Healthism: why "just take better care of yourself" keeps making you feel worse

Short answer

Healthism is the idea that health lives mainly in your personal behaviour — your habits, your discipline, your choices — rather than in the conditions you live in. The sociologist Robert Crawford named it in 1980 and warned that it would make health promotion "non-political, and therefore, ultimately ineffective." Forty-five years later, wellness is a trillion-dollar industry and population health is worse, not better. The details it sells are usually true. The framing is where it goes wrong.

Originally published on Founder And The City, Jane's newsletter about building in health tech. This version is written for the person on the receiving end of the advice.

And if you have tried repeatedly and it hasn't worked — you are not failing, and it is not your fault. That sentence does a lot of work in this article, so it's worth stating early: the most common experience in this space is doing the recommended things, not getting the promised result, and quietly concluding the problem is you. The research says otherwise, fairly emphatically.

The factory with the toxic air

Picture a factory where the air is bad. Workers start coughing. Management doesn't fix the ventilation — it hands out breathing apps. The app tracks your respiration, monitors your blood oxygen, and sends you personalised recommendations. Breathe deeper. Try 4-7-8. Your breathing score is 67, you can do better.

Some workers improve their scores. Most don't. The ones who don't get labelled non-compliant. The ones who do still get sick — slightly more efficiently.

At no point does anyone open a window.

That's the shape of the argument, and it's worth sitting with before the evidence, because the evidence is mostly about how well the metaphor holds.

The lie isn't in the details — it's in the framing

Worth being precise, because this is where the argument is usually misread: the wellness industry is not lying to you about the content. Sleep matters. Movement matters. Breathing techniques do something real. That's all supported.

The problem is what the framing does to the location of the cause.

If you're chronically stressed because your job is insecure, your commute eats two hours, your food is engineered to be over-eaten, and healthcare costs a fortune — and an app tells you to prioritise recovery and optimise your sleep hygiene — something quiet happens. The cause of your suffering moves from the system into you.

Your stress stops being a reasonable response to circumstances and becomes a management issue. Your burnout stops being structural and becomes a boundary issue. And if you get sick anyway, the implied conclusion is that you didn't try hard enough, track carefully enough, or meditate long enough.

Barbara Ehrenreich, who had a doctorate in cellular immunology before she became a writer, put the endpoint of that logic bluntly: when wellness becomes an ideology, every death can be understood as suicide.

What the evidence actually shows

The strongest reason to take this seriously isn't the rhetoric. It's that the outcome data doesn't behave the way the personal-responsibility model predicts.

The single best natural experiment is the Whitehall study. Michael Marmot followed more than ten thousand British civil servants. Men in the lowest employment grade died at roughly three times the rate of those at the top — with identical access to the same doctors, the same hospitals, the same national health service. The gradient didn't track diet or exercise. What it tracked was autonomy: how much control people had over their own work. Marmot's question has stayed with the field ever since — what good does it do to treat people and send them back to the conditions that made them sick?

Tracking more doesn't reliably produce better outcomes. The most rigorous trial of wearable trackers to date — 471 adults over 24 months, published in JAMA — found that the group using activity trackers lost less weight than the group without one. That's a single trial in one domain, and it shouldn't be over-read. But it is the opposite of what the more-data-equals-better-health premise predicts.

Generational biomarker data points the same way. An analysis spanning 28 years of NHANES data — blood drawn and waists measured by trained technicians, not self-reported — found physiological dysregulation rising continuously from Boomers through Gen X to Millennials, across every sex and racial group. Each generation arrives at adulthood measurably less well than the last, while having far more health data available than any generation before it.

And the AI version is already showing the same pattern. A 2026 randomised trial from Oxford, published in Nature Medicine with around 1,300 participants, tested what happens when powerful language models are used by ordinary people rather than clinicians. The same models that identified the correct diagnosis roughly 95% of the time when queried by doctors got it right in under 35% of cases when regular people described their own symptoms — and participants using AI performed worse than a control group using an ordinary search engine. Same model, same knowledge. The difference was who was asking.

That last finding matters for the argument, because the implicit response to it is exactly the pattern this article is about: if it didn't work, you probably didn't prompt it right.

Why information alone doesn't change what you do

This is the part that tends to land hardest, because most people have lived it.

You know you should sleep more. At 11pm, after the children are finally down and the day is finally over, you don't sleep. You scroll.

Not because you're weak. Because the 11pm version of a tired person is running on different machinery from the morning version.

There are names for the pieces. BJ Fogg at Stanford calls the underlying error the information-action fallacy — the belief that the right information changes behaviour. Wendy Wood's research at USC found that a large share of daily behaviour, around 43%, is habitual: automatic, cued by environment, not decided. And chronic stress changes the hardware itself, shifting the balance between the prefrontal regions that handle planning and impulse control and the amygdala's threat responses.

Which produces the cruel version of the loop: the person who most needs to change their behaviour is, at that moment, least equipped to.

The philosopher Byung-Chul Han names the trap one level up: nobody forces you to optimise — you do it to yourself, which is precisely what makes the exhaustion feel like your own fault.

Giving a very stressed person a recommendation is like handing someone with a broken leg a running programme. When they can't complete it, they don't blame the programme. And shame is not a health intervention. If this is familiar, health tracking anxiety is the version of it that happens inside the app itself.

The most useful finding in all of this is about control

If you take one thing from the evidence rather than the argument, take this one, because it's the most actionable and the least discussed.

What separated the Whitehall civil servants wasn't access to care, and it wasn't the obvious lifestyle variables. It was the degree of control people had over their own work — how much say they had in what they did, when they did it, and how. The people with the least of it fared worst, in a population where everyone had the same doctors.

That finding has been reproduced in adjacent forms often enough that the general shape is well established: high demands combined with low control is the corrosive combination. High demands with reasonable control is much better tolerated. It's the powerlessness rather than the workload that does the damage.

Which is unhelpful if you read it as "get a better job," and quite useful if you read it more carefully. Control is not binary, and the version that matters is local rather than grand. Whether you can decide the order you do things in. Whether you can say no to one thing a week. Whether you can take the break when you need it instead of when the calendar allows. Whether anyone asks you before changing your work. Whether you can see far enough ahead to plan anything.

Most people have more of these available than they use, partly because the wellness framing has trained everyone to treat the problem as internal — as a resilience deficit to be worked on — rather than as a question about the design of their day. And it is worth noticing that "increase your autonomy where you can" is advice almost nobody sells, because there's nothing to subscribe to.

It also reframes what recovery is for. If the thing wearing you down is the absence of control, then rest that you feel obliged to take, scheduled by someone else, monitored by an app, and scored afterwards, is a strange instrument to reach for. Rest that is genuinely yours does something the same number of hours under supervision does not.

What this argument is not

Two things need saying clearly, because the argument is easy to break in either direction.

It isn't an argument that behaviour doesn't matter. Sleep, movement, food and alcohol all affect how you feel and how long you live. Nothing here says otherwise. The claim is narrower: behaviour is not the only variable, it is heavily constrained by circumstances, and treating it as the whole story produces both bad outcomes and unearned shame.

And it definitely isn't a reason to disengage from care. If you have symptoms, a diagnosis, or a treatment plan, none of this is a reason to stop. Structural critique and seeing your doctor are not alternatives.

What to do with this if it describes you

Concrete, and none of it requires fixing the world first.

Change what you hold yourself accountable for. "Did I close the ring" and "am I better than I was two months ago" are different questions, and only one of them is about you.

Look at load before looking at discipline. If the stress doesn't switch off, or you're flat every evening, the useful question is what's producing that rather than why you aren't overriding it better.

Treat the environment as the lever, not yourself. Most durable change comes from altering what's easy and what's in reach rather than from resolving to want it more. That's the practical version of Wood's finding.

Notice the things nobody sells an app for. Social connection is one of the better-evidenced influences on health outcomes, and the US Surgeon General's 2023 advisory placed lacking it in the same risk territory as several better-known factors. Loneliness has measurable physiology, and no amount of tracking substitutes for a person you can call.

Be suspicious of guilt as a motivator. It runs on the same budget as the effort you needed. This shows up concretely in things like eating in response to stress, where the shame reliably makes the loop worse rather than shorter.

Take back the small pieces of control that are actually available. Per the Whitehall finding above, this is probably the highest-value item on the list and the one least likely to be suggested to you. Pick one thing this week where you decide the timing rather than accepting it.

Reduce the number of things you're measuring. If tracking has become another surface to fall short on, that's the opposite of what it's for. One or two things you genuinely act on beats eight you feel vaguely bad about — and you can turn the rest off without losing anything.

Separate the two questions. "Is something wrong with my body" and "am I living in a way that would make anyone feel like this" are both worth asking, and conflating them is how people end up either medicalising a difficult year or ignoring a real illness for one. They need different answers, and often both are true at once.

Why this gets confusing when you're the one living it

One more thing worth naming, because it makes the argument easier to use.

The reason healthism is hard to see from the inside is that individual behaviour is the only lever visibly under your control. You can't change the price of housing this evening. You can change what time you go to bed. So attention flows to the lever that moves, and the model that says the lever matters most feels intuitively right — because it's the one you keep pulling.

The trap isn't that the lever does nothing. It's that when it doesn't produce the promised result, the only remaining explanation on offer is that you didn't pull hard enough. There's nothing in the framework that lets you conclude anything else, which is why people so reliably arrive at self-blame rather than at a different question.

Having a name for the pattern helps more than it sounds like it should. It doesn't fix the conditions, but it does break the loop where every unsuccessful attempt becomes further evidence about your character. That's the modest but real thing on offer here: not that you stop trying, but that failure stops meaning what it currently means.

When to see a doctor — and what to say

This article is about framing, and framing is not a substitute for assessment.

Book an appointment if fatigue, low mood, or a change in how your body works has persisted for weeks; if you've gained or lost weight without trying; or if something simply isn't right and hasn't resolved. Persistent exhaustion has a long list of treatable causes — thyroid problems, anaemia, sleep apnoea, depression among them — and "I should just take better care of myself" is a common reason people wait far too long before checking.

Seek help promptly if you feel persistently hopeless, or if you are having thoughts of harming yourself. That is a reason to talk to someone now rather than a reason to try harder.

What to bring. Specifics: how long, how often, what makes it worse, what you've already tried and what happened. If you track anything, bring the pattern rather than a screenshot of one bad day.

If you're waved off with advice to sleep more and manage stress, it's reasonable to ask directly: "What would you want to rule out before we conclude it's lifestyle?" That single question tends to change the conversation, and it is a fair one to ask.

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How Welltory fits — and what it can't do

Jane's stated position, publicly and as CEO, is that Welltory does not give recommendations, set programmes, run streaks, or trade in discipline — on the reasoning that if a product makes a struggling person feel worse about themselves, the product is part of the problem.

What it does instead is narrower and worth stating without decoration.

It shows you what state your body is actually in. Not as a score to beat, but as context: why a task that was easy on Monday feels impossible on Thursday, why an ordinary comment lands harder than it should. That's not a mood mystery — it's a nervous system in a particular state, and seeing it is different from being told to fix it.

It tells you whether something you changed did anything. Which is a much smaller claim than telling you what to change, and considerably more useful, because it's the part memory is worst at.

It doesn't score your compliance. There's no streak to break and nothing to fail at, which is deliberate rather than a missing feature.

And the honest limits: an app cannot fix the food system, give you a better manager or an affordable home, or replace a community. It can't diagnose anything. If you're unwell, it is not a substitute for care. What it can do is make the air visible — and noticing that the air is the problem is a different act from trying to breathe better.

This article touches on some difficult subjects, including research on suicide and substance-related deaths. If any of it is close to home for you, that's worth talking to someone about — and I'm happy to help you find the right support if that would be useful.

Read more from Jane

Jane writes about health tech, evidence, and the gap between what the industry sells and what it delivers in Founder And The City. The original is longer and angrier, and carries a full reading list — Ehrenreich, Marmot, Case and Deaton, Byung-Chul Han, Crawford's original 1980 paper. Her post on the Oxford study of AI medical advice, which is one strand of the argument above, is on LinkedIn.

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