RT Journal
A1 Brook RH
T1 BAlancing responsibilities in health care—reply
JF JAMA
JO JAMA
YR 2010
FD September 15
VO 304
IS 11
SP 1165
OP 1166
DO 10.1001/jama.2010.1314
UL http://dx.doi.org/10.1001/jama.2010.1314
AB 
In my Commentary, I indicated that responsibilities should begin not with the poor, but with the rich and middle class. I distinguished those responsibilities for which an individual is mostly responsible from those (such as cigarette smoking, exercising substantially, and controlling weight) for which social determinants play a major role. Thus, for the middle class my Commentary focused on diagnostic testing that would identify diseases while they were curable and taking medication that would prevent the occurrence of serious diseases, such as myocardial infarction. These actions are under the control of the individual, as opposed to the environment in which he or she lives, especially if care is easily available and is free of charge.