Formal recognition of self-care

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Vision in Brief:

Self-care is the true front line in Canadian health care. Canada’s consumer health products industry is encouraging the healthcare sector, governments and other organizations involved in the delivery of healthcare services and products to recognize self-care as a critical component of health care by incorporating self-care initiatives into their policies and activities. When this vision is achieved, consumers will be aware of their self-care options and feel supported in making responsible healthcare choices. In addition, more formal healthcare resources will be opened up to those who need them.

Summary:

Self-care involves the range of activities individuals undertake to enhance health, prevent disease, evaluate symptoms and restore health. These activities are undertaken by lay people on their own behalf, either independently or in collaboration with health professionals. Before they consult with any health professional, enter any walk-in clinic or present to an emergency room, the vast majority of Canadians will have practiced some form of self-care to deal with most health concerns. Canada’s consumer health products industry helps consumers to improve their quality of life by providing them with products, knowledge and programs to stay healthy and play a bigger role in managing their health concerns.

A variety of social and health trends are driving the growing importance of self-care. An aging, better educated population that is living longer and with more chronic conditions will not only require more professional care, but will have a greater role to play in that care as well. There is also strong evidence that Canadians are quite prepared – even eager – to play a greater role in their own health care in general.

To support Canadians’ efforts to practice responsible self-care, the healthcare sector, federal and provincial governments and other organizations involved in the delivery of health care services need to recognise self-care as a pillar of our healthcare system. Initiatives and policies that support Canadians’ ability to practice responsible self-care should be formally incorporated into the strategic goals of every organization involved in healthcare.

Vision in Detail:

Demands on healthcare resources are increasing significantly. The entry of the baby boom generation into late middle age is a major factor in many parts of the world, but especially in North America, given the sheer numbers involved: in 2009, Canada saw the proportion of its population over age 65 double by comparison to post-war levels. Advances in medical technology are another significant factor as they are creating high social expectations of the healthcare system. Advanced diagnostic and therapeutic technologies have had not only dramatic impacts on health outcomes but also on the cost of care. Providing broad access to these technologies (everything from MRIs to medicines) will increasingly strain public purses as both the individual costs of the services and the number of people who can benefit from them rise faster than the broader economy and population, respectively.

The common need to control the per capita cost of care, while continuing to provide high quality healthcare services, will drive real change over the next few years. Signs that there is a new willingness to engage in cost control measures can be seen in the supportive undertakings by the medical, hospital and pharmaceutical industry sectors in the United States in response to the Obama Administration’s reform proposals.

Options for delivering health services and products in new ways are also being developed as an alternative to either increasing funding or putting in cost-containment measures. This is where self-care can become an even more important factor. Consumer health product industries around the world have a long history of supporting the growth of self-care. More recently though – as the demand for healthcare services grows – several jurisdictions are recognizing the value that enhancing self-care can yield in both health and economic benefits. In 2000, the Department of Health in the United Kingdom formally recognized self-care as one of the four pillars of the National Health Service. Five years later, they reported that:

 “There is growing evidence to show that supporting self-care leads to:

  • improved health and quality of life
  • a rise in patient satisfaction
  • a significant impact on the use of services, with fewer primary care consultations, reduction in visits to outpatients [walk-in clinics] and A&E [emergency rooms], and decrease in use of hospital resources." 

This recognition of the important role that self-care plays in enhancing both quality of life and the cost-effectiveness of health care has led to numerous innovative approaches to supporting self-care. Manufacturers, government, physicians and pharmacists have all rallied together to figure out how to make more health products available for self-care that previously had only been available by seeing a doctor to get a prescription. Scotland implemented a minor ailments scheme which added consumer health products to reimbursement formularies. In British Columbia and other Canadian jurisdictions, patient education and self-care resources such as the BC HealthGuide home health manual and online reference, nurse hotlines and other health reference services seek to improve the quality and accessibility of health information in support of self-care.

A 2004 survey found that Canadians value this type of support for self-care and recognize its importance to the healthcare system, with 90 per cent agreeing that “If our healthcare system is to remain sustainable, it is more important than ever that governments in Canada provide Canadians with the tools they need to practice responsible self-care for healthy living.

Canadians appear eager to embrace the kinds of self-care supports being offered in the United Kingdom and elsewhere. It is time to harness the unrealized potential of the greatest resource in the Canadian healthcare system: Canadians themselves.

The Solutions:

Federal Government:

In Canada, one area where the federal government can support self-care is by revising its health product regulations to ensure that all products that have a similar range of risks associated with them should be evaluated by the same criteria. This is not currently the case: while the requirements for evaluating some types of consumer health products have been updated (those sourced from ingredients found in nature), other health products that are also suitable for self-care are still being evaluated by inappropriate criteria (ie., the same regulations [Part C of the Food and Drug Regulations] that apply to prescription drugs). Under risk-based regulation, consumer health products would not be subject to the same regulatory requirements as prescription medicines.

Another example is price regulation. The Patented Medicine Prices Review Board (PMPRB) was created two decades ago to regulate the prices of patented prescription drugs, which are not subject to the self-regulating forces of a consumer marketplace. However, the regulations were written in such a way that they also captured consumer health products (even if the patent was only for a flavouring or a manufacturing process), which are priced according to a marketplace that takes into consideration that products must compete for consumers’ attention. Removing consumer health products from the PMPRB’s jurisdiction would be an important way of recognizing the distinct role that self-care plays in Canadian health care and health economics.

Provincial Governments:

In Canada, the provincial governments are responsible for managing the funding of health services. CHP Canada encourages all provincial governments to embrace self-care and provide its citizens with the support they need in order to practice responsible self-care. The United Kingdom’s recognition of self-care as one of the four pillars of health care and their strategy of supporting self-care through education, awareness and balanced financial incentives have opened new avenues to improving health outcomes and increasing the overall cost-effectiveness of care.  British Columbia’s BC HealthGuide and similar informational/educational efforts are important steps in the right direction, but more has to be done to integrate these programs with the broader formal healthcare system.

Options for delivering health services and products in new ways are also being developed as an alternative to either increasing funding or putting in cost-containment measures. For example, the expansion of prescribing rights to various professions such as nurses, naturopathic doctors and pharmacists has been adopted by many jurisdictions. While this concept decreases the burden on physicians’ time and services, care must be taken to ensure that consumers seeking products for use in self-care are not diverted toward prescription drugs as a result.

Healthcare sectors:

Canadians are seeking health information from a great variety of sources, including the Internet. CHP Canada encourages all professions involved in the delivery of healthcare services to support Canadians’ efforts to practice self-care by providing them with factual and relevant information so they can do more to safely manage their own health. In the UK, the tremendous support being given by family physicians and pharmacists is playing a key role in the success of the self-care initiatives in that country.

Everyone involved in the development and delivery of health products and services:

Manufacturers, governments, physicians and pharmacists should work together to figure out how to make more health products available to its citizens that previously had only been available by seeing a doctor to get a prescription. By working together, they can come up with innovative products, programs and services to ensure that consumers can safely and responsibly use the products to improve their quality of life.

CHP Canada Successes to Date:

  • Consumer Health Products Canada has provided evidence-based guidance on consumer health products and self-care to governments and healthcare organizations for more than 115 years.
  • CHP Canada recommendation that natural health products (a category of consumer health products) be regulated separately from prescription drugs was accepted.
  • CHP Canada provided evidence-based expertise and knowledge to Health Canada that it used to help develop the Natural Health Products Regulations (2004).
  • CHP Canada has succeeded in ensuring that federal political and public service officials understand the problems with having over-the-counter medications regulated by the same regulations as prescription drugs.
  • CHP Canada was successful at gaining consensus among pharmacists and provincial governments to develop and implement a national set of drug schedules that specify the conditions under which the various health products can be sold and these “schedules” were designed to be applied across the country (ie., harmonization) (1990s).
  • The Patented Medicine Prices Review Board has implemented CHP Canada’s recommendation to only subject the prices of patented consumer health products to regulatory control on a complaints basis. This enables marketers of consumer health products to price their products according to the needs of the local market.
  • CHP Canada held a self-care education day where federal officials heard first-hand from a doctor from the UK who walked them through the UK’s process and experiences, and helped them to understand how important it is for a government to openly and actively recognize self-care as a pillar of health care.
  • CHP Canada provided consumer research insights to the BC HealthGuide program.
  • CHP Canada has brought together a Self-Care Coalition, comprising representatives from all the healthcare sectors, to champion self-care within their organizations.

CHP Canada in Action:

  • CHP Canada has been meeting with parliamentarians and Health Canada staff to ensure that amendments to the Food and Drugs Act will provide for risk-based regulation and the development of regulations that will enable all consumer health products to be regulated appropriately.
  • The Association is also meeting with Health Canada, Industry Canada and the Patented Medicine Prices Review Board to seek agreement to remove consumer health products from the oversight of the Patented Medicines Regulations.
  • The Association is developing a research and policy paper outlining the benefits to consumers and the Canadian healthcare system of supporting prescription to over-the-counter switch initiatives.
  • CHP Canada is working with pharmacy regulators to ensure that self-care remains the first response to health care.
  • CHP Canada is working with its counterpart in the UK (Proprietary Association of Great Britain – PAGB) and Canadian politicians to increase awareness among Canadian officials of the value of formally recognizing self-care as a primary component of our healthcare system and providing the resources necessary to support the efforts of its citizens to practice responsible self-care.