In this second blog during Self Care Week, Dr Selwyn Hodge, previously chair of the Self Care Forum and of the Royal Society for Public Health, gives a personal view on how creating an effective, population-wide commitment to wellness and self-care is the way forward for a sustainable healthy future.
The recent political discussions in the UK have again demonstrated that, over time, many factors influence the quality of healthcare; these include economic policy, population growth, staff recruitment levels, scientific research and, of course, public education, attitudes and behaviour.
During my long and varied career in education, public health and youth work, I have written many academic articles and opinion pieces - especially about self-care and health literacy. Having now retired from many of my previous roles, I thought it would be useful to reflect on some of the key issues that have influenced my deliberations.
My first reaction, sadly, is real disappointment with the repeated failure of many committed professionals to agree the essential nature and scope of population-wide self-care. Too many people still seem to view the promotion of self-care as just ensuring that patients with long term illnesses are able to follow, and adhere to, the instructions they have been given for coping with their conditions. In other words, self-care is viewed by many as being more concerned with treatment than prevention.
Not only is this a very limited viewpoint, but, since as human beings we all owe a large degree of responsibility to each other for our wellbeing, health professionals should be especially concerned about our collective failure to make self care a core part of everyone’s everyday life. Particularly since this is having such a huge impact on the supply and demand situation in healthcare provision.
Why are we failing to self-care?
The reasons for this failure are fairly obvious; addressing self-care effectively can be time consuming and linked closely with making changes in people’s behaviour that are difficult to sustain and monitor. In addition, self-care is often concerned with modifying cultural and social attitudes that would require busy health professionals to have access to far more societal involvement and support than they sometimes receive.
Despite the massive efforts of the many people working in this field, not only does self-care remain an unfamiliar concept for most people, but it probably scores much lower on the general population’s interest charts than their favourite television programme!
Why then are people generally so disinterested in self-care? Sadly, apart from an obvious degree of lethargy, it is mainly because people no longer feel the need to engage fully in self-care, since they have absorbed the often quoted cross-party political message that “the state will provide for all their major health needs”. Although wellness and keeping fit have a degree of popularity amongst some sections of the population, linking these into self-care is highly problematical since levels of health literacy in the UK are generally abysmal (if it’s any consolation they are in the USA as well!)
Self-care and the NHS
Now don’t get me wrong, like most people, I value greatly the fantastic national medical and healthcare provision that is available to people in this country. In reality though, as a nation, we have to question whether we are creating an unsustainable future for ourselves and our children by allowing uncontrolled access to health services at all times and for all eventualities; particularly since so much of the expenditure involved is directed at minor treatments rather than prevention.
Worryingly, it now seems as if the majority of the population thinks it is not only appropriate, but also their right, to seek medical or health advice at any time of the day or night for any bodily condition which seems slightly abnormal, or might have a negative effect on their usual day-to-day activities.
Is this really a situation we want to see grow to a point where health services become totally unmanageable and in which many people’s serious medical needs become undermined in the process?
What is self-care?
I certainly don’t believe though that it should be an existential function of our health services to police this burgeoning demand situation by refusing to see people that do not immediately need their help. Instead people should be taught from their earliest years onwards how to look after themselves effectively, to know what to do in the case of common illnesses and how and where to seek help from the appropriate professionals or healthcare outlets if their condition actually requires it.
I’m old enough to remember the time when most people did actually achieve this set of processes fairly well and managed their health status along these lines. But, of course, general levels of health literacy were much better then than they are now and health education was both family orientated and a reasonably well taught part of the compulsory school curriculum. We must now once again see schools and parents as the keys to better future wellbeing and the more appropriate use of healthcare resources.
So given where we are now, why did this situation change so much? Well, in my view, mainly as a result of political opportunism from all sides which popularised the ideal of an, any time, free-at-the-point of delivery, all singing and all dancing health service which also responded fully to medical advancements. While this model obviously gained enormous populist support, it is, in my view, no longer sustainable – and probably never was in terms of both human nature and the available resources.
I have no doubt whatsoever though about the levels of support that most people working in the health service want to give to improving both people’s health and self-care standards in this country, but they cannot do this without the full backing of both the government, and the responsible departments of state – education as well as health.
While the future will continue to bring advances in medical and health technology, these will only fully benefit individuals as they should if the minor ailments such as common colds and mild headaches experienced by us all from time to time, are dealt with, at least initially, by the sufferers themselves.
At present, my personal contribution to improving self-care is working with young people in schools to encourage and help them develop self-care strategies for themselves, and to be able to promote these with their peers. In addition, I help train some of them to act as youth health champions, along the lines of an approach developed in a number of former health authorities in this country 20 years ago, but, now, sadly largely in abeyance.
If it is to be successful, health promotion has got to be seen and enacted upon as a community-led and delivered entity that utilises all the resources that the state can offer.
Supporting Self Care Week
Alongside my own small contribution, I also want to highlight the excellent work which is done each year by all those people across the country who actively support Self Care Week. Having, over the past five years, judged the many entries for the Self Care Forum’s competition for the best Self Care Week programme, I can testify to the enormous amount of innovative and dedicated work which is taking place in different parts of the country (indeed over 600 organisations took part last year).
It saddens me though that this treasure chest of innovative and workable ideas and processes has not been actively followed up and developed more by national health bodies. Again this probably has a lot do with the fact that many of the best programmes are aimed at prevention rather than treatment, and do not, therefore, always meet the requirements for the appropriate funding.
We are rightly proud of our national health services, but we do need to nurture them and ensure that they are used effectively and properly by every citizen of this country; something that will only happen if everyone shares my vision for the tools needed to bring this about:
- effective health literacy
- good wellness regimens
- the personal capability to self-care whenever appropriate.
My hope, now, is that the theme for this year’s Self Care Week, which is aptly entitled ‘Think self-care for life’, will actually generate sufficient support from all national and regional health directors to begin to make this vision a reality. If it doesn’t, I can only conclude that we can all expect to look forward to increasingly unhealthy futures.
Dr Selwyn Hodge was previously chair of the Self Care Forum and the Royal Society for Public Health.
Self Care Week is on 18-24 November 2019. Visit the Self Care Forum for information on how you can support the week.