• Health Promotion

Let us first thank the four commentators who have taken the time to read and thoughtfully reflect on our paper. In that paper, we discuss how responsibility concepts must be sensitive to the temporal (diachronic) and social (dyadic) aspects of health-related behaviour, if responsibility is to play a role in health policy.

This ‘if’ is a big one, and Hanna Pickard rightly challenges our position of neutrality with regard to whether or not responsibility should be incorporated into health policy.1 Pickard proposes that responsibility should play a forward-looking role in health policy—used as a tool to facilitate and encourage healthy behaviours where it is reasonable to expect people to adopt such behaviours. While the conditions for such responsibility are similar to those involved in the backward-looking, desert-based responsibility we invoke, they do not warrant responses such as praise, blame, reward and punishment that may follow from desert-based responsibility. Pickard argues that even asking the question of ‘what would desert-based responsibility look like in these health contexts’ risks encouraging moralisation, stigma and blame, all of which have no place in healthcare.

We agree that forward-looking responsibility could be an important tool in healthcare. We have offered …