Self-Care Topics & Issues
Every country should aim for a consistent, evidence-based narrative which frames the subject of self-care in a way that all stakeholders accept, and which becomes embedded in society. Currently, however, the understanding and even the acceptance of self-care varies considerably. There are few fully-developed policies focusing on self-care, and many opportunities for future research.
Further, there are many aspects of self-care which deserve a broader and more explicit consideration and discussion. ISF has drafted discussion papers around self-care topics and issues that merit greater public debate. Any opinions expressed or perceived are not necessarily those of ISF, and alternative viewpoints are invited. For copies of individual discussion papers, please contact [email protected] .
Topics and issues introduced here are:
Disease is not our inevitable destiny
One reservation sometimes expressed about self-care is the sense that disease is an inevitable part of getting older, so why should we bother with the discipline and hassle of complying with medical advice, exercising, healthy eating and so on? This attitude actually represents a false understanding of the normal processes of ageing and disease, and of the difference that self-care can make in delaying or preventing disease. Ageing is inevitable, but disease is not our inevitable destiny.
Culture and Self-Care
Every country has its own cultural characteristics, its own ideas, customs, and social behaviours, both nationally and within particular groups or communities. This applies as much to self-care beliefs and practices as to any other aspect of life. Cultural differences between countries are in fact deeply and historically entrenched and affect self-care beliefs and practices to a major degree. Country programmes and policies that seek to influence self-care need to understand, reflect and work with the existing realities. This discussion paper describes the contrasting perspectives on health in the West (e.g. the UK or USA) and in the East (e.g. China).
Rights and Responsibilities in Self-Care
To lead healthier lives and to self-care, people need health-conducive environments.
Self-care does not mean that there is any abrogation of government and health system responsibility for creating health-conducive environments. At the same time, it is a fundamental fact that self-care can only be undertaken by individuals themselves. A person-centred approach recognizes the strengths of individuals as active agents, and not merely passive recipients of health services. Thus, while it is right to pay particular attention to unhealthy environments, this should not be to the point of treating people as incapable victims of their circumstances.
The Economic Case for Self-Care
Researchers have modelled lifetime healthcare costs of obese people, smokers and ‘healthy-living’ persons. They showed that because of differences in life expectancy, lifetime health expenditure was highest among healthy-living people and lowest for smokers, with the obese in an intermediate position. This could imply that countries should not encourage self-care, for economic reasons. However, it is not an absolute necessity for self-care and healthy lifestyles to have a positive economic benefit – society may simply consider that the social good of longer, healthier lives justifies the cost. And a broader economic analysis bringing other factors into consideration may lead to a different set of conclusions.
Barriers to Self-Care
There are many personal, systemic and environmental barriers to self-care, which make it much harder for people to change unhealthy behaviours and sustain good self-care practices. Addressing the barriers is an important way to facilitate self-care. This discussion paper considers the barriers to self-in terms of the broader ‘external’ environment, the health system context, the local community setting, social capital, and the home environment. Barrier factors specific or ‘internal’ to the individual – their physical and psychological profile, and their day-to-day practical challenges, are also relevant.