How do lifestyle factors affect health?

Prevention as a moral virtue of lifestyle

Dr. Notburga Auner, Prof. Enrique H. Prat
Status: October 2004

Prevention comes from the Latin “praevenire”, which means “to anticipate”. In medicine it means to anticipate diseases, i. H. avoid them. Diseases only break out when certain conditions (risk factors) or combinations of individual conditions are present. So prevention means reducing risks, i. H. to reduce or avoid the conditions that can lead to the development of a disease. In this context, one speaks of primary, secondary and tertiary prevention. The elimination of health-endangering factors (risk factors) before they take effect is called primary prevention. Secondary prevention is to ensure the earliest possible diagnosis and treatment of diseases through preventive medical check-ups. Tertiary prevention means limiting the consequences of the disease, rehabilitation and relapse prevention. In the English-speaking world, secondary prevention is counted as primary and the tertiary described above is listed as "secondary preventive medicine".

Lifestyle factors and health risk

Scientific data show that lifestyle factors such as diet, alcohol, cigarette smoking, physical activity and socio-economic factors are interrelated with health and illness. For the steadily increasing cardiovascular diseases, as well as for some tumor diseases, these risk factors have already been well investigated. This is of great importance because, for example, cardiovascular diseases are now the leading cause of death in the western world. In 2002, 39.7% of men and even 53.3% of all women died from it in Austria. A change in lifestyle can significantly reduce the risk. The recommended lifestyle optimization is: at least 30 minutes of exercise / day, 5 servings of fruit and vegetables / day, 2 - 4 low-fat dairy products / day, max. 25 - 35% fat content daily, max. 10% saturated fatty acids daily, at least 2 servings of fish / Week, up to 5 grain products / day, no smoking, 1 - 2 glasses of wine / day and suitable stress management mechanisms. With just four essential lifestyle measures, the risk of many chronic and degenerative diseases can be kept very low. These measures are called: no smoking, proper diet, physical activity and normal weight. The result will not only be a reduction in morbidity and mortality, but also a significant improvement in subjective well-being.

In its 2002 World Health Report, the WHO set out what could be achieved through primary prevention alone. Table I shows how many years of life could be gained annually through targeted prevention. Around 5 million people die around 12 years too early from tobacco smoking alone.

Risk factorsDeaths
in millions
Lost years
per death
Blood pressure7,1  9
cholesterol4,4  9
Sedentary lifestyle1,910
Table I: Deaths in 2000 by causal risk factors and the average number of years lost. Source: WHO, The World Health Report 2002

The moral status of prevention: a duty and / or a virtue?

Disease prevention makes specific, lesser or greater demands on the lifestyle of the individual or a collective: The way of life would have to be designed in such a way that the risk of illness is kept very low.

  • The primary prevention could be summarized with the maxim: "Maintain a healthy lifestyle and avoid behavior that is harmful to health!"
  • Secondary prevention is based on the following moral maxims: "Check the health parameters regularly so that you can be certain that your lifestyle adequately excludes the risk of illness and that the onset of illnesses can be detected early!"
  • The tertiary prevention then continues: "Take all necessary measures for rehabilitation or change your lifestyle so that the risk of relapse is minimized!"

The three prevention maxims are sensible, everyone agrees to them in principle. Common sense is life as a good that should be protected. Therefore, the unhealthy life that leads to the development of the disease is an evil that must be avoided whenever possible. One can therefore say that these guiding principles have general validity in the sense of the Kantian imperative: "Only act according to those maxims through which you can at the same time want them to be elevated to a general law". This can be used to justify that prevention is an obligation.

The virtue of prevention

Prevention is also a type of action that is assigned its own virtue. However, the virtue of prevention cannot be reduced to medical acts alone. It is the attitude to forestall any kind of evil. Medical prevention is part of it. The three maxims mentioned above are the goals of moral virtue, which consists in the habitual attitude of choosing, from among the various options for action, those that contain the lesser health risks.

Actions that directly endanger life or cause damage to health must of course be avoided as a preventive measure. On a freezing winter's day with a blizzard, you won't just go for a walk in the open air wearing a t-shirt, coat and hat, as a severe cold or pneumonia would be the likely consequences. No special explanation is required to recognize this.

What is really required, however, is the virtue of prevention in making subtle decisions about the health risks of lifestyle. H. in the case of repetitive actions which do not in themselves cause any directly verifiable damage to health, but which, if repeated, cause accumulated damage in the long term In principle, the one-time consumption of 3/4 liter of wine is not expected to result in any health problems for an adult, but considerable damage when it comes to the daily consumption of this amount over months and years.

A person's lifestyle is shaped by their specific preference structure and their habitual behavior patterns. Medical science is responsible for the question of whether certain traditional lifestyle actions pose a health risk. Most of the time it will be the case that behavior only becomes risky once a frequency threshold has been exceeded. However, this threshold is also not the same for all people. It depends on many factors: genetic disposition, physical condition, environmental factors and much more. a. m.

The virtue of prevention aims at making the fundamental decision to lead a healthy lifestyle in the context of the given circumstances and to develop a great sensitivity to choose health-promoting options or to avoid behavior that is harmful to health. Subsequently, this virtue will be related to the four cardinal virtues. This shows what is virtuous about prevention, i. H. how prevention makes people morally perfect. In addition, it will also be shown that preventive actions are not necessarily virtuous. H. Virtuous prevention must also be wise, just, appropriate, and brave, because an act that does not meet the requirements of the four cardinal virtues cannot be an act of virtue.

Prevention and Wisdom

Prevention is directly related to prudence, and especially to caution, foresight and circumspection in all matters that may have an impact on health. The virtue of caution and therefore also to prevention is related to vigilance, which allows a quick recognition of dangers and threats without falling into pathological anxiety. In each individual case, an act of prudence will have to be used to decide which of the possible courses of action is best for health. In many cases it will be a matter of proportionality to judge whether it is really sensible to take a particular health risk. Proportionality is a criterion for judging the wisdom (i.e. appropriateness) of a measure.

Reasonable, d. H. Virtuous prevention must also be wise, just, appropriate, and brave in order to be an act of virtue.

Prevention and Justice

Justice is the virtue by virtue of which a steadfast and constant will recognizes everyone's rights. It is that voluntary attitude that allows everyone to give what is indispensable to him, a cardinal virtue of the will. Serious violations of life, including one's own, are violations of justice because neither the human life of others nor one's own life are free to dispose of without restriction. This principle is not questioned for the life of others as a good that does not belong to us. But it also applies to one's own life, whose beneficiaries and administrators, but not whose owners we are. Life is a gift, not only for the subject of this life alone, but also for those around him, a gift that obliges both to justice towards the Creator and towards the other people bestowed by that life.

Prevention and moderation

It is first and foremost the task of preventive medicine to rigorously determine what, when and how is preventive. How much exercise, sport, what diet, how much alcohol, etc. ... represents the reasonable amount can only be stated in specific individual cases. Based on medical findings, moderate regular wine consumption (e.g. 1/8 l daily) is usually beneficial to health, and from around 3/4 liter per day one must expect health damage. The right balance between an "too much" and a "too little" will depend on many factors to be considered: that is what reason, supported by the virtue of moderation, does.

Prevention and bravery

Prevention usually means restricting spontaneous desire and requires overcoming it. Quite a few people see the need to act preventively. You even make specific resolutions regarding diet, exercise, etc. However, some do not find the right moment to start implementing it, or they make a start but are unable to hold out. But the virtue of prevention is not possible without courage and perseverance.

Prevention from a socio-ethical and political point of view

The creation, regulation and control of social structures is the task of the solidarity community. This means a clear political mandate to minimize the risk of illness and accidents. Prevention and its promotion must be incorporated into political decisions in public health and urban planning, public leisure facilities and education. There is little point in preaching prevention if it is not facilitated by trying to set up exercise parks, provide homes and workplaces in such a way that as many distances as possible can be covered on foot, devoting sufficient resources to physical education, etc. But that is allowed should not be understood to mean that politics can interfere with the lifestyle of citizens as long as there are no disadvantages for third parties. However, it can effectively support the preventive attitude of the citizens through supportive measures. Especially recently, z. For example, the EU paid particular attention to the protection of non-smokers from passive smoking. In Austria, smoking is therefore prohibited in the workplace if non-smokers work in the same room.