Page 176 - The Handbook of Persuasion and Social Marketing

168 The Handbook of Persuasion and Social Marketing

economics, social justice, health promotion, or new conceptualizations of
“stewardship.”
Stewardship is another wrinkle in the WHO’s quest to nudge people
into rethinking what counts as good citizenship, not only at the national
level but at the international or global level. In a series from the Bulletin of
the World Health Organization, John Krebs (2008) asked, “Whose responsi-
bility is health?” Individuals and families have historically held the pri-
mary responsibility for the health of individual family members, but over
time, with increases in human population and an increase in structural
complexity and interconnectedness in the form of globalization, govern-
ments and world organizations are now taking more active roles.
Individuals must still be responsible, but there is now more encroachment
from outsiders because of scientific knowledge about the way personal
lifestyles and choices affect personal health.
Attempting to deal with the delicate issue of mandating that people do
not do certain things, whether in regard to eating, physical activities, the
use of recreational drugs or tobacco, or risky behaviors, points to a new
conceptualization of public health ethics using a stewardship model
(Krebs, 2008). The stewardship model lays out a basic framework for the
things governments ought to take on as primary responsibilities—in align-
ment more with the expanded list of items in the UDHR than with the
traditional, limited legal or constitutional understanding of negative
rights—and also seeks to provide guidelines so that within this important
and beneficial work, individual rights and wills are not trampled. Krebs
states that governments have a responsibility to provide the conditions
under which people can lead healthy lives, and that the “stewardship state”
has the particular responsibility of reducing health inequalities and pro-
tecting the most vulnerable among us. In implementing policies and pro-
grams to reach these goals, full recognition is given that some people will
feel coerced into doing or refraining from doing whatever is specified in
these goals. Hence, the stewardship model seeks to create a sliding scale
for both coercion and the justifications that would need to be made ex-
plicit in the face of coercion. The higher the level of coercion, the higher
the level of justification that would need to be provided to offset the nega-
tive or harmful aspects of that coercion.
But who, ultimately, will decide what sorts of justifications will be ac-
cepted for particular forms or levels of coercion? The citizenry? Not likely.
Almost none of these proposed measures are being put to referendums
where citizens can decide, at the ballot box, whether they want to see
projects of moral entrepreneurism implemented. Ultimately, lawmakers
will attempt to justify new health and welfare initiatives based on expert