About this report

Enabling people to manage their health and wellbeing:  Policy approaches to self-care is a report written by The Economist Intelligence Unit and sponsored by RB, a UK consumer goods company. The report considers the key elements and drivers for self-care, and examines the political and regulatory response across three global markets: the US, Europe and BRICS (Brazil, Russia, India, China and South Africa).

The findings of this report are based on desk research and in-depth interviews with 12 experts drawn from healthcare professionals, patient groups, regulators, healthcare system groups, academics and industry bodies. Our thanks are due to the following for their time and insights (listed alphabetically): 

• Huiliang Bai, council member, International Self-Care Foundation (ISF), China
• William Dib, director-president, Agência Nacional de Vigilância Sanitária (ANVISA), Brazil
• Austen El-Osta, director, Self Care Academic Research Unit, School of Public Health, Imperial College London, UK
• Ian Hudson, CEO, Medicines & Healthcare products Regulatory Agency  (MHRA), UK
• Edward Kelley, director, Service Delivery and Safety, World Health Organisation, Switzerland
• Scott Melville, president and CEO, Consumer Healthcare Products Association (CHPA), US
• Ilaria Passarani, secretary-general, Pharmaceutical Group of the European Union (PGEU), Belgium
• K Srinath Reddy, president, Public Health Foundation of India (PHFI), India
• Kawaldip Sehmi, CEO, International Alliance of Patients’ Organisations, UK
• David Webber, president, International Self-Care Foundation (ISF), UK
• Janet Woodcock, director, Centre for Drug Evaluation and Research, Food and Drug Administration, US
• Naoyuki Yasuda, director of the office of international regulatory affairs, Japanese Ministry of Health, Labour and Welfare

This report was written by Becca Lipman and edited by Elizabeth Sukkar of The Economist Intelligence Unit. The findings and views expressed in this report are those of The Economist Intelligence Unit and do not necessarily reflect the views of the sponsor. 

Executive summary

Self-care entails actions that people take to promote or maintain their health and wellbeing. This encompasses an active role in the management of minor, self-limiting conditions as well as taking a greater role in any diagnosed medical conditions that involve partnership with healthcare professionals (HCPs).

In this sense, the human species has always practised self-care through daily choices and lifestyle decisions, long before doctors and health systems emerged. Old as the concept may be, self-care has become an increasingly important policy in recent years, where it needs to work alongside formal services to boost people’s health and wellbeing.

The growing impetus to further engage populations in their own health practices is largely in response to the financial pressures on health systems. Although these have advanced considerably in their ability to treat and monitor patients, this has come at a great economic cost to governments and citizens. By encouraging populations to self-care, this will lower demand for formal health systems.

Yet the transition from professional care to more self-care is complex. Many cultural, systematic and safety barriers to patient involvement remain. And the role of policymakers and HCPs to safely empower populations to self-care is not always clear.

To address the challenges, this report will first examine the definition, components and drivers for self-care, and how self-care is already being adopted. Next, we will explore the challenges and benefits associated with self-care and the role of policymakers, HCPs, patient groups and industry organisations in promoting safe, accessible self-care. Finally, it will look at developed and developing markets – Europe, US and the BRICS (Brazil, Russia, India, China and South Africa) – to explore and compare today’s political and regulatory approaches to self-care, and the impacts of those decisions.

Key findings of the research include: 

• From a modern public health perspective, a self-caring population is a necessity. It has become socially and economically unsustainable to maintain the traditional, ever-advancing delivery of care. Health spending already stands at around 15% of all government expenditure across OECD countries. And global demographic shifts – namely ageing populations and rising chronic diseases among them – are driving greater demand for health services. Reforming health services to advance self-care practices is therefore increasingly becoming a priority.
• People are eager to self-care. Many people lack confidence in maintaining their health and managing their condition, but are eager to do more. Studies show that patients who are educated about their condition and care, from common colds and sexual diseases to diabetes, may see better adherence to treatment plans. Those engaged with self-care also show optimal health outcomes and a higher quality of life, while putting less strain on the health system. 
• Health literacy is a critical enabler for self-care. It empowers people and societies to transform health. Health literacy is needed to promote health equity and our research shows there is significant room for improvement and for greater research. For example, rural areas in China with low health literacy have higher instances of hypertension than their urban, relatively educated counterparts. Low literacy rates can be lifted through life-long learning programmes that begin at school and continue through adulthood. 
• HCPs should be engaged in people’s self-management practices. Self-care does not mean no care, but it is not always clear where and when it is appropriate for HCPs to transfer care responsibilities to people. Interviewees suggest patients will be most successful when HCPs are trained to support them in self-care and can provide guidance as appropriate.
• Self-care will increasingly be built into healthcare policies and play an integral role in healthcare systems. More focus should be highlighted in policies on how self-care can improve health and wellbeing in concert with formal healthcare systems. Nonetheless, strong healthcare systems should empower self-carers. Countries can promote self-care by providing populations with effective, efficient and inclusive primary care services, quality healthcare information, and easy access to preventative care services and supplementary care. While some European countries like the UK have demonstrated the benefits of this approach, the BRICS countries show significant issues in this area, and consequently face overwhelming demand for emergency care services. In the long term, systems will benefit from less wasted resources across primary and secondary care services.
• The ability to self-medicate, especially for self-limiting conditions, is an important component of self-care. The availability of over-the-counter (OTC) medicines can lessen reliance on prescription medicines and could relieve the burden on healthcare systems (such as primary care) from patients seeking medication for minor ailments. Regulators must be content with the risk-benefit balance of a product to human health. Our research finds that they differ in their assessment of when it is safe to switch medicines from prescription-only to OTC. Nonetheless,  it is evident that a range of OTC medicine has been expanding in most markets. Regulators will need to seek a balance in improving access to innovative and effective self-care technologies while maintaining consumer safety, quality and efficacy.
• Medical devices, apps and e-pharmacies are shifting self-care dynamics. Most regulatory bodies are embracing technological advances in healthcare, particularly those that can aid populations to better manage chronic diseases and help prevent future medical issues. Pills embedded with a sensor that remind patients to take their medicines, for example, have already been approved in the US. Regulators are learning to focus their attention, as it is becoming impossible to oversee the flood of applications, devices and e-pharmacies entering the market. It would be helpful if healthcare systems provided information to people on trusted and safe digital tools and apps.