The premise that individuals have a personal responsibility to protect and promote health has been debated throughout public health history. This notion gained a special place in country agendas and political discourse in 1978, when it was included in the Declaration of Alma-Ata, which also posed health as a fundamental human right and primary health care as essential to achieve it.[1]

Undoubtedly personal responsibility was one of the original underpinnings of primary health care, although the term was never defined. Nearly four decades later, the idea that individuals have a responsibility for their own and their community’s health has not been fully articulated theoretically or explored empirically. It is always accompanied by polemics emerging from a) inexact translations of the term (in our case, between English and Spanish); b) lack of consensus on the concept itself; and c) multiple health strategies adopted in the late 20th century by various countries, using personal responsibility for their neoliberal rationale and theoretical foundation.

In 2011 the Cuban health system began a process of sectoral reform to maintain and improve the health of Cuba’s population, in response to new challenges and demands in the health sector and population health status. The main actions involved are reorganization, consolidation and regionalization of services and resources. Although community engagement and personal responsibility are not explicitly mentioned in the strategy document, it is advisable to use this opportunity to revitalize both topics and encourage appropriate and full incorporation into the Cuban health system. Both are consistent with the objectives and actions of system reforms proposed, in that they allow the various social actors to assume shared responsibility in working toward social goals—in this case, health gains.

This approach also recognizes that reaching such goals is a collective endeavor, to be pursued according to ethical principles (beneficence as responsibility and justice as solidarity), with community involvement and personal responsibility emerging as two important factors subject to reorientation in the context of the health system reform under way.

KEYWORDS Community action, community participation, self care, self-management, social responsibility, health care reform, Cuba