Last week, I suggested self-care should be a strategic priority for Canada’s health system.
Done well, it can reduce unnecessary demand for professional care while at the same time improving outcomes, empowering patients and enhancing personal and community capacity for caring.
While self-care is often seen as being about the self-management of minor ailments and injuries (coughs and colds, upset stomach, cuts, bumps and bruises, sprains, etc.) and chronic diseases, it is — or should be — much more than that.
It’s about all the things we do for ourselves and with our families, neighbours and communities that make us healthier, protect us from harm and even prepare us for our end-of-life passage.
Importantly, self-care is not simply about education, although obviously education is important.
A 2010 article on self-care in the British Medical Journal noted the literature on changing health behaviour “shows that mere provision of information has little effect. Changing behaviour often requires multiple interventions that work at several levels: the individual, the immediate family or social circle, and society in general.”
A comprehensive strategy must begin in school, where children need not only to learn about how their bodies work, but how to look after their health and deal competently with minor health problems.
While the usual lifestyle issues of diet, physical activity, use of tobacco, alcohol and other drugs should be addressed, so, too, should mental wellbeing. Given the crucial importance of social connections, children should be supported in the development of social skills that will help improve their ability to create and maintain social networks.
In the latter years at school, they should also learn first aid and CPR, a set of skills that should be maintained over the years through refresher training. After all, while not in the literal sense self-care, the ability to provide emergency first aid before the professionals arrive is a form of collective self-care.
But since most of us are well past childhood, we also need a system of education, training and support that enables adults to acquire the skills they need to keep themselves and their families healthy, to manage minor ailments and injuries, and live well with chronic diseases and disabilities.
They also need to learn when it is appropriate, and indeed, necessary, to access the illness-care system, and to work with their primary-care team to ensure they receive the preventive services laid out in B.C.’s Lifetime Prevention Schedule.
With HealthLink B.C., British Columbia has in place an important component of this support system. Available by phone or online 24/7, and in many languages, the service can provide you with health information, help you navigate the health-care system and find health services across the province, or connect you with a registered nurse, registered dietitian, qualified exercise professional or pharmacist.
When it comes to chronic diseases, B.C. supports an independent program, Self-Management B.C., provided through the University of Victoria.
The program serves people with chronic pain, diabetes, cancer and other chronic conditions, and has programs tailored to the Chinese, Indigenous and Punjabi communities.
These programs are delivered by trained volunteers, and range from one-on-one coaching by phone to both in-person and web-based group learning and support. Importantly, Self-Management B.C. also trains health-care professionals to use self-management support strategies when interacting with patients.
But self-care can and should reach even further. Social prescribing is an approach that refers people needing social support to community groups and activities.
Learning the skills needed to work with people in mutual support can enable us to work with others in our own communities to make them healthier. The B.C. Healthy Community initiative is just one of the many organiszations that support such work in B.C.
Finally, at the end of life, being supported in making preparations for one’s own death, including being supported in having conversations with family, friends and care providers about one’s wishes, is perhaps the ultimate form of self-care.
While not cost-free, when done well, self-care should cost less overall than business as usual, making it cost-saving for the illness-care system while improving the health and wellbeing of the population.
To be truly effective, then, the health system must invest in self-care support.
Dr. Trevor Hancock is a retired professor and senior scholar at the University of Victoria’s School of Public Health and Social Policy
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