There are many elements in lifestyle disease prevention but at its core is the need for individuals to change their self-care and lifestyle habits. But there are significant system-based challenges with implementing self-care change:

1. Today’s healthcare systems are effectively ‘sickness services’ oriented more towards treating the sick than preventing disease. Worse still, health systems can encourage reliance and complacency towards one’s own health.
2. Self-care is the foundation of healthcare, but it occurs largely outside formal health and social systems, making it harder for governments to engage in and support.
3. Self-care can be supported at many different levels – in the family, in the community, in companies or cities, but currently there is little connection or integration.
4. The individual elements of self-care are simple in concept and some are even commonsensical, but they should be approached in an integrated and holistic manner. By contrast, Western approaches tend to target one problem at a time.
5. There is much interest and support in the individual elements of self-care, but no natural champions covering the entire self-care space.

In addition to these system-based externalities, of at least equal significance is the fact that it is difficult for individuals to adopt and sustain good self-care practices. Reasons advanced for not undertaking lifestyle changes include:

• It (lifestyle disease) won’t happen to me /‘they’ exaggerate the risk
• I’ll start tomorrow, I have bigger problems today; anyway we’ve all got to die from something
• Lifestyle modification is hard to keep up; I don’t have time/money/energy for it
• If I get sick I go to the doctor – that’s what I pay my taxes for

Taking all of this together, it is apparent that while the threats of lifestyle diseases are massive, the challenges of adopting self-care are also massive.