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            A BRIEF HISTORY OF SELF-CARE

Self-care is not a new activity. People have necessarily managed their own health since the beginning of mankind. Throughout human history the dominant paradigm of healthcare was individual self‐care in the family and local community. Treatment involved self‐medication with locally‐produced preparations of generally uncertain efficacy. People themselves were responsible for their own health, and that of their families, as self‐sufficiency was obligatory and almost universal. The opportunity and need for improvement were great.
Starting in the 19th Century and carrying on through the 20th Century, health care was revolutionized by scientific and medical discoveries, technological advances in diagnostics, surgery and medicines, and the development of the healthcare professions. Patients gratefully placed themselves into the hands of doctors and took the effective newly‐developed medicines they prescribed. The role model of the patient as a largely passive recipient of public services was complemented by the mystique of the expert healing physician. At the low point of self‐care – around the 1960’s in the West – self‐care and self‐medication were regarded as unnecessary and potentially even unhealthy practices. This paternalistic approach to medicine, supported by health systems designed to treat sickness (rather than to prevent disease) remains a familiar aspect of healthcare in many countries to this day.
Circumstances and societies are ever‐changing, however. The paternalistic approach to medicine is expensive when applied to entire populations, especially in ageing countries. People around the world are better educated and want more information, choice and control over their lives – not least in the area of health. Chronic ‘lifestyle’ conditions such as cardiovascular disease, cancer and diabetes are taking over from infectious diseases as the primary cause of death and disability in most countries. These chronic non‐communicable diseases are significant in that they are substantially preventable through better ‘self‐care’ – by individuals avoiding risks such as smoking and obesity. The paternalistic approach and health systems that provide ‘sickness services’ are becoming less well‐attuned to the 21st Century’s health challenges and needs.
As a result, over the past 40 years there has been a push‐back against the paternalistic model of health, towards a more person‐centric approach involving self‐care. A patient’s needs and rights have become central considerations and run through many of today’s initiatives in health – in medical ethics, patient autonomy and ‘person or patient‐centred medicine’. Of course, along with patient’s rights comes responsibilities. There has been a growing realisation that personal self‐care in the home environment and community setting should be the starting point of healthcare, and is in fact the foundation for people to manage life‐long health. Initiatives in ‘community healthcare’ and ‘health promotion’ are aspects of the new approach.

自我保健简史
自我保健并不是一项新的活动。自人类起源,人们就开始管理自己的健康。纵观人类历史,医疗保健的主导形式是以个人为单位在家庭和当地社会中的自我保健形式。保健的内容包括使用一般不确定药效的局部制剂进行自我药疗。人们自行对自己和家人的健康负责,因为充分发挥自主性是人们义不容辞且普遍的行为。因此自我保健带来的商机和人们对改善健康的需求都很大。
从19世纪到贯穿整个20世纪的时间里,医疗保健在一次次科学和医学新发现中,诊断技术、手术和药物的进步中,医疗保健行业的发展中经历了革命性的转变。病人安心地将其生命交付给医生,并积极服用有疗效的新发明药物。因此在当时,病人大多扮演的是公共服务的被动接受者,专业医师的治疗也十分具有神秘色彩。20世纪60年代, 西方的自我保健程度达到最低点,自我保健和自我药疗均被视作非必要和存在潜在健康风险的行为。这种以治疗疾病(而非预防疾病)为主的传统医学方法,直到今天仍然存在在许多国家的医疗体系中。
然而,当今环境和社会发生了前所未有的改变。传统的医学方法对于全人类,尤其是对老龄化国家来说,花费相当昂贵。随着全世界的人们接受越来越良好的教育,他们需要了解的信息更多,希望得到更多的选择和对生活更多的掌控,而且不仅仅局限在健康领域。慢性“生活方式”疾病,如心血管疾病、癌症和糖尿病已经远远超过传播性疾病成为大多数国家致死和致残的主因。这些慢性非传播性的疾病基本上大多是可以通过个人的自我保健来预防的,这样就可以规避诸如吸烟和肥胖这样的风险因素。因此,以提供“疾病服务”为主的传统医学方法和健康医疗体系也变得渐渐不能应对和满足21世纪的健康挑战和需求。
在过去40年里,传统的医疗模式大多被推翻,人们更愿意去选择适合自己的(以人为本的)自我保健方式。病人的需求和权利已然成为现今最主要的考虑点且贯穿于今天如医学伦理、病人的自主权和以个人/病人为中心的医学等诸多健康倡议的理念。当然,与病人的权利相对的就是责任义务。现在越来越多的人意识到,无论在家庭还是社会中,个人的自我保健应该成为医疗保健的最佳起始点,实际上也是人们管理长久健康的基础。因此,新的医疗保健方法应当涵盖“社会健康医疗”和“促进健康”等方面。


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