From Sick-Care to Well-Care: Pragmatic Solutions to Build Resilient Populations Today

Introduction

“Healthcare in crisis,” “structural inequities,” “transformation needed.” These emboldened words spark much of the conversation about the state of healthcare systems around the world today. According to the Deloitte 2022 Global Health Care Outlook,

Most stakeholders agree: sweeping change is needed. This type of change takes time. It will take 20, 40, maybe even 60 years to rebuild our healthcare systems. This is time many people, particularly those in underserved communities, just don’t have.

Even before the pandemic, half the world didn’t have access to basic and essential healthcare services.^[2] No access to hospitals. Little access to healthcare providers. Lack of health education. This problem has been magnified due to world events, exacerbating existing inequalities and inequities. Why? These communities often have higher rates of homelessness or housing insecurity, coupled with low wage work, leaving them without access to healthcare or the resources needed to take care of themselves well. These and many other social determinants of health put them at greater risk for health issues, including COVID-19 and many non-communicable diseases such as cardiovascular disease, asthma, and cancer.

A recent editorial in the Journal of the American Medical Association (JAMA), written by U.S. Secretary of State Antony Blinken and Health and Human Services Secretary Xavier Becerra, said it well: “The goal must be to design a global health security regime that will reduce morbidity and mortality and improve well-being across all populations in all countries. It is the right thing to do, and it is in the enlightened self-interest of each nation because viruses like SARS-CoV-2 do not stop at borders. Without an equitable and fully inclusive approach, every country and every person is vulnerable.”^[3] While there’s certainly merit to a long-term view towards rebuilding health systems, people in these communities need and deserve a more pragmatic solution so they can have healthier, better lives today.

Health systems play a critical role in addressing the basic health needs of citizens. But according to the United Nations Development Program’s Human Development Index, 90 percent of the 191 countries examined failed to achieve a better, healthier, more secure life for their people in 2020 and 2021.^[4] In both developed and developing nations, current health systems are inadequate in meeting basic needs. For instance, even in the United States, more than 45 percent of consumers experience at least one unmet basic healthcare need.^[5] Yet inequities have been magnified in the face of COVID-19, with women and children in low- and middle-income countries seeing the biggest impact. According to a recent analysis by the World Health Organization (WHO), “the pandemic’s long-term impact on the health and well-being of women, children and adolescents is becoming evident: their chances for healthy and productive lives have declined sharply.”^[6]

Building Resiliency

In order to meet these basic needs, behavioral change is needed—both on societal and individual levels. To drive collective change, governments that set up health systems prioritizing preventative care will build resiliency. And resiliency is set to win in the face of geopolitical headwinds and global pandemics which have highlighted the importance of supply chains, logistics, availability of healthcare workers, effective infrastructure, accurate information, and health literacy.

Healthy populations are critical to economic competitiveness. This is particularly relevant given that the rate of deaths from noncommunicable causes, such as heart disease, stroke, and injuries, is rapidly rising with an early impact on already-underserved communities. Noncommunicable diseases are largely based on lifestyle (e.g. diet, behavior, environment) and can be mitigated with preventative care and health education. Societal change will help empower individuals to change, because they’ll be armed with the know-how and tools to take better care of themselves and their families. Several existing programs already inspiring action and change are outlined in subsequent sections of this article.

Below are five practical ways to start the transition towards more resilient populations and health systems. Countries that invest in these practical solutions—a focus on preventative care, health education programs to drive healthy behavior change, expanding where health happens to include community hot spots, building a cadre of community care workers, and ensuring regulations enable access to over-the-counter products and practical remedies—will have greater success in creating healthy, prosperous communities.

Accelerated Transition from Sick-care to Well-care

Most health systems today focus on sick-care, which is essentially damage control: reactively managing sickness and the results of poor lifestyle choices, lack of access to care, and health illiteracy. A “sick-care” model is very expensive; it typically costs a lot of money to diagnose and treat disease. For instance, in the United States alone, heart disease and stroke cost the healthcare system $216 billion per year while obesity costs nearly $173 billion annually.^[7] A sick-care model involves well-trained healthcare professionals, equipment, medicines, and other often-costly infrastructure. Today’s model also does not allow for proactivity or much flexibility, and in a crisis-packed healthcare world—ranging from climate disasters to cyber ransom in hospitals—a new order of care is needed.

Research shows that 80 percent of non-communicable diseases could be prevented through healthy lifestyle behaviors.^[8] These are the basic practices everyone should be doing to lead a healthy lifestyle. Yet many people don’t, often because of access to health information. Practices like stopping smoking, eating a more healthful diet, increasing physical activity, and limiting harmful consumption of alcohol don’t need costly infrastructure. Instead, the focus should be placed on health education and improved access to other science-based self-care solutions.

Only about three percent of healthcare expenditure across Europe and the United States is spent on preventative care.^[9] This imbalance needs to shift to well-care, helping people learn how to take care of themselves before they get sick, so our health systems can have more bandwidth to focus on those who do get sick.

Some healthcare systems are already doing this. Self-care, the ability of individuals, families and communities to promote health, prevent disease, maintain health and cope with illness, is recognized by the World Health Organization as an effective part of a supportive health system.^[10] Last year, the Global Self-Care Federation introduced the Self-Care Readiness Index, an advocacy-centered research initiative that seeks to understand and recognize the enablers of self-care and how to improve them.^[11] The Index examined ten countries, both developed and developing, to better understand and create actionable plans for how self-care can become a stronger part of the healthcare continuum.

This transformation, which should involve multiple stakeholders both inside and outside the traditional health system, should also include a focus on health education, a distributed network of care, and an improved policy environment.

Health Education Programs

Health literacy is a prominent theme within the Self-Care Readiness Index. It is critical to have credible, consistent sources of information that are aligned with healthcare providers. Education is an often-overlooked aspect of healthcare, but it is nevertheless critical. Consider the health education effort behind the COVID-19 handwashing best practices. The efforts were orchestrated, focused, and made simple for people to implement—so they did. There’s a lot of information available, but it is not always accurate or beneficial. Two-thirds of Americans often hear conflicting medical information from friends and family.^[12] This needs to change. In order for people to feel empowered, they need to be confident in their ability to take the right actions. This could be as a part of school curriculums, as well as science- and government-led health literacy programs, integrated into healthcare provider consultations and supported by easily-accessible tools such as digital QR codes in community hubs.

There are already some good examples happening around the world that can serve as inspiration.

The United Kingdom is one of the countries that is more progressive in its health education programming. England, for example, made its health curriculum mandatory in 2020, including simple self-care techniques, nutrition, personal hygiene, prevention of health and wellbeing problems (for example, through exercise and not smoking), and basic first aid.^[13]

In Australia, the government’s Centre for Culture, Ethnicity and Health sponsors “Drop the Jargon Day” on October 25.^[14] The initiative aims to bring attention to language used by healthcare professionals that is often not understood by consumers and patients. There’s a movement to use plain language, stop using acronyms, explain terminology better, and do more to make sure patients understand what is being explained.

Health education doesn’t always need to happen through schools or be sponsored by health systems. NGOs, community health workers, and even companies can play a role here. For instance, in some Latin American markets, the government approved use of QR codes to help educate on a range of health topics. Consumers are becoming much more comfortable with QR codes due to uptake by restaurants and stores in business during the pandemic. QR codes serve as an easy way to communicate information, from product ingredients and safe usage to other health information.

Another important enabler of this acceleration are healthcare providers themselves—broadly defined to include doctors and nurses, as well as pharmacists, community health workers, and others who are trained to provide health recommendations. Healthcare providers are one of the most trusted sources of information and recommendations for practical, science-led personal healthcare solutions for prevention and first-line treatment. More than 70 percent of respondents surveyed in Poland, Thailand, Brazil, Nigeria, and the United States say their healthcare providers already speak to them about self-care as part of a treatment plan for a specific medical condition or at every visit. On the contrary, in the UK, less than half of respondents say the same thing.^[15] People would be better enabled to take care of themselves if they regularly received this guidance during standard visits with their healthcare providers.

Distributed Network of Care

Society needs to expand where health happens—to the home, pharmacies, grocery stores and online, where patients actually are in their daily lives.

There is still value in traditional healthcare settings, but in many communities, especially underserved ones, patients may have more access to the local store than to a conventional healthcare provider. Services facilitated by a pharmacist or in-store healthcare provider can often be more affordable and offer 360° solutions: people can obtain healthcare provider-endorsed recommendations for how to take care of themselves, secure prescriptions, and shop for over-the-counter solutions, all in one place. In order for this to be successful, policies also need to change to enable permission-based access to medical records for in-store healthcare providers and referrals to other doctors.

The expansion of digital health will also foster enablement. While the pandemic encouraged certain forms of telehealth, in order to help create health ownership, telehealth should be expanded to other health services. A patient’s home is becoming the primary site for taking care of their health needs, and this is already happening with at-home medical devices. For example, diabetes is a chronic condition that currently can be monitored with the help of digital remote-monitoring tools like glucose monitors and activity trackers. A patient can sync their devices to track progress, check their health data in real time, send and receive messages from a nurse, and share progress with their doctor. This helps address long periods of ongoing care and allows people to take control of their health.

There is also opportunity for the whole community to take control of their health. In many low- and middle-income countries, governments are empowering community health workers to provide health education. These are non-professionals who are trained on important and community-relevant health topics, everything from heart health to constipation, and work directly with residents. Since community health workers typically live in the community they serve, they have the unique ability to supply information where it is needed most. They can reach community residents where they live, eat, play, work, and worship.

One example of this dynamic in action is the social tech enterprise reach52, which aims to connect the 52 percent of the world’s population without access to healthcare to the services they need.^[16] They empower community health volunteers to understand the basic needs not being met within a population and then train them to provide health services, ranging from education to distribution of over-the-counter products. This assistance provides immediate access to practical solutions while further infrastructure and health reform is being developed.

People within the community thus understand the community best and can help develop trusted and novel ways to empower people to improve their health.

Improved Policy Environment

The Self-Care Readiness Index also looks at the role health policy and the regulatory landscape have in helping people take health ownership. Policies should look at new approaches to behavior change when policymakers are determining future investments in health promotion, prevention, and self-care initiatives.

For instance, more could be done to foster the safe shift of certain prescriptions to over-the-counter (OTC) drugs. These transitions have been proven to reduce doctor visits, thereby easing the burden on strained national healthcare budgets. According to an article published in the Brazilian Journal of Economics and Health (JBES), every $1 spent on OTC drugs saves $7 for Brazil’s public health system^[17]—about the same ratio observed in similar studies in the US.

Or, re-consider how and where self-care products can be sold. In many countries, despite not requiring a prescription (as OTC products are some of the most widely studied and safe products for use) many common pain and cold medications require an additional layer of consultation, limiting people’s ability to easily access a solution to take care of themselves when they have a minor ailment, such as a headache.

Increasingly, countries are starting to integrate self-care into their public health plans. For example, the Colombian government recently launched its new ten-year public health plan, which focuses on behavior change, health promotion, and prevention. In Indonesia, prior to 2000, more than 40 percent of children under 5 were stunted due to malnutrition.^[18] Working with multiple public and private stakeholders, the government prioritized supplemental nutrition as part of its public health programs, particularly the accessibility of multiple micronutrient supplements (more commonly known as prenatal vitamins), leading to improved growth and development.^[19]

While programs like this offer good progress, no country offers a standalone self-care policy. The Global Self-Care Federation and its partners are working with the World Health Organization to improve overall integration of self-care into the healthcare continuum.^[20]

A “whole of government” approach to self-care is required: think local, state, and federal governments working with each other and with communities to both educate and encourage behavior change. This is similar to what we saw with hygiene and social distancing efforts during the height of the COVID-19 pandemic, but this time a sustained effort.

Self-care Embedded into Health Systems

In the developed world, particularly, one of the most interesting transformations that took place due to COVID-19 was the increased role of health ownership. In certain respects, the pandemic focused greater attention than ever on personal health. Specifically, extreme circumstances forced some people to take control of their personal health, and now, almost three years later, it is a practice that is here to stay.

Yet enabling all people—not just those with easy access to medical professionals and other resources—to proactively take care of themselves is an essential way to help rebuild health systems. Self-Care offers a pragmatic solution to empower individuals and contribute to health equity without putting further strain on the system.

New research from the Global Self-Care Federation shows healthcare systems and national economies worldwide could save approximately $119 billion per year through greater adoption of self-care practices, and if more people took a proactive approach to their health, an additional $60 billion per year could be saved.^[21] Imagine the additional programs that could be created with this surplus.

Moreover, the study found other striking statistics regarding the impact of self-care on society. Self-care allows individuals to continue their day-today activities, including their employment, saving around 11 billion patient hours worldwide. This is especially notable in low- and middle-income countries where productivity gains are essential, given that many people are not paid if they do not work. For instance, in South Asia, individuals can gain up to 7 days of productivity per year with the use of OTC products. That’s seven more days that they can spend working and bringing home a paycheck to take care of their families.

Conclusion

In sum, empowering people to take care of their own health—by giving them the know-how and the tools—will help create a more resilient society, particularly in parts of the world with less access to conventional healthcare. Self-care offers a health lifeline and can serve as both the first line and last line of healthcare.

Building resilience is a key to prosperity, and a pragmatic approach to health systems change should help enable this. Healthier communities help fuel economies: good health enables adults to be productive and tends to lead to an increased long-term savings rate, given longer lifespans and increased awareness of future financial needs. Healthy children are better-equipped to attend and then thrive at school, creating a foundation for the future, including increased earning potential. And finally, as detailed earlier, there is a dramatic financial benefit to shifting towards disease prevention and self-care, enabling spending to be shifted to other worthy healthcare needs.

[1] Deloitte, “2022 Global Health Care Outlook: Are we finally seeing the long-promised transformation?” 2021, https://www.deloitte.com/content/dam/assets-shared/legacy/docs/perspectives/2022/gx-health-careoutlook-Final.pdf.

[2] World Health Organization, “World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses,” December 13, 2017, https://www.who.int/news/item/13-12-2017-world-bank-and-who-half-the-world-lacksaccess-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-healthexpenses#:~:text=At%20least%20half%20of%20the,out%20of%20their%20own%20pockets.

[3] Antony Blinken and Xavier Becerra, “Strengthening Global Health Security and Reforming the International Health Regulations: Making the World Safer From Future Pandemics,” JAMA 326, no. 13 (2021): 1255-1256.

[4] UNDP, “Human Development Report 2021-22: Uncertain Times, Unsettled Lives: Shaping our Future in a Transforming World,” September 8, 2022, https://hdr.undp.org/system/files/documents/globalreport-document/hdr2021-22pdf_1.pdf.

[5] Tamara Baer, Erica Coe, Anne Koffel, and Jordan VanLare, “Patients struggle with unmet basic needs: Medical providers can help,” McKinsey & Company, April 1, 2022, https://www.mckinsey.com/industries/healthcare/our-insights/patients-struggle-with-unmet-basic-needs-medical-providers-can-help.

[6] World Health Organization, “Protect the promise: 2022 progress report on the every woman every child global strategy for women’s, children’s and adolescents’ health (2016-2030),” October 18, 2022, https://apps.who.int/iris/rest/bitstreams/1476010/retrieve.

[7] Centers for Disease Control and Prevention, “Health and Economic Costs of Chronic Diseases,” September 8, 2022, https://www.cdc.gov/chronicdisease/about/costs/index.htm.

[8] NCD Alliance, “NCDs,” https://ncdalliance.org/why-ncds/NCDs.

[9] European Union, “3% of healthcare expenditure spent on preventive care,” eurostat, January 18, 2021, https://ec.europa.eu/eurostat/web/products-eurostat-news/-/ddn-20210118-1.

[10] World Health Organization, “Self-care interventions for health,” https://www.who.int/health-topics/ self-care#tab=tab_1.

[11] Global Self-Care Federation, “Self-Care Readiness Index,” Self-care promise, https://selfcarepromise. org/self-care-readiness-index/.

[12] “Merck Manuals Survey: More Than Two Thirds of Americans Often Hear Conflicting Medical Information from Family and Friends,” The Merck Manuals, October 7, 2021, https://www.prnewswire. com/news-releases/merck-manuals-survey-more-than-two-thirds-of-americans-often-hear-conflicting-medical-information-from-family-and-friends-301395024.html.

[13] UK Department of Education, “Statutory guidance Relationships and sex education (RSE) and health education,” Government of the UK, September 13, 2021, https://www.gov.uk/government/publications/relationships-education-relationships-and-sex-education-rse-and-health-education.

[14] Centre for Culture, Ethnicity and Health, “Drop the Jargon,” https://www.dropthejargon.org.au/.

[15] Global Self-Care Federation, “Self-Care Readiness Index 2021,” September 17, 2021, https:// www.selfcarefederation.org/sites/default/files/media/documents/2021-09/Self-Care%20Readiness%20 Index%20Report%20170921%20%281%29.pdf.

[16] reach52, “Who We Are,” https://reach52.com/who-we-are/.

[17] Antonio Cesar Rodrigues, “Use of non-prescription drugs and savings generated for health systems: a review,” Brazilian Journal of Economics and Health 9, no. 1 (2017): 128-136.

[18] Milan Thomas and Takashi Yamano, “Food Alone Will Not Address Malnutrition in Indonesia,” Asian Development Blog, March 17, 2022, https://blogs.adb.org/blog/food-alone-will-not-address-malnutrition-indonesia.

[19] “Nutrition International and the Government of Indonesia helping to prevent and reduce stunting by reaching pregnant women and children under five with essential micronutrients,” Nutrition International, January 14, 2020, https://www.nutritionintl.org/news/all-news/nutrition-international-and-the-government-of-indonesia-helping-to-prevent-and-reduce-stunting-by-reaching-pregnant-women-and-children-under-five-with-essential-micronutrients-2/.

[20] Global Self-Care Federation, “Joint statement: Integrating self-care into the global healthcare continuum to create better health outcomes for all,” September 22, 2021, https://www.selfcarefederation. org/sites/default/files/media/documents/2021-09/Joint%20statement%20pdf%20v2.pdf.

[21] Global Self-Care Federation, “Economic and Social Value of Self-Care Report,” July 28, 2022, https:// www.selfcarefederation.org/ecosoc-report.