Facts and Feelings about Disease Prevention and Health Promotion - The Self-care Movement

In the United States and other developed countries, where does most medical care take place? Is it delivered in hospitals, clinics, or physicians' offices? The correct answer, according to Lowell Levin, Ed.D., M.P.H., emeritus professor of epidemiology and public health at the Yale University School of Medicine, is "none of the above." Dr. Levin says most medical care is delivered in bathrooms, with kitchens running a close second. Naturally the caregiver in these settings is not a physician, nurse, or other health care professional. Levin contends that lay people—frequently mothers—deliver most medical care.

Although Americans traditionally have cared for themselves with treatments ranging from cod liver oil to vitamin E to chicken soup, today many people are taking FIGURE 10.14
Prevalence of current smoking among adults aged 18 years and over, 1997–2003 even greater responsibility for their own health and wellness. They are seeking to prevent disease through diet and lifestyle changes and treating themselves for minor medical problems before visiting a health care practitioner. Many Americans also may rely on the Internet for health information and advice.

Most Americans rely on their own best judgment when it comes to dealing with everyday health problems. In a 1997 joint survey conducted by Prevention Magazine and the American Pharmaceutical Association, respondents were asked what they would do first if they had each of twelve different symptoms and/or conditions. Most said they would self-treat first for headaches (80 percent), upset stomachs (76 percent), diarrhea (75 percent), cold or cough (73 percent), fever (71 percent), menstrual cramps (69 percent), and muscle or joint pain (59 percent). Survey participants said that for more serious conditions, such as chest pain (78 percent), toothaches (63 percent), and yeast infections (48 percent), they would consult with a physician before taking any action.

Dr. Levin and other health educators characterize these self-care educated consumers as curious, assertive, proactive about their health, and intensely interested in complementary and alternative medicine. As a group, self-care consumers expect to be treated respectfully by practitioners. Critics view the self-care movement as antiphysician and dangerous for consumers, and they contend that "a little knowledge may be dangerous," prompting FIGURE 10.15
Percent distribution of smoking status among adults aged 18 years and over, by sex, January–June 2003 patients to make unwise choices or to reject effective treatment. Dr. Levin uses the same argument to bolster his plea to enlarge significantly the breadth and scope of school and community health education programs.

Self-Help Groups

Once considered a form of alternative medicine, self-help groups (also known as mutual aid or peer support groups) have developed to address a host of medical problems, such as diabetes, arthritis, cancer, and alcoholism, as well as psychological and health-related issues, such as bereavement (grief following the death of a loved one), smoking cessation, caregiver support, and coping with disability.

ARE THEY EFFECTIVE FOR EVERYONE?

Although group facilitators, self-care educators, and self-help group members believe that the groups work, there is no scientific evidence demonstrating that participation in self-help groups reduces morbidity or mortality for any specific medical condition. The lack of scientific evidence does not refute or challenge the groups' claims of effectiveness. Instead it underscores the difficulties involved in researching and assessing the outcomes of organized groups, even those widely acknowledged as beneficial, such as Alcoholics Anonymous.

Self-help groups vary in terms of leadership, composition, therapies offered, the setting in which mutual aid FIGURE 10.16
Prevalence of current smoking among adults aged 18 years and over, by age group and sex, January–June 2003 occurs, and the involvement of health professionals. This variability challenges researchers attempting to analyze the data available. Another question that researchers ask is, "When mutual aid group members recover, even when the improvement is measurable, how much improvement should be credited to involvement in the group?"

A 1999 study by the Harvard Medical School suggests that peer support groups may be harmful for some patients. A comparison of breast cancer patient health outcomes reported poorer results—increased physical discomfort and emotional distress—among women who participated in support groups. Harvard Medical School researchers followed 480 women with newly diagnosed, early-stage breast cancer. They found that participants in peer support groups suffered more psychosocial distress and worse quality of life than women who did not attend peer support groups. This lone study offers preliminary support for the observation that self-help groups may not be beneficial for everyone.