With vast amounts of resources and tools available to empower individuals to optimise their health, we discuss the value of self-care strategies, and barriers to their adoption, with the Director General of the Global Self-Care Federation, Judy Stenmark.
The definition of self-care is shifting. While in the past the term has been somewhat diluted in its association with indulgent activities, its connotations are evolving as individuals and health organisations increasingly recognise the value of personal care as a contributor to physical, mental, and emotional wellbeing.
From the simple task of brushing teeth to healthy eating and exercise, self-care can define daily practices that help to maintain an individual’s overall health and, in turn, reduce the risk of chronic disease. In contrast to the firefighter model that many healthcare systems are operating within, it supports a holistic approach to health and empowers individuals to take a more active role in their well-being. Likewise, approaches to self-care have evolved in tandem with the increasing uptake of digital technologies and access to medical literature, enabling individuals to monitor and better understand their health.
To discuss the intersection between healthcare provision and personal care interventions Health Europa Quarterly spoke to Judy Stenmark who is the Director General of the Global Self-Care Federation (GSCF), an organisation representing responsible self-care and self-medication.
How would you define self-care and what is its current significance and role within the wider healthcare landscape?
The Global Self-Care Federation (GSCF) adheres to the WHO definition of self-care, which encompasses a broad range of activities, practices, and products that individuals can adopt to improve their health and wellbeing:
‘It is the ability of individuals, families, and communities to promote health, prevent disease, maintain health and cope with illness and disability with or without the support of a health worker. The scope of self-care in this definition includes health promotion, disease prevention and control, self-medication, giving care to dependent people, seeking hospital, specialist, or primary care when needed, and rehabilitation, including palliative care.
‘Self-care interventions are tools that support care of oneself. These include evidence-based, high-quality drugs, devices, diagnostics, and/or digital interventions that can be provided fully or partially outside formal health services and be used with or without a health worker.’1
While GSCF adheres to this multi-dimensional concept of self-care, its recent report, ‘The Global Social & Economic Value of Self-Care’, focuses primarily on over-the-counter consumer products as tangible and measurable indicators to measure economic and social benefits.
What are the key barriers to the adoption of personal care practices and how these can be overcome?
There are several barriers to the adoption of personal care practices, starting with the very understanding and definition of self-care. Given its multi-faceted nature, it is not universally well understood and means different things across different countries including some of the ‘softer’ elements of self-care that include spa treatments and relaxing massages. While governments recognise the value related to personal care strategies in terms of prevention and treatment, there are few countries where an explicit connection is made.
Another barrier is in terms of education – be it in terms of health literacy, more specifically ‘self-care literacy’ of individuals. A multitude of information is available to individuals, but it is not always easy to navigate through diverse sources and to understand which information is both credible and evidence-based to enable individuals to take increased ownership in managing their health. The other challenge is also in terms of the health professionals involved across the whole spectrum of care. Healthcare workers may be interested in advancing personal care but are not always equipped with the training necessary to best support their patients.
Finally, legislation is common at a global level but often disjointed. Numerous government strategies, plans, and programmes touch on self-care, but few call it by name or paint a coherent healthcare policy vision.
More really needs to be done to further awareness and recognition of self-care and its contribution to the health system. This includes awareness raising, education, and encouraging governments to foster more coherent and integrative policies.
What are the key benefits of incorporating this strategy into the Universal Health Coverage (UHC) agenda?
Integrating self-care into UHC is essential because it can improve health outcomes and reduce the current burden placed on healthcare systems. According to the WHO, personal care will ease the burden on overstretched health systems, reduce costs and increase the effectiveness of care, all of which contribute to achieving UHC.
The cost savings associated with self-care are beneficial to the whole of society – to the patient, the healthcare system, and the broader economy. GSCF’s recent report quantifies these significant benefits as follows:
- Savings of nearly $120 billion each year for global healthcare systems and, therefore, national economies;
- Savings of 40.8 billion productive days for both health practitioners and individuals, which translates to an average of 11.83 workdays per person per year. It corresponds to a value of $1,879bn in welfare effects; and,
- Gain of 22 million quality-adjusted life years (QALYs), the standard measurement for the value of health outcomes.
The value of self-care goes beyond its impact on resource constraints. Personal care interventions give users greater choice, access, control, satisfaction, and affordable options to manage their healthcare needs. This practice can recognise the strengths of individuals as active agents in their healthcare, and not merely passive recipients of health services.
In line with this individual empowerment, healthcare professionals (including pharmacists) continue to have a pivotal role to play in the self-care continuum by guiding individuals to appropriate products and interventions, which, in turn, reduces the number of non-critical doctor consultations and directs patients to medical practitioners when a more severe condition is suspected.
Given the uptake in healthcare technologies during the COVID-19 pandemic, would you say this has had a positive impact in terms of enabling individuals to optimise and manage their health? What scope for improvement is there here?
The estimated shortage of 12.9 million healthcare workers by 2035, and an estimated one in five of the world’s population now living in humanitarian crises, point to the urgent need to find innovative strategies that go beyond a conventional health sector response.2
The rapid evolution of technology is transforming healthcare. New diagnostics, devices, drugs, and digital health are all transforming how patients and health systems interact. Healthcare will increasingly be delivered beyond hospital walls, reaching more people regardless of location/region, with the use of telehealth.
The World Health Assembly Resolution on Digital Health unanimously approved by the WHO Member States in May 2018 demonstrated a collective recognition of the value of digital technologies to contribute to advancing UHC and other health aims of the SDGs.3
Self-care practices, including digital practices, have been a crucial line of defence throughout the COVID-19 pandemic, helping to relieve burdens on healthcare providers and health systems themselves. Individuals across the globe turned to self-care options to not only manage COVID-19 symptoms but also to deal with other health conditions, as well as help their general well-being and mental health.
From favourable regulatory flexibilities that we have seen implemented during the pandemic, to the growing role of e-commerce and maintaining robust supply chains, different innovations have helped the self-care industry move forward. These innovative policies and regulations affecting non-prescription medicines should be assessed for potential adoption into normal practice. In addition, as regulatory bodies reflect on their actions during the pandemic, whether successful or not, they might consider the implementation of new best practices to modernise their approach to non-prescription medicines. This should include increased use of digital technologies and enhanced international cooperation to streamline and harmonise inspection practices.
What key actions would you like to see taken at a policy level to promote self-care health interventions?
Coherent healthcare policy and regulation supporting self-care is required. Accountability and collective action are required from all stakeholders to ensure that it is a key driver in accelerating the delivery of Universal Health Coverage.
Health literacy should be recognised as a fundamental catalyst for change, ensuring individuals understand and act upon credible health information to become active self-managers of their health. Furthermore, self-care should be understood as a multi-faceted and multidimensional concept that includes a variety of health-related practices. There needs to be greater recognition of these elements and the benefits from all key stakeholders.
Finally, are there any examples of best practices in terms of interventions in the health sector that could be adapted for use in other countries or healthcare settings?
The NHS in the UK has 111 operators that connect roughly 1.5 million callers per month with local services. Monthly reports show that about 20% are given self-care advice, potentially saving millions of medical visits per year.4
In the second iteration of the Self-Care Readiness Index which launched in September, we found that in Kenya, self-care is included as a core concept in the medical guidelines for the management of heart failure. Another example is India, where the Indian Council for Medical Research (ICMR), the apex body in India for the formulation, coordination, and promotion of biomedical research, released guidelines for the management of type 2 diabetes in 2018. These guidelines include a section about diabetes education in which self-care skills, appropriate resources for self-care, and self-monitoring skills are cited as key concepts for the empowerment of diabetic patients.
One-stop-shop for health information is another example of how the health sector can put forward science-based, trusted health information. Examples include Health Direct, the government-supported platform on which Australians can find trusted health information on a broad range of health topics, a symptom checker, and an OTC and prescription drugs directory4; and the gesund.bund.de platform in Germany, an internet portal for quality-assured, neutral, and understandable health information launched by the Federal Ministry of Health in 2020.4,5
- www.who.int/reproductivehealth/self-care-interventions/questions-answers-self-care.pdf?ua=1 (June 2019)
3. WHO Guideline: recommendations on digital interventions for health system strengthening (April 2019)