chronic health conditions (e.g., diabetes, heart disease, stroke), and 40% of deaths from these causes are preventable. To prevent these diseases, a common approach has been to focus on personal choice and responsibility

However, constant reminders of individual choice and responsibility could cause harm. How? By distracting from a focus on environmental and social factors that contribute to the disease—factors like public safety, pollution, social inequality, availability of nutritious food, and costliness of high-quality medical care.

The American way of life?

In individualistic cultures, like those in the United States, people are seen as separate and independent. Their behaviors are assumed to be driven by individual factors (e.g., unique goals, preferences, knowledge), not social or environmental factors (e.g., what others do, access to resources).

For instance, we assume a person who purchases a sugary beverage does so because he or she desired the drink and thus consciously chose to buy the beverage, not because the person was surrounded by vending machines or was influenced by other people around drinking the same beverage.

Similarly, we assume a person who chooses to wear or not wear a mask during a pandemic has consciously made the decision based on personal views and goals, not based on how others behave, the messages the person has received from authority figures, etc.

Other assumptions fundamental to this view include the following:

  • People are in control of their lives and thus responsible for their health.
  • A person’s ill health affects mainly the person.
  • People should be allowed to do whatever they like, as long as their actions do not directly harm others.

Not surprisingly, behavior modification policies (e.g., taxes on unhealthy products) are often perceived as undue government interference or threat to individual freedom.

The dark side of pure individualism

Nevertheless, a one-sided focus on the individual can have negative effects. To illustrate, consider the assumption of having control over one’s own health. If you believe health, like success, is always achievable only if one works hard enough at it, how will you judge an ill person? As someone who is lazy, irresponsible, and does not care about their health?

Those who hold such individualistic beliefs may blame and stigmatize individuals who are ill, particularly if the illness is a “preventable” condition (e.g., addiction, obesity, skin cancer, lung cancer, diabetes) commonly attributed to poor choices and irresponsibility.

Needless to say, blame and stigma do not motivate people to change. For instance, obese individuals may deal with stigma not by exercising more but by avoiding public places or engaging in unhealthy behaviors like drinking or stress eating.

Another negative aspect of pure individualism is the anxiety an individual feels when having to choose from among many options (e.g., healthiest foods, best exercise regiment).

Indeed, as psychologist Barry Schwartz has previously discussed, having too many options can result in dissatisfaction and even depression.2 Why? Perhaps because nowadays we are expected to be in control (e.g., choose the best option). When it comes to health, this puts a lot of pressure on us, since some aspects of our health are beyond our control.

Individualism’s emphasis on choice and responsibility also weakens people’s trust in experts and authorities, like doctors and scientists.1 Some examples of such mindsets may be refusing vaccinations, going to the doctor not to get diagnosed but to get prescriptions for desired drugs, and generally not respecting the advice of scientists and health authorities (e.g., not wearing masks during the COVID-19 pandemic).

AnnaliseArt/Pixabay (Modifications: Arash Emamzadeh)
Source: AnnaliseArt/Pixabay (Modifications: Arash Emamzadeh)

Individualism combined with social and environmental concerns

We do not exist in a vacuum. We affect others and our environment, and we are affected by them in turn. The same is true of making healthy choices—environments and social contexts facilitate or hinder these choices (e.g., affecting how costly or time-consuming they are).

In fact, to modify health behavior, it is often more effective to change the environment (e.g., banning smoking in public; taxing alcohol, tobacco, and sugary drinks) than to remind people of their choices. If the environment makes unhealthy behaviors easy and healthy behaviors hard, no matter how many times we ask others to be responsible—to “drink responsibly” or to “stay home” during the pandemic—they will struggle to make safe and healthy choices.

We can still view people as free and responsible, while also acknowledging that human beings are connected to each other and their environments (see Figure 1). For example, whether we are aware of it or not, we model healthy or unhealthy behaviors for each other. In the case of wearing masks, we also affect other people’s health (just as they affect ours) more directly by influencing the spread of SARS-CoV-2.

This more complex view suggests we do not have full control over our health; however, we have sufficient control to adopt healthy habits. In addition, we can engage in the political process (e.g., contacting local representatives) to influence health policy decisions and make healthy behaviors more convenient for ourselves and others.  

So next time you want to blame an individual for not following health advice—be it for not getting sufficient sleep, overeating, being ant-vaccination, not wearing a mask, etc.—consider all other social and environmental factors in the person’s behavior. A good approach is holding people responsible while making the right behavior easier for them.


1. Hook, C. J., & Rose Markus, H. (2020). Health in the United States: Are appeals to choice and personal responsibility making Americans sick?. Perspectives on Psychological Science, 15(3), 643-664.

2. Schwartz, B. (2000). Self-determination: The tyranny of freedom. American psychologist, 55(1), 79.