The idea that people have an obligation to be healthy has been popping up more, I suspect as a reactionary response to debates about health care and increased scaremongering about ‘the obesity epidemic.’ People attempt to divide each other into good and bad categories based on health, and efforts surrounding personal health and ‘wellness,’ and they’re often spurred on by their environments. Corporations reward ‘good’ employees who participate in voluntary lifestyle initiatives, for example, and reality television features people who attempt to shed massive amounts of pounds for the camera, even if they gain those pounds back later like the vast majority of people who attempt diets.

People like to harp on the perceived ill-health of others like it somehow infringes upon their quality of life, and people should just not be sick, or at least put in a good faith effort. Thus a disabled person who is trying really hard and doing all the right things and complying with medication regimens is a good person, for at least attempting to meet the obligation to be healthy. Likewise, a fat person who rushes to provide the details of a diet and exercise routine, to provide information about blood pressure and cholesterol levels to prove a good level of health, to tout a ‘fit and fat’ lifestyle, is a good person, again, for being healthy. Not like those other ones. The bad ones.

Health is not worth, though, and people have no particular obligation to be healthy. The general public seems to struggle with this idea, and it feeds into a lot of social attitudes. Chief among those, of course, is that people who are unhealthy because they choose to be, or because they do not actively take measures to address health issues, or because they are trapped in a situation where they can’t do anything about their health, are worthless. Are human garbage. Do not deserve human rights, and can be treated with hatred and disdain. It shows in scathing comments about fat people who eat high-calorie foods, for example.

Believing that ill health makes you less of a person also means that people feel entitled to the health of others. By which I mean that they feel quite comfortable quizzing other people about personal medical issues, and offering unsolicited advice on treatments or lifestyle. They also feel entitled to judge the activities of the people around them, even when those activities have no actual impact on their lives. And even when people are unhealthy, aware of it, and perfectly okay with that fact, with no personal diminished quality of life. A fat person eating a doughnut in Cleveland and deeply enjoying it has absolutely no material effect on my existence, just as an asthmatic who doesn’t adhere to a care plan in Miami doesn’t influence my life in any way.

Persistent belief that health equals worth means people feel quite comfortable assigning each other to arbitrary categories on the basis of whether they are healthy or not, and if they are unhealthy, what they are doing about it. It’s less about how people feel—Are they happy? Are they stressed? Are they unhappy? Do they want to be healthier?—and more about how other people perceive them, as ‘unhealthy.’

A lot of pushback against this attitude has unfortunately persisted in recentring health; there’s talk like being aware that there are a lot of factors to health, for example, and you can’t know what someone is doing or not doing. There’s talk that there are environmental and genetic factors that may be outside control, and that every person is different so one size fits all approaches to care are not going to work.

What there’s less talk of is how health, or lack thereof, is a personal matter, and quality of life should be the more important concern. No one is entitled to private medical information about other people, and it is not acceptable to make value judgments about people no matter what their health status is. The pushback here shouldn’t be that some people are healthy and don’t look it, or are unhealthy but trying, but that, more to the point, the health of other people is not your business. What people should be worried about is whether people are happy, whether they like the lives they have or want something else, and what role society plays in their quality of life.

This is not the only example of a situation where social campaigning to fight stigma has inadvertently reinforced some of that stigma, of course, but it’s a stark one, and it’s a situation that seems to be growing worse. There’s increasing pressure from all sides to judge people for being unhealthy, with flames fanned by rhetoric suggesting that unhealthy people are a drag on society and should be punished for it. Citizens are encouraged to police each other’s health ‘for the common good,’ and to sweep away unsightly people who not only aren’t healthy, but refuse to play by the rules.

Fighting systemic health issues should be a social priority, and there should be a focus on how to reduce preventable disease, how to address inequalities in the health care system, how to provide treatment to people who want it. On improving quality of life and access to services that people want and need. But that doesn’t include judging individuals for their personal health choices, or reinforcing systems that shame people even further. The obligation to be healthy is what leads the fat patient to stay away from the doctor out of fear, thus allowing a serious health problem to become even more serious. The same obligation leads a patient with a chronic illness to lie to a care provider to appear compliant, which may mean missing critical treatment. Or leads that patient to stop going to the doctor, worried about being lectured for failing to keep up with a treatment regimen.

This idea, that people have an obligation to be healthy, that they owe it to society in general and you personally, is a major contributor to a stigma that can sometimes be fatal. And, yes, costly. Because those patients who avoid treatment because they don’t want to be told they’re bad human beings may eventually end up in an emergency room requiring costly medical interventions, all because they were too afraid to make an appointment to see the doctor, too shamed by the social structures telling them they are bad, horrible people. And that, the fear wrapped up in the obligation to be healthy, the fact that people think they are worthless human beings for not being ‘good,’ is a problem created by society.