Healthism: A New Public Health Challenge for People with Long COVID

With Medical Ethicist Dr Alyssa Burgart, MD

What is Healthism?

In my latest Long Covid, MD episode, I had the pleasure of speaking with Dr. Alyssa Burgart — pediatric anesthesiologist, bioethicist, and passionate advocate for ethical medical care. She’s also writes two wonderful newsletters here on Substack about medical culture and its impact on both patients and healthcare workers. Together, we explored the concept of healthism: the idea that individual choices are the primary determinants of health, and that poor health outcomes are often seen as personal failures.

Healthism isn't new. It has long shaped the wellness industry and diet culture, but it is increasingly shaping public health policy as well. Recent remarks by leaders like Robert F. Kennedy Jr. and Dr. Mehmet Oz highlight a concerning trend. Kennedy, now Secretary of Health and Human Services, suggested that personal behaviors like smoking could justify limiting Medicaid benefits. Dr. Oz, newly appointed to lead Medicare and Medicaid Services, called being healthy “an act of patriotism” during his confirmation.

This shift toward emphasizing personal responsibility over collective action has enormous implications for people living with chronic conditions like long COVID — conditions that are not the result of "bad choices."

Why this matters now

We're entering a time when public policies may increasingly expect individuals to prove they deserve healthcare based on their behaviors, rather than recognizing that health is profoundly shaped by structural, environmental, and biological factors — many of which are beyond our control. As Dr. Burgart points out, when we focus only on individual actions, we lose sight of social determinants of health like pollution, housing, food access, and systemic inequalities. Structural determinants that impact our vulnerabilities to a COVID infection also include housing, availability of personal protective equipment like high-quality masks, our ability to isolate based on the type of employment, discriminatory practices against masking, and public health messaging.

Healthism impacts medical culture, too. For those of us living with long COVID, this mindset can make it even harder to access compassionate, unbiased care. It risks turning complex, poorly understood illnesses into moral failings in the eyes of policymakers, healthcare providers, and even ourselves.

How to Recognize Healthism and Push Back

In our conversation, Dr. Burgart offered practical strategies for recognizing and pushing back against healthism.

• Ask critical questions: When you encounter health messaging, whether from a public figure, an advertisement, or a healthcare provider, notice whether it focuses on individual behavior or collective responsibility.

• Name the bias: If safe to do so, you can say things like, “It sounds like you’re blaming me for my illness. Was that your intention?”

• Support trauma-informed care: Healthcare providers should be trained to understand that many patients carry trauma, including from previous medical encounters. Approaching patients with curiosity rather than judgment leads to better, more humane care.

Long COVID is Not Your Fault

If you are living with long COVID, your illness is not your fault. You deserve care, dignity, and respect, without having to "earn" it by demonstrating the right mindset or making perfect lifestyle choices. You deserve healthcare that honors complexity, not one that demands perfection.

I encourage you to listen to the full episode on your favorite podcast app or here on Substack. Share it with someone who might need to hear it, and continue building a community that believes no one should have to fight for their right to care.