Trevor Hancock: Self-care most neglected part of health system

The largest single component of our health-care system is self-care. Most of the time, people care for themselves and their families; a U.K. study found that “people with diabetes have on average about three hours contact with a care professional and do self-care for the remaining 8,757 hours in a year.”

Yet self-care is also the most neglected part of the system, even though it has tremendous potential benefits both for the public and the health-care system.

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The study found that self-care can markedly reduce use of health-care services while improving the quality of care, patient satisfaction, independence and — the real bottom line — health and quality of life.

So why is self-care neglected? In part, I think, health professionals find it a bit threatening. After all, we are trained to look after people and we are the experts. People without our knowledge and skills might get it wrong.

More important, I think the politicians, senior policymakers and administrators who run our health-care system are afraid to promote self-care because it might be seen as simply a cost-cutting initiative, removing services and leaving people on their own to deal with health problems.

That is a possibility, but we need to have a serious discussion about self-care as an integral part of the system. We have Internet-savvy people moving into their senior years; the generations coming up behind them are even better connected and informed. They are not as likely to just do what the doctor tells them, but will question, push back and be more demanding.

So what would a self-care system, as part of our health-care system, look like? There are two main issues: Keeping healthy and managing illness.

Self-care to keep healthy starts in our families, and includes everything from having a smoke alarm to the usual “healthy living” issues, from having good relationships to making sure you are up to date on your immunizations or cancer screening.

Self-care extends beyond the family. When you work with colleagues to make the workplace safer and healthier, with your PTA to make the school healthier, with your neighbours and your local government to create a healthier community — that is also self-care.

Then there are four forms of illness self-care. First comes caring for minor ailments and injuries, the coughs and colds and cuts and bruises we all get. Most often, there is no need to go to the doctor or the ER, although we do need to know when to seek professional care. There are programs such as NurseLine that can help us cope, but why are we not taught this in school?

Not all ailments are minor — some are life-threatening emergencies such as heart attacks and injuries. We need to know how to care for our families, friends, even strangers, until the first responders arrive. But again, why is this not taught in school?

A growing issue is chronic-disease self-management. B.C. has had a program for many years that includes diabetes, chronic pain and arthritis. It is offered in many communities, including First Nations, in Chinese and Punjabi and online. A 2006 evaluation found a wide range of benefits to patients.

Finally, preparing for end of life is another form of self-care. How do we want to die? How do we ensure we avoid an unhealthy death? We can prepare advanced directives, living wills and similar documents, but we need to be supported in doing this.

However, the knowledge needed for all these forms of self-care is not innate. It should be incorporated into our education system as a set of life skills that all students acquire. In addition, the health-care system must develop a self-care support system, so people can be confident they will be supported, not abandoned, and that when they need to stop self-care and use professional care, it will be there.

The potential benefits are enormous, and not just for the health-care system. It is time for a significant new policy initiative to develop a comprehensive self-care support system here in B.C. and across Canada.

 

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

thancock@uvic.ca

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