This article describes the emergence of an ideology which blames the individual for her or his illness and proposes that, instead of relying on costly and inefficient medical services, the individual should take more responsibility for her or his health. At-risk behavior is seen as the problem and changing life-style, through education and/or economic sanctions, as the solution. The emergence of the ideology is explained by the contradictions arising from the threat of high medical costs, popular expectations of medicine along with political pressures for protection or extension of entitlements, and the politicization of environmental and occupational health issues. These contradictions produce a crisis which is at once economic, political and ideological, and which requires responses to destabilizing conditions in each of these spheres. These ideological initiatives, on the one hand, serve to reorder expectations and to justify the retrenchment from rights and entitlements for access to medical services, and, on the other, attempt to divert attention from the social causation of disease in the commercial and industrial sectors.
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