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 There are a number of definitions of self-care produced by different authorities at different times – the World Health Organisation for example has produced three much-cited definitions (in 1983, 1998 and 2009). The WHO 1998 definition is:          

‘Self-Care is what people do for themselves to establish and maintain health, and to prevent and deal with illness. It is a broad concept encompassing hygiene (general and personal), nutrition (type and quality of food eaten), lifestyle (sporting activities, leisure etc), environmental factors (living conditions, social habits, etc.) socio-economic factors (income level, cultural beliefs, etc.) and self-medication.’

Different definitions include or emphasise different aspects of self-care. A discussion of the different definitions of self-care has been published (Webber et al. Self-Care in Health: We can define it, but should we also measure it? SelfCare 2013 4(5): 101-106). The range of definitions of self-care, together with the broad and disparate activities that are part of self-care, can lead to definitions of this sort becoming unwieldy for practical purposes.
What is needed for practical implementation of self-care is a description of the all the elements positioned from the individual’s point of view. ISF therefore proposes that a framework for self-care can conveniently be visualised and organised around seven ‘pillars’ or ‘domains’:
1. Health literacy – includes: the capacity of individuals to obtain, process and understand basic health information and services needed to make appropriate health decisions
2. Self-awareness of physical and mental condition – includes: knowing your body mass index (BMI), cholesterol level, blood pressure; engaging in health screening.
3. Physical activity – practicing moderate intensity physical activity such as walking, cycling, or participating in sports at a desirable frequency.
4. Healthy eating – includes: having a nutritious, balanced diet with appropriate levels of calorie intake.
5. Risk avoidance or mitigation – includes: quitting tobacco, limiting alcohol use, getting vaccinated, practicing safe sex, using sunscreens.
6. Good hygiene – includes: washing hands regularly, brushing teeth, washing food.
7. Rational and responsible use of products, services, diagnostics and medicines – includes: being aware of dangers, using responsibly when necessary.
The seven pillars illustrated schematically:
 

The focus of the International Self-Care Foundation is on self-care in the preservation of wellness in healthy people, to help prevent the epidemic of lifestyle diseases. This is where the greatest need lies currently. However, it is important to emphasise that self-care is also essential for people with an existing disease condition, and this is also sometimes referred to as ‘self-management’ of the condition.
Self-care is also usually the first treatment response to everyday health conditions and common ailments. Overall, an estimated 70% to 95% of all illnesses are managed without the intervention of a doctor. Knowing when to consult a healthcare professional is a self-care skill under pillar 1 (health literacy) and pillar 2 (self-awareness).
Self-care is therefore the fundamental level of health care in all societies and should be seen as a major public health resource. Yet self-care is often unrecognised and underappreciated, leading to comparisons with the invisible majority part of an iceberg below the surface, or to a hippopotamus in those countries in latitudes less familiar with icebergs.
       
         
More on definition of self-care
Definitions of self-care have evolved over time. Commonly quoted definitions are as follows (chronological order):
 “Self Care in health refers to the activities individuals, families and communities undertake with the intention of enhancing health, preventing disease, limiting illness, and restoring health. These activities are derived from knowledge and skills from the pool of both professional and lay experience. They are undertaken by lay people on their own behalf, either separately or in participative collaboration with professionals.”

World Health Organization (WHO). Health Education in Self-Care: Possibilities and Limitations. Report of a Scientific Consultation. Geneva, Switzerland. November 21–25, 1983.
“Self-Care is what people do for themselves to establish and maintain health, and to prevent and deal with illness. It is a broad concept encompassing hygiene (general and personal), nutrition (type and quality of food eaten), lifestyle (sporting activities, leisure etc.), environmental factors (living conditions, social habits, etc.), socio-economic factors (income level, cultural beliefs, etc.) and self-medication.”
WHO. The role of the pharmacists in self-care and self medication: report of the 4th WHO consultative group on the role of the pharmacist. Geneva, 1998.
“Self-Care is a lifelong habit and culture. It is the action individuals take for themselves and their families to stay healthy and take care of minor and long term conditions, based on their knowledge and the information available, and working in collaboration with health and social care professionals where necessary”.
UK Department of Health Steering Group. Joining Up Self-Care in the NHS. 2003
 “Self care is a part of daily living. It is the care taken by individuals towards their own health and well being, and includes the care extended to their children, family, friends and others in neighbourhoods and local communities. Self-Care includes the actions individuals and carers take for themselves, their children, their families and others to stay fit and maintain good physical and mental health; meet social and psychological needs; prevent illness or accidents; care for minor ailments and long-term conditions; and maintain health and wellbeing after acute illness or discharge from hospital.”
UK Department of Health. Self-Care – A Real Choice. 2005.
“Self-Care is the ability of individuals, families and communities to promote health, prevent disease, and maintain health and to cope with illness and disability with or without the support of a health-care provider”.

WHO SEARO. Self-Care in the Context of Primary Health Care. Report of the Regional Consultation Bangkok, Thailand. 7-9 January 2009.
Some general observations about these definitions may be made. Self-care definitions commonly include individuals, their families, friends and communities. Community-level action to support people in self-care will be of increasing importance in future.
There is an emphasis on the prevention of disease or illness and the maintenance of wellness. In this the definitions are aimed primarily at healthy people.
This is not to say that self-care is unnecessary or inappropriate for people with an existing disease condition. Self-care in this situation is essential and is sometimes referred to as ‘self-management’ of the condition.
Self-care is personal healthcare oriented around the individual, but does not exclude healthcare professional support. A current focus of attention in self-care includes recognition of new roles for healthcare professionals in ‘collaborative care.’


In fact, knowing when to consult a healthcare professional is an important judgement that a self-caring person must make, and should be the result of a self-determined self-care decision-making process. The role of patient in symptom recognition and minor ailment diagnosis is relevant in this context.
More recent definitions have included a focus on risk factors and risk factor avoidance in areas such as personal injury and accidents.
The concept of health promotion is emerging and will be of increasing importance in future.
Self-medication is mentioned in the pharmacist-context definition, meaning ‘responsible’ self-medication with non-prescription (over-the-counter, OTC) medicines. Self-medication with prescription medicines is unfortunately a common practise in many countries but is undesirable and potentially dangerous. By contrast, rational and responsible use of prescription medicines under the supervision of a doctor is an important self-care activity where responsibility ultimately lies with the individual.
For a further discussion on self-care definitions see the following paper: David Webber, Zhenyu Guo and Stephen Mann. Self-Care in Health: We can define it, but should we also measure it? SelfCare 2013 4(5):101-106.

什么是自我保健?
“自我保健”在不同时期有多种不同的官方定义,例如世界卫生组织在1983、1998和2009年就分别出台了三种被数次引用的定义。以下是WHO1998年的定义:
 ‘自我保健是人们为了维护健康并且预防和应对疾病的一种行为。这是一个广义的概念,它包括卫生(大众和个人),营养(类型和所食用食品的质量),生活方式(运动、休闲等),环境因素(生活条件、社会习惯等),社会经济因素(收入水平,文化信仰等)和自我药疗。’
不同的定义包括或者强调了自我保健的不同方面。有关对自我保健不同定义的讨论一书已经发表(韦伯等人撰著的《自我保健:可以被定义,是否也该被衡量?》 SelfCare 2013 4(5): 101-106)。
对于自我保健的定义,有的定义包含了广泛的活动,有的只针对单一活动,由此得出的定义对于实际实践来说意义甚微。
自我保健的实际实践就是需要对个人观点全方位的描述。因此国际自我保健基金(ISF)提出了一个可视性高且易于总结的自我保健框架,它主要包括七个“核心”或“方面”:
1. 健康素养——个人获取和理解健康信息,并运用这些信息维护和促进自身健康的能力。
2. 对身体和精神状况的自我意识——包括了解自身身体质量指数(BMI)、胆固醇水平、血压水平和进行健康检查。
3. 身体锻炼——进行中等强度的身体锻炼,如散步、骑自行车或以一种理想的运动频率进行运动。
4. 健康饮食——饮食营养且膳食均衡,同时有适当水平的热量摄入。
5. 风险规避或缓解——包括戒烟、适量饮酒、接种疫苗、安全性行为和使用防晒霜等。
6. 良好的卫生习惯——包括勤洗手、刷牙和洗净食物。
7. 合理使用产品、享受服务、接受诊断和食用药物——要有危险意识和鉴别能力。
   
七大核心解析示意图:
国际自我保健基金的重点在于健康人群通过健康自我保健来防止生活方式疾病的蔓延。这便是当前的重中之重。然而,值得强调的是,自我保健对于患病者来说依旧重要,这有时也被称为身体状况的“自我管理”。
自我保健通常是人们日常健康状况和常见疾病的第一回应。统计表明70-95%的疾病都可自我控制,而无需医生介入。知道何时向医疗专家进行咨询是继核心1(健康素养)和核心2(自我意识)后的又一个自我保健小技巧。
因此,自我保健是全社会健康保健的最基本的行为,应该被视作主要的公众健康维护方式。然而自我保健往往不被重视或被低估,(若将此现象以冰山作比的话)可以看到自我保健就像一座冰山被淹没于水平面下的部分,但该部分却是冰山的主要部分,或者也可以类比成那些远离冰山纬度地区国家的河马(因为河马身体的大部分也隐藏在水面下)。
   
     

更多自我保健的定义
自我保健的定义随着时间的推移也发生了很多变化。以下是通常被引用的定义(按时间顺序排列):
“自我保健是指个人、家庭和全社会所进行的旨在巩固健康、预防疾病、减少疾病风险和恢复健康的各种行为活动。这些行为活动都是基于从专业健康知识和丰富经验总结出来的一些知识和技巧。人们可以自己进行自我保健实践或者与专业人士一起合作进行。”
世界卫生组织(WHO)《自我保健健康教育:可能性与局限性》科学咨询报告,日内瓦,瑞士,1983年11月21-25日。

 ‘自我保健是人们为了维护健康并且预防和应对疾病的一种行为。这是一个广义的概念,它包括卫生(大众和个人),营养(类型和所食用食品的质量),生活方式(运动、休闲等),环境因素(生活条件、社会习惯等),社会经济因素(收入水平,文化信仰等)和自我药疗。’
WHO《论自我保健和自我药疗中药剂师的作用》:第4届世界卫生组织咨询小组关于药剂师作用议题的报告,1998年,日内瓦。

 “自我保健是一种终身的习惯和文化”。自我保健是人们在已有知识和信息的基础上,为自己和家人保持健康和照顾身体小疾大病所做的行动和必要时寻求专业健康和社会医疗专家帮助所付出的努力。”
英国卫生部健康督导组,2003年英国国民健康保险制度自我保健项目。
 “自我保健是每日生活的一部分。它是每个人为了自己的健康,并推及到孩子、家人、朋友、邻里和本地社区的健康而进行的保健活动。自我保健包括个人和护理者为自己、孩子、家人和其他人保持身心健康所采取的行动;符合社会和心理所需的行动;预防疾病或事故的行动;对小疾大病的护理行动和在患急性病之后或出院后维持健康的行动。”
英国卫生部,《自我保健——现实的选择》,2005年。
 “自我保健是个人、家庭和社会为了促进健康、预防疾病、维持健康并且在有/无医疗保健支持的情况下积极应对疾病和残疾的能力。”
世界卫生组织东南亚地区办公室,泰国曼谷区域咨询报告《初级健康保健中的自我保健》,2009年1月7-9日。
从这些定义中可以得出一些结论。自我保健的定义通常包含个人、家庭、朋友和社会。社会层级的帮助人们进行自我保健的行动对于未来的意义将愈加重大。
同样,疾病的预防和健康的维护也至关重要。在这里,这些定义主要是针对健康的人群。
这并不是说自我保健对于已患病患者不必要或不合适。这种情况下的自我保健仍旧必要且有时会被说成是健康状况的“自我管理”。
自我保健虽然是指个人的健康保健,但并不排除有专业指导下的健康保健。当前自我保健的一个重点是需要认识到医疗专业人士在合作保健中所扮演的新角色。
事实上,知道什么时候向医疗专业人士进行咨询是一个重要的判断,这也是自我保健人士必须做出的自我决策。本文中所说的病患在病症识别和小疾病诊断中所起的作用的相互关联的。
最新的定义则将焦点放在了诸如人身伤害和事故中的风险因素和风险因素规避上。
促进健康是一个比较新兴的概念,其重要性将在未来日益增加。
上文药剂师一文的定义中提到了自我药疗,意思是负责任的自行服用非处方药(OTC)。自行服用处方药的现象在很多国家都司空见惯,但不幸的是该种行为很不可取并且存在现在的危险。相较而言,在医生的监督下合理且负责任的服用处方药就是一种重要自我保健行动,而责任也最终归于个人。

如想进一步了解自我保健定义的讨论,详见:David Webber,郭振宇和Stephen Mann共同撰写的文章《自我保健:可以被定义,是否也应该被衡量?》出自《自我保健2013》 4(5):101-106.







 


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