Health Inequality: Could enabling self-care support in tackling this challenge?

As we begin a new year, like so many others, I have taken the time to reflect on the past year. I have started a new job, I’m leading a team of dynamic leaders as our company works to become independent. But, thanks to COVID-19 I still haven’t managed to move across the Atlantic and take up residence in London.

COVID-19 has impacted the way we work. It's changed my view of socialization and, most importantly, has exposed societal and health challenges that were, in the past, overlooked. For me the most glaring challenge is the deeply entrenched health inequity which limits the access marginalized communities have to effective health services and product and entrenches discrimination in healthcare. This much is clear when we look at that data: more people from these communities are disproportionately becoming ill or dying from COVID-19 infections.

One of many potential routes we can take to address these disparities is by increasing the understanding and implementation methods of self-care (which the WHO defines as the enabling of “individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with our without support of a healthcare provider” WHO, Accessed: 9 Dec 2021). We have already seen the impact that self-care interventions, such as social distancing and masks, have had on controlling the spread of the coronavirus in communities. Thus, expanding self-care initiatives to support in enabling access to medicines and services, as well as reducing stigma and discrimination in healthcare, could be a viable solution (WHO,?Accessed: 9 Dec 2021).

But how do we make self-care real in markets like the US, where the dangerous effects of health inequity are clear, with African-Americans being twice as likely to die from COVID (NPR, Accessed: 9 Dec 2021)? I've thought about this...a lot and have three ideas:

Consumer Belief

“Self-care” is a being a phrase that is used widely by healthcare professionals and lifestyle gurus so can mean a myriad of things to many different people. However, my Sunday basketball game and a conversation with a pharmacist before the purchase of an over-the-counter medication have very different implications on impacting healthcare systems and reducing health inequity.

Surveys conducted by the Global Self-Care Federation (GCSF) suggest that both US healthcare providers and consumers are aware and supportive of self-care products and practices. Therefore, it is about amplifying the perception of self-care being both an effective means to manage healthcare as well to tackle health inequity, especially as already 75% of US primary care doctors recommend over-the-counter medicines for common health issues.

To encourage more people to engage in the WHO definition of health care we will need to create a common understanding of self-care and the benefits: while we can't restrict the definition of self-care to mean health-focused self-care but we CAN make it something in which every person can believe.

Consumer Skill

Self-care delivers the best value to individuals with a high level of health literacy, enabling them to make better decisions. A study based in Los Angeles found that older patients who are informed and motivated to self-manage chronic conditions were more empowered to change their quality-of-life outcomes by participating in more physical activity.

However, only 36% of US adults have basic or below-basic health literacy (Pfizer, Accessed: 9 Dec 2021) and the 2003 National Assessment of Adult Literacy revealed that 58% of African Americans had basic or below basic health literacy (Muvuka B. et al., 2020). This means that even if marginalized communities believe in the power of self-care, many won’t be able to understand, access and use healthcare information and services to make more quality decisions about their health.

Therefore, we need to strive to improve health literacy in all communities, to support greater health equity. Active use of health or wellness applications on smartphones is one way to make an improvement, and another is creating new careers around health literacy and education. I am committing to finding, building and launching creative partnerships to increase health literacy.

Consumer Ability

Lastly, people may believe and be more skilled at administering personal healthcare, but governing bodies play a critical role in enabling this. Smart policy and regulation changes would drive stronger and more sustained self-care interventions, which would ultimately lend to greater health equity across communities.

A regulatory solution could look like more medical products switching from prescription-only to OTC status, particularly in conditions that consumers can treat such as allergies, insomnia, and heartburn. This is and is simply a continuation of what has been happening across the last few decades and would empower more consumers to carry-out self-care. (Stomberg et al., 2013).

I was at a US based policy conference in December and we discuss policy interventions like greater tax exemptions on health-related products as a means of improving access. For example, US consumers can set up accounts with the Health and Safety Authority (HSA) and Food Standards Agency, which allow pre-tax funds to be used for qualified medical expenses, such as OTC medications and self-care products. A step to further to empower better management of one’s health could be adding vitamins and minerals to the list of qualified goods.

Another policy focused solution to champion health-equity, could be investing in reimbursement models based on value-based care where bills are based on positive clinical outcomes rather than on individual services rendered. This could curb over-provision of services, inattention to clinical need, and fragmented provision of care. I am committed to working with policy groups to remove financial barriers to health-focused self-care.

Self-care is a force for good for in challenging and changing health equity, across communities, countries, and continents. And with nimble and thoughtful solutions that tackle consumer beliefs, skills, and ability, we could see greater and lasting change.?Will you join us on this journey?