Crawfords work on healthism was published before some major public health crises and panics in the U.S. It was published just before the AIDS crisis began, and queer and trans people watched one another die at astronomical rates, with a delayed government response that many LGBTQ+ people experienced as indifference to our very lives. It was published before obesity was declared an epidemic, and before we declared a war on obesity, often fighting that war by stigmatizing fat bodies. And it was published before health became, in a sense, a moral imperativeand one that nearly all of us feel compelled to enforce at one moment or another.

As a fat person, my health is one of the primary grounds offered by those who mock, harm, and reject me as a fat person. Cruel and judgmental behavior is often justified with an off-handed Im just concerned about your health. As if my health were their responsibility. As if I owed it to them, a debt Id never taken out and could never repay.

And often, as many fat people know, trolling often masquerades as genuine concernthats what makes it so insidious, and what can make it so cutting. But underneath its explicit message of caring concern, theres a clear implicit judgment. Youre doing it wrong. You have failed. I have been monitoring your health. I know your body better than you.

And healthism isnt just a problem for fat peopleits a tool used to further anti-fat bias, yes, but also ableism, transphobia, misogyny, racism, and more. Healthism shows up when we joke about getting diabetes from a single dessert, or refer to a rich meal as a heart attack on a plateimplying that those health conditions are caused by failures of a perceived personal responsibility to be healthy, not by structural forces that disproportionately harm the health of people living on the down side of power. Healthism shows up when we suggest that trans people should be more worried about the side effects of long-term hormone therapy than their own lived experience of their gender.

Healthism isnt just an individual problem, eitherits present in many of our systems and institutions. Until the passage of the Affordable Care Act in 2010, U.S. insurers routinely (and legally) denied health insurance to people with pre-existing conditions. Paradoxically, we had a system where people were not healthy enough to qualify for health care coverageand countless patients were unable to meet their most basic needs as a result. Healthism even shows up in the war on drugs, when we culturally and politically respond to drug dependencystrongly linked to environmental factors like poverty, stress, and traumaas a personal responsibility to just say no. And it shows up in the worlds of fertility, pregnancy, and lactation, all of which pressure expecting parents to become pregnant, be pregnant, and give birth in one or two right ways.

To be clear, healthism isnt the root cause of transphobia, ableism, racism, anti-fatness, or misogynybut it can be a tool to enforce all of them. Thats in part because healthism assumes a playing field that simply isnt there. And when it stubbornly attributes societal and community outcomes to individual choices, it reinforces the biases facing marginalized communities. If health is a personal responsibility, and so many marginalized communities have such bad health outcomeswell, they must just be less responsible. Its an insidious and powerful kind of bias, and one that many of us perpetuate every dayeven if we dont know it, and even if we dont mean to.

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Healthism Is the Bias Many of Us Already Have - SELF