The most important task in creating a health system is to keep people healthy, so they do not need to use the illness-care part of the system.
My three most recent columns looked at ways in which we could keep the population healthy through societal change.
The next most important way to reduce the burden on the illness care system is self-care. If people know how to recognize and manage their own and their families’ minor ailments and injuries and chronic diseases, they will not need to use the health-care system.
A couple of recent articles in this newspaper by local physicians have lamented the lack of healthy living and self-care skills, and lack of “common sense’ among the general public.
This leads to people not making healthy choices in the first place, and not knowing how to care for minor problems when they occur, both of which result in an unnecessary burden on the illness-care system.
But the real problem is that self-care has never been afforded the respect and attention it requires.
Yet in reality, most care is self-care, a simple fact that the professionally oriented illness-care system has never fully recognized. A 2010 U.K. survey found half of those with a minor ailment self-treat, while almost one quarter do nothing.
Self-care is also hugely important in chronic illnesses. For example, 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.”
Moreover, self-care is effective. A recent article in BMC Public Health noted: “In chronic illness, higher levels of self-care have been associated with better health outcomes, including decreased hospitalization, costs, and mortality.”
But it’s no good lamenting people’s unwise use of the illness-care system if we have not trained them in self-care in the first place.
In fact, not only have we not given them the knowledge and skills they need to look after their own minor ailments and injuries, we have only too often implied that they shouldn’t risk being wrong, but should consult a health professional.
So it should be a strategic priority for the health system to help people develop the knowledge and skills needed to stay healthy, to care adequately and appropriately for minor ailments and injuries and chronic illnesses, and to know when it is time to seek professional care.
And when they do, they need to be secure in the knowledge that appropriate professional care will be there when they need it.
It is important to stress that self-care is not about abandoning people to their own devices. As Swedish doctoral student Silje Gustafsson noted in her 2016 dissertation: “Just as health is more than the absence of disease, self-care is more than the absence of medical care.”
Self-care does not just happen — we are not born with a set of self-care skills. We need both to train people in self-care from an early age and put in place a support system — including mutual-support groups — that enables them to practise self-care with confidence.
People also need support from health professionals, who themselves need to be trained and supported so they can, in turn, support self-care.
Yet while self-care is arguably the largest and most important part of the entire illness-care system, we do not have a robust self-care strategy.
In fact, no province that I am aware of has prioritized self-care or created a proper self-care strategy.
The only group I am aware of that has argued for a national self-care strategy is an industry association, Food, Health, and Consumer Products of Canada.
However, unsurprisingly, their motivation is self-interest and focuses on improving access to, and reducing the cost of and taxes on their products.
But if we really want to reduce the burden on the illness-care system, we need to prioritize self-care, so people do not inappropriately access the system.
At a time when the federal government and the provinces are squabbling over money for hospitals and primary care, we should demand that they also put money into a comprehensive national self-care strategy.
Next week, I will discuss what that might look like.
Dr. Trevor Hancock is a retired professor and senior scholar at the University of Victoria’s School of Public Health and Social Policy
