Recently, PRAXES Medical Director, Dr. John Ross, wrote an insightful piece for Doctors Nova Scotia on the role self care plays in long-term health care. As an emergency physician, professor at Dalhousie University and telemedicine provider, he continues to advocate for personal behaviour and public policy change. Please find the full story below.
Self care is the future of health care
Most people, including those of us who are health care providers, think of health care as made up of doctors, nurses, hospitals, CT scans and pills – all the people and things that try to make us well when we get sick. But there is a difference between what we now call health care and what health care could be. Most of us don’t seek out the things and people that try to make us well until after a health problem such as a disease or injury occurs and we want our health back. This is actually “disease care” – reacting to a problem – not health care.
Health care should imply caring for one’s health – staying healthy. After all, repairing broken things rarely results in something as good as the original. Car owners do not wait for the engine to seize up and catch fire to tell them it is time for an oil change – they change the oil proactively based on how far they drive.
So, where does self care fit in?
We believe our public health-care system will be there for us no matter what health difficulties we may face. But here in Nova Scotia, we still find ourselves struggling with getting timely access to primary care providers and we experience long waits for diagnostic imaging, specialists and elective surgery. There are more inconsistencies: we enjoy living in Nova Scotia, yet our province has one of the highest rates of people using anti-anxiety and anti-depressant medications. When Nova Scotians are asked to report on their own health they say it is “good” or “very good,” but general population health studies always report our low ranking in heart, lung and joint diseases.
It seems to me that Nova Scotians have a problem. We seem unaware of the need for self-care.
Let’s look at the data:
The 2013 Canadian Tobacco, Alcohol and Drugs Survey reported:
• 19.4 per cent of Nova Scotians smoke tobacco
• Less than 50 per cent of Nova Scotians get regular physical activity
• 37.5 per cent of people in the province are overweight (compared to 33.6 per cent in Canada) and 25.1 per cent are obese (that is, with a body mass index greater than 29) – almost seven per cent higher than the Canadian population as a whole
We can directly influence all of these behaviours and habits that affect our health. We can prevent, or at least modify, the negative effects. But there are other big society-wide challenges that can interfere with caring for one’s own health, and these challenges cannot be ignored.
The social determinants of health (SDOH) dwarf the too-little-too-late effects of showing up at a hospital when sick. Income and income distribution, education, unemployment and job security, working conditions, early childhood development, food security, housing, social isolation, health services (we spend over 40 per cent of our taxes on health services), aboriginal status, gender, race and disability all influence our personal health outcomes.
For people living in poverty, self-care for a healthy future may be impossible to achieve. For example, for a person who works from 6 a.m. until midnight every day and has to raise a family on a poorly paying job, finding time for self-care is nearly impossible. This is an all too common situation in Nova Scotia.
In the 2015 Report Card on Child and Family Poverty in Nova Scotia, the provincial rate for children living below the poverty line was 22 per cent. The rates increased for Cape Breton: 32 per cent of all children in Cape Breton are living in poverty, with 42.7 per cent of children aged newborn to six years old living below the poverty line. Simply put, one in five children in Nova Scotia and one in three children in Cape Breton lives in poverty.
Children who spend their early years in poverty are at a disadvantage from the start, and their personal health may never recover. Our increasingly expensive “disease-treatment system” is forced to deal with our failure to understand the long term impacts of the SDOH. Nova Scotia could be the first province to redefine ‘health care’ far more broadly than doctors, hospitals, and pills by accepting that a truly healthy, economically-productive population is only possible by directing some health-care dollars to education, housing, affordable good food, employment and other social determinants.
Why not start with dramatically reducing child poverty rates in Nova Scotia and focus on giving all kids a good start in life? This would give them the chance to build healthy habits from an early age. What if more people were encouraged and enabled to be more active – at school, at work, at home? We know that physical activity results in less obesity, lower rates of diabetes, fewer heart and blood vessel diseases, and is also a natural anti-depressant.
What if we redirected more of our tax dollars to programs and services that support communities as a whole? One such program is Nova Scotia’s Community Health Centres, where communities identify their own needs, gather their own resources, work together to practise disease prevention and health care, and innovate locally.
To move our province from “disease care” toward true health-care and self-care, we need to see significant reform. It’s time to make progressive changes to public policy that support individuals in taking responsibility for their own health, encourage us to demand more of each other and demand more of system managers.
Self-care is the future of health care, but it takes more than just going to the gym three times a week and avoiding fast food. Fixing the social determinants of health is complicated, but it can be done. Everyone deserves a fair chance at good health. Everyone deserves a fair opportunity to care for their own health.