The evidence considered in this review establishes that the state of self-care and self-management policy, programs and support in Australia is fragile at best. While many health policy documents talk about the importance of health literacy – the understanding and ability of individuals to understand and make better-informed choices about their health and health care – and sometimes about either self-care or self-management in health care, these terms are ill-defined, poorly understood and not backed by systematic and programmatic support. Typically, the terms are used but not defined in policy documents, with the benefits of both asserted rather than demonstrated.
Evidence suggests that people are mostly willing to take some personal responsibility for enhancing their health and that of their children and families through self-care and many see it as ‘natural’ to assume some responsibility for self-care. However, most health policies have focused, and continue to focus, on discrete programs and interventions to tackle risk factors for poor health such as smoking, obesity or lack of exercise. The term ‘self-care’ is not commonly used in Australian health policy documents; however, the term ‘selfmanagement’, generally implying the active participation of individuals in the management of established health conditions, is used in a range of health policy statements. Both of these terms are implicit in the widespread development of peer group support programs, particularly for mental health and established chronic diseases. However, government-supported programs for self-care and self-management lack a firm conceptual foundation, are not integrated with the wider health system, and few are properly evaluated. Some good ideas and notable practices exist but these are not shared or promoted. As a result, self-care activity, including policy and best practice, is uncoordinated and invisible.
There is no evidence that people who most need support with self-care and self-management are being effectively targeted by existing programs. There is no coherent approach to establishing clear priorities for self-care, particularly in populations where the need is greatest, as evidenced by their poorer health. Indeed, there is strong evidence that people with poor access to financial resources – those in the lowest socioeconomic quintiles of the population – have much worse health outcomes than other Australians. These people – 40% of the Australian population – are 33% more likely to have diabetes and 172% more likely to die from diabetes. They are much more likely to be obese, to do little or no exercise, and much more likely to smoke. Australia has been very slow to adopt evidence-based approaches for reaching these groups, including social prescribing and community referrals.
People living with chronic health conditions, their families and carers may be advised they need to engage in their own care, but receive little support to do so. There is likely to be a significant unmeasured and unmet demand for structured and supported self-care and self-management guidelines and programs, particularly amongst those at most risk of poor health and living in the most disadvantaged localities in Australia.
There are extensive and longstanding gaps in data and evidence in many relevant areas in which self-care and self-management are either implicit or explicit concepts, including in relation to the management of chronic diseases and their mental and physical comorbidities and the impacts of environments on health. This is compounded by the rise of technology: hand-held Internet-capable devices, applications to assist people with health conditions, and an endless supply of poorly-curated information. Those offering support for self-care and self-management include peers (people living with the same or similar health conditions), commercial interests promoting their products or services, and providers who may or may not disclose ideological prejudices or commercial interests.