The Moralization of Health: Measurement, Correlates, and Predictive Validity

The present research argues that common messages and beliefs about the controllability of health problems, individual responsibility for health, and the societal harm caused by preventable health conditions, have left many health behaviors and chronic conditions susceptible to moral judgment. Although individual health behaviors are important for well-being and chronic disease prevention, there may be unintended consequences of an ideology of individual responsibility for health, particularly when moralized health attitudes develop. Just as research has found individual differences in related constructs, such as obesity moralization and protestant work ethic values, the present studies examined health moralization as an individual difference. An instrument was developed to measure health moralization and, separately, the personal importance a person places on health, so that the moral component of health attitudes was isolated as a predictor. The instrument was validated across four studies. Studies 1 and 2 focused on scale development and establishing discriminant and convergent validity. Study 2 confirmed that health moralization is associated with a conservative worldview characterized by a strong endorsement of the Protestant work ethic and belief in a just world. Correlations across the four studies suggest that, compared to low moralizers, high moralizers are more likely to be politically conservative and religious, and they report having slightly better self-rated health and engagement in healthy behaviors. The predictive validity of health moralization was demonstrated through the confirmation of multiple hypotheses across Studies 2 – 4. The more a person endorses a moral view of health, the more they perceive common health conditions to be preventable (Study 2), assign greater personal responsibility for common health conditions (Study 3), expect individuals with preventable conditions or poor health behavior to pay more than others for their healthcare (Study 3), and attribute greater control, negligence, and blame to an individual described as failing to prevent heart disease or skin cancer (Study 4). The results suggest that health moralization has important motivational and interpersonal implications, and that future research should investigate its causes and continue to evaluate its consequences in a number of domains, including employment and healthcare contexts