The coronavirus (Covid-19) pandemic has illustrated the importance of self-care – in good hygiene practices such as handwashing, covering coughs and sneezes, and the use of facemasks. Self-care is also central to mutual risk reduction through physical distancing, in community spirit and collaboration, and in cultivating mental and physical wellbeing during lockdowns. Many positive self-care behaviours have been highlighted.

At the same time, elderly people and those with pre-existing chronic conditions including cardiovascular disease, cancer, hypertension, respiratory conditions and diabetes – and obesity – appear to be at a higher risk of complications and death from covid-19. A major factor in chronic diseases is often insufficient (or inaccessible) self-care. The disease-preventing nature of leading a healthy lifestyle through self-care is illustrated yet again by the coronavirus pandemic.

Some have argued that an emphasis on personal responsibility ignores or denies the fact that health is affected, for better or worse, by a wide range of social factors, which may be more influential than individual behaviours. The social determinants of health are highly consequential, but it is clear that the management of health risk from infectious diseases such as Covid-19 necessarily involves actions by individuals as well as by health services and governments.

Taking all this together, the recognition that self-care must be undertaken in a social context has clear implications for the ethos and priorities of future health policy. When the lessons from the pandemic are considered, the place of self-care should be prominent. Population knowledge and health literacy, not least around the concepts of risk, will need to be reinforced. The formulation, delivery and support of coherent programmes and policies designed to encourage self-care will need much greater attention. Health behavioural research and the formulation of effective public health messages will continue to increase in importance. A rich discussion is needed about people’s sense of rights (e.g. to be tested) and responsibilities (e.g. to look after themselves, to avoid infecting others, to be vaccinated).

In addition, the International Self-Care Foundation (ISF) believes that in future there are two significant opportunities to tackle potential future pandemics (and chronic diseases more generally):

1. Help unite the many “stakeholders” in self-care. The doctor who promotes ‘lifestyle medicine’, the life assurance company developing policies that encourage healthy lifestyles, and the urban planner who includes green spaces are all, in different ways, encouraging self-care. As are fitness instructors, health food shops, pharmacies, and local community centres. In fact, very many different stakeholders each make a valuable contribution to self-care, but they all tend to operate in separate silos, promoting their individual agendas. But there is in reality just one self-care.

The unified self-care is illustrated in ISF’s “Seven Pillars of Self-Care” framework, and promoted through International Self-Care Day on July 24 each year. ISF is developing a Global Self-Care Network to help bring together the “community of practice” interested in self-care.

2. Genuinely focus on the self-carer, on the individual themself. Stakeholders naturally claim to be representing the person, patient or consumer, but in reality tend to see things through their own perspectives. What would a true focus on the self-carer actually look like? From a self-carer’s (holistic) perspective, all the following elements taken together are key, on a daily basis and throughout life, in sickness and in health:

My self-care activities. (The Seven Pillars of Self-care, holistically, throughout the day, and over the life course from age 5 to 105)
My attitudes, behaviours and habits, and the processes of self-care. (My capability, opportunity and motivation. Mindfulness, body listening, self-awareness, empowerment, spirituality, agency and resilience.)
My social context and social capital. (The home and community, the health system and the broader green and built environment – the facilitators and the barriers)

In summary, the lessons of the pandemic must include new directions for health policy, emphasising and investing in prevention and strengthening the health resilience of the population by enabling better self-care for all.

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