Self-Care Is the Future of Health-Care

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.

Over to you: What are some of your ideas for how Nova Scotians can practice better self-care? Leave your thoughts in the comments section below.


Dr. John Ross is an emergency physician, professor at Dalhousie University, and medical director of a telemedicine provider. He continues to advocate for profound personal behaviour and public policy changes despite the stifling powers of the status quo.


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Submitted By: Norma Johnson-MacGregor

Another thing that should be focused on heavily is the importance of mental health. It’s important to know how to manage one’s emotions properly (i.e. allowing yourself to feel whatever you’re feeling without letting society shame you into thinking you should be doing otherwise). It’s equally important that the stigma on mental health be lifted and that people who do suffer from mental health issues are able to get the help they need without the societal stigma or financial burden.

Submitted By: Elaine Garland

I attended a meeting last Friday, facilitated by Pictou county Community Health Board. It was excellent and covered some of the points you cover in this piece.

It was attended by a large crowd. However, one of the presenters cited a stat on stress, which was evidently from research done in Pictou county. The presenter said most people reported their stress level was quite low. Everyone at my table laughed and were astonished by that as we had just been talking amongst ourselves that the first thing we have to do is get the stress levels down among seniors and kids! We got rid of physical training teachers years ago and our children are now paying for that. I co-facilitate a Family Support Group on mental illness and in Pictou County. It is desperate. The Unit at the Aberdeen is not serving families who need it and the silo across the street is run like they are all in private practice and spend more time ‘screening’ people than they do treating people. There is little volunteer work done, unlike in the Valley where the leaders are out in the community with some great programs. Mental health in Pictou County is in terrible shape and the professionals are unwilling to do work in the community voluntarily. we need more mental health practitioners in schools from elementary to high school. We do not have public transportation for people to access the Wellness Centre and seniors cannot afford the fees. It is an awful failure on society’s part that so many children live in poverty, parents are stressed and kids are going to school upset and hungry. We have to listen to Dr. Stan Kutcher, as he says, we know what to do and how to do it and building more buildings to put professionals in silos is not what it is going to take. I am very hopeful this government is focused on actually putting in place a way forward so this cycle of hopelessness can be changed. Now is the time, don’t wait until it gets worse and we lose more adolescents to suicide and drugs. Thank you for taking the time and effort to hold these meetings and read what people are saying. It is the people in these communities who know what is going on and often problems are not reported because it wasn’t asked for in the past, by professionals who run the programs. So, when the outcomes were not good, it was swept under the rug and more funding was requested to do another program. Nobody was overseeing what was being done. Our local Community Health Board is amazing and really are the ears and eyes of this community and are not afraid to publish a report card and let mental health know they have failed.
E. Garland

Submitted By: Lisa staples

One major shift that people need to make is to increase the amount of food they prepare themselves and to minimize the amount of packaged and processed food they rely on. The additives and chemicals that are added to these food products (not to mention sugar in its many forms and names) are extremely harmful to our health (physical and mental). For the people who say they don’t have time to cook meals for themselves, I ask “What are you spending your time doing that is more important than your health?”
For those who say they can’t afford to buy healthier food, I ask “What are you spending your money on that is more important than your health?”
We also need doctors to start treating the root cause of a patient’s illness, using a functional medicine approach. Treating symptoms with medication will only mask them or cause adverse side-effects, and eventually the patient’s illness will progress and cause new symptoms.

Submitted By: linda landry

not smoking, cutting down on sugar, and fat and salt. Getting a doctor for everyone in the province!!!

Submitted By: Catherine Macneil

We need preemptive programs that address all the social determinants of health . It could be something like a good start program for children of low income families to free blood pressure clinics with an education component . I recently had a middle aged friend , who unknowingly had high blood pressure. This was not diagnosed until he had a medical emergency , spent two years on dialysis and subsequently died. This could have been preventive had someone just checked his blood pressure.
The concept of health as simply an absence of illness is mechanistic and outdated. This obscures the social nature of disease where social conditions such as poverty, culture, social and economic class and consumerism all have direct linkages to our health status.While Medicare eliminated access barriers our attention must shift now to more broadly based efforts to promote health into the domains of all the determinants of health. Health promotion must be robust but cannot be divorced from social and ideological contracts.

Submitted By: Mary Stevens

I am a healthcare professional. I have a strong family history of diabetes and high blood pressure. Being a put 20 lbs overweight and in my 50’s I completed an online risk assessment for diabetes which showed I was at an extremely high risk. I had done WW’s, plateaued and lost interest. I then got a referrals rom my GP to a nutritionist. This was successful and very helpful. My health plan through my employer(NSHA)did not cover this preventive service. My health plan is more than happy to cover medication, syringes and all the expensive equipment for diabetes, but not 600 dollars for a nutritionist. Does this make sense?