Is ‘self-care’ the future of medicine?

One of the barriers to establishing a clear role is a lack of a standardised definition of what constitutes self-care and how it can be integrated into the Australian healthcare system.
 
A 2018 Australian Health Policy Collaboration (AHPC) report on self-care broadly defines it as the understanding of what helps to achieve or maintain good health, coupled with the ability to address minor illnesses promptly and seek help from healthcare services when necessary. Yet, the same report also states it is often ill-defined, poorly understood, and not backed by systematic and programmatic support.
 
A recent roundtable meeting hosted by the Australian Self Care Alliance sought to alleviate some of these issues and provide a clearer understanding of self-care, as well as how it can be described in a manner that will make sense to policy-makers.
 
Leader of the AHPC at Victoria University’s Mitchell Institute, Professor Rosemary Calder, believes self-care has a major role to play in improving the health of Australians, particularly in respect to chronic disease and alleviating socioeconomic disadvantage.
 
However, she told newsGP the concept of self-care is complex and can be difficult to explain.
 
‘We wanted to … bring together people from diverse perspectives – health professionals, health service provider organisations, health advocacy groups and consumers, and have a fairly intense discussion about what self-care is,’ she said.
 
‘How do we think about the roles for both health professionals and health consumers in supporting self-care? What’s the role of funding … [or even] the role of government at all?’
 
Professor Calder said the meetings attendees – which included representatives from Medicines Australia, the Pharmacy Guild and the RACGP – identified fragmented healthcare and socioeconomic disadvantage as two of the main obstacles in people’s ability to engage in self-care.
 
‘You have several levels of government involved in funding healthcare and then making health policy,’ she said. ‘That’s a big issue and it’s a constant problem for getting anything like system-thinking into a healthcare arrangement in Australia.
 
‘Contemporary funding arrangements don’t help. [For example], the way in which we don’t fund coordinated care, we don’t fund integrated care, we don’t fund GPs to help people to self-care.
 
‘This meeting was about identifying the issues and getting agreement about the key enablers or barriers to developing self-care.
 
‘Now we have to start working on the policy options that might address these.’
 

Associate Professor Mark Morgan says GPs are ideally placed to promote self-care. 

Associate Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), represented the RACGP at the meeting. He believes GPs will likely be central to any kind of effort to improve self-care in Australia.
 
He told newsGP primary care already promotes self-care, but that it needs to be recognised more in order to help avoid low-evidence-based drivers such as ‘Dr Google’ from overwhelming high-quality messages for patients.
 
‘It’s all about providing really good quality information and reducing the barriers to evidence-based self-care practice,’ Associate Professor Morgan said.
 
‘At the moment, self-care happens because it needs to happen, but we know that if we could formalise self-care and provide additional help, then you start to get a win–win situation where people’s overall health improves without necessarily over medicalising, or increasing the use of health resources.
 
‘GPs see most of the population and we understand both the science and evidence, and we understand the primary and secondary prevention of illness. That understanding means we’re in an ideal place to support and help with self-care.’
 
Dr Mark Harris, Professor of General Practice at the University of New South Wales, also believes GPs are critical to preventing and managing chronic illness in Australia, but has some reservations about self-care taking on too great a role.
 
‘One of the problems I have with the term self-care, although it’s a legitimate term, is that it often gets seen as this thing whereby if you care for yourself properly, you won’t have to go and see the doctor – and I think that’s pretty misguided,’ he told newsGP.
 
‘GPs recognise that self-management support takes a lot of time, and that’s where involving other health professionals comes in, whether that’s the practice nurse, or referral to an allied health provider, etcetera.
 
‘We know that managing, particularly chronic conditions, is complicated … so people need all the support they can get. They need sophisticated programs and multiple disciplines to be involved in the care and that’s what care plans are meant to be about.
 
‘It’s always good to promote the idea of self-management and it’s something we need to do better, but it’s not something we need to do instead of good general practice care, seeing a doctor regularly and having a planned approach to [managing the] chronic condition.’
 
However, Professor Calder said an increased role for self-care within the health system will not translate to less of a need for GPs.
 
‘We’ve got an ageing population, and we’ve got increasing health risks in the community. It’s changing the capacity of primary care to do more about health improvement, prevention, and self-care,’ she said.
 
‘If we funded primary care to be multidisciplinary to think about ways in which the primary care practice could be screening for health literacy and helping people to understand when they’re lacking in health literacy … we could shift the demand from managing health problems to enabling health learning, health improvement.’
 
But Professor Calder cautions that while health literacy is an essential tool towards self-care, it is only part of the answer.
 
‘Self-care really is much more about trying to articulate the way in which the person is supported to be as engaged and capable of having optimal health as possible,’ she said.
 
‘We didn’t start road safety by assuming drivers who didn’t want to drive safely should be blamed. We assumed we had to teach them how to be safe. We assumed we had to resource them, we assumed we had to improve roads and car design, as well as educate drivers.
 
‘We know society is obesogenic. We know that the world in which we live and work now puts on weight. That tracks with socioeconomic disadvantage.
 
‘So let’s think about why that happens, not blame the person.’

chronic disease health literacy primary care self-care