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Jan
2018
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The future of healthcare is self-care

What is the future of healthcare? The answer to this question depends on whom you’re asking. Within the healthcare system, the answers range from new care delivery options, big data and electronic health records, telehealth technology, and better R&D pipelines.

More people are thinking outside of the box in order to develop a new model of wellness and care (instead of trying to optimize the current model). At the core of this new model of wellness are self-care practices like healthy eating and nutrition, stress management, herbal medicine, sleep hygiene, social connection, and movement. Not only are these effective, they are less costly and support systemic change.

It’s better: the power of complexity

Self-care practices involve several modalities and techniques: nutrition, stress management, herbal medicine, lifestyle, exercise, and social connection. These are complex interventions and support several aspects of health. Healthy eating habits can affect energy levels, mood, and digestive function simultaneously. Mint and yarrow tea can help clear a stuffy nose, but may also benefit digestion and mental function. Oregon grape root improves digestion and liver function, while also regulating blood sugar levels. Conversely, medicinal interventions tend to be simpler and mechanistic, associated with side effects and unintended consequences. For example, while NSAID drugs can reduce inflammation and decrease pain, they can also negatively impact the digestive tract, as well as liver and kidney health with long-term use.

Our bodies are also complex and multifaceted. Complex interventions work for complex bodies, and is supported by research. A 2-year longitudinal study found that enhancing self-care agency, regular exercise, and self-management skills decreased the progression of frailty among Japanese elders (1). Another study revealed the clinical effectiveness of self-care interventions with an exercise component to manage knee conditions (2). A systematic review found that self-management interventions improved health-related quality of life, specifically in depression and anxiety symptoms (3). Many more studies address the effectiveness of self-care practices in various health conditions.

That said, self-care practices are not equivalent to medical interventions and should not be viewed as a replacement for it. Rather, they are different levels of intervention. Self-care practices are safe and accessible methods to encourage and maintain balance within the body. When imbalances escalate to serious health conditions (or when acute care is needed), medical attention should be sought immediately.

Less cost, greater accessibility

The United States spends more on health care as a percentage of GDP than other developed countries (4), but Americans are less healthy. Why does the United States spend so much more? The most obvious reason is that U.S. healthcare delivers a more expensive mix of medical interventions. Compared to the average OECD country, the U.S. delivers almost three times as many mammograms, twice the number of MRI scans, and 31 percent more C-sections (5).

How can we collectively reduce the costs of healthcare? While public debates surge about healthcare reform, pharmaceutical regulations, and insurance premiums, one cost-cutting method is available to each of us.

Self-care and prevention practices are less costly than medical interventions and therefore more accessible. If an individual is able to meet their mood management needs through St. John’s wort and 5-HTP supplementation instead of pharmaceuticals, then the cost of treatment is drastically reduced. Similarly, if someone is able to reduce gastric reflux through the use of bitter digestive herbs instead of PPIs, there is less cost to patient and insurer.

The economic benefits of self-care practices have also been documented. An economic evaluation of self-care for adults with epilepsy supported its cost-effectiveness (6). A 2017 observational study found that people with diabetes who received self-care training had 14% reduced odds of any hospitalization, lower numbers of hospitalizations and ER visits, and approximately $830 lower Medicare expenditures compared with those who did not receive it (7). A clinical trial follow-up revealed the cost-effectiveness of self-treatment of chronic obstructive pulmonary disease (COPD) flares (8).

The numbers add up, and many countries are outpacing the United States in the integration of holistic and self-care practices into their healthcare system. In Germany, most general practitioners use complementary and alternative therapies in their daily practice, most of which are covered by insurance programs (9, 10). Germany has a universal multi-payer health care system funded by a combination of statutory health insurance and private health insurance, and spends nearly half per capita on healthcare compared to the United States (11). Providers and patients in Switzerland widely embrace homeopathy, naturopathy, osteopathy, herbal medicine, and acupuncture (12), practices that are covered by the country’s basic health insurance. Switzerland’s total healthcare expenditures are 2/3 of the United States (13). The National Health Service in the United Kingdom has also incorporated herbal medicines, osteopathy, homeopathy, acupuncture, and diet-based therapies into their healthcare offerings (14), which altogether costs as half as much as the healthcare system in the United States (13). The Indian healthcare system integrates ayurveda, unani, siddha, naturopathy, homeopathy, and yoga. India spends 4.7% of its GDP on healthcare, which dwarfs in comparison to the United States’ spending of 17.1% GDP on healthcare according to the most recent WHO data (14).

It leads to big change

We live in a time of rapid change, stress, and chaos. We need healing. Our societies need healing. What to do; where to start?

We start with the self to heal the whole. When I am strong and clear in body, mind, and spirit, I can show up to our collective challenges each day with love, compassion, stamina, and integrity. If I’m burned out and running on an empty tank, I am not an effective activist, researcher, friend, or community member. Many people disengage from collective work and activism because it’s difficult and draining. So we must care of ourselves to care for the whole. This can take many forms: mindfulness meditation, healthful eating, herbal medicine, and activities that foster connections with nature and community.

Similarly, if our societies are ill, our social infrastructure is weak, inequalities and injustices proliferate. And we suffer. Health is not a solo endeavor: healthy bodies need healthy societies, and vice versa.

In the context of U.S. healthcare, going back to basics will move us forward. Instead of taking the form of an app or new delivery system, the most significant healthcare innovation may be a walk in nature and an evening cup of tea. Caring for our own physical, mental, and emotional well-being is a powerful next step for effectively altering the course of American healthcare.

Originally featured in the Dec 2017 issue of Face the Current magazine.

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