Introduction

Self-care is about people taking responsibility for managing their health themselves in conjunction with, when needed, healthcare professionals and other information and support services.

A recent definition for self-care, developed by a multi-disciplinary expert panel, was as follows:

PAGB has long been championing the need for self-care by lobbying at the government level, conducting research, producing relevant publications and organising self-care conferences.

The notion of people managing their own health can mean different actions to different individuals. For a healthy twenty-something woman who eats healthily and exercises regularly, self-care could mean simply treating the symptoms of a cough and cold. For a middle-aged man who smokes a lot and leads a sedentary life, self-care could involve making major changes to his lifestyle and improving his diet.

Self-care does not mean individuals are left on their own. Nor does self-care translate into "no-care". The expertise and support provided by pharmacists, GPs and other health professionals are absolutely critical to making self-care work. Achieving an effective partnership between the individual and health professionals is the crucial matter.

The origin of self-care

Self-care is not a new concept. For as long as man has been alive, we have been taking care of our own health. Within the last fifty years or so, however, with the evolution of the healthcare professions - doctors, nurses and pharmacists - and the creation of institutional and public services - like the National Health Service - people have become much less self-reliant for managing their health.

Consequently, people have become increasingly used to turning to their doctor and to the NHS as their first port of call when illness has struck, including for many common ailments. Many people do not think about managing their health proactively themselves and, anyway, do not have adequate knowledge or skills to do so. Findings from recent research indicate that:

• 50 per cent of consumers don't worry about their health at all or don't worry very much and 70 per cent of people would rate their health as being very good or fairly good
• At least 10 per cent of common ailments are still presented to the GP. This equates to 96 million consultations a year, equivalent to 300,000 consultations each day.
• More than 1 in 3 GP consultations are for minor illnesses and 20-40 per cent of GP time is spent on minor ailments
• In emergency care as many as 30-40 per cent of attendances are for minor illness/injuries

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Range of common ailments in self-care

Pharmacists know well the wide range of common conditions that people experience - including the common cold, tiredness, headaches, other aches and pains, cuts, bruises and stomach-related upsets.

However, if the scope for self-care is extended to longer-running, everyday conditions such as skin problems and smoking cessation and potentially wider still to conditions like obesity, diabetes, cardiovascular disease, arthritis and asthma, it is quickly apparent that the relevance and importance of self-care to the health of the nation is immense.

Heart disease alone causes more than a quarter of a million deaths a year in the UK, and the government's recent decision to approve the switch of simvastatin to over-the-counter status was a clear signal of its support for growth of self-care.

The potential market for self-care should also be seen as including a larger role for vitamin and mineral supplements. Data from the government's recent National Diet and Nutrition Survey confirmed the poor state of the average person's diet, with only 13% of men and 15% of women actually consuming the recommended five portions of fruit and vegetables a day.

How people treat themselves

PAGB research (1997) clearly shows that consumers, when they experience a minor ailment, see it as important to have access to suitable medicines over-the-counter and that they are confident in their ability to select what to buy. At the same time, though, they are safety-conscious and value the advice that a health professional can offer if they are unsure about a health problem:-

Panel - Consumers' attitudes to medication
Percentage of responses that agreed a lot, or agree a little

• ''It is important to me to have medicines that you can buy
  to help relieve minor medical problems" 79 per cent
• ''If I have a minor problem I am confident I can decide what to
  buy to treat it" 70 per cent
• ''If I am unsure about a problem, I always look for
  professional medical advice" 79 per cent
• ''I read the instructions carefully before taking a medicine
  or treatment for the first time" 92 per cent

The same PAGB research showed that a significant proportion (46 per cent) of minor ailments are actually left untreated, one key reason being that people think the condition is not serious enough or will get better by itself. About one in four minor ailments (27 per cent) were treated with an over-the-counter product (either bought or turning to a product already in the home).

When people chose to use a medicine without a visit to a professional, the key reasons were that they recognise the symptoms readily or they have had prior experience themselves of the condition. After they have used an OTC, the overwhelming majority of sufferers consider the medicine to have been effective (89%).

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The OTC market

At the end of 2003 the OTC market in the UK, based on figures supplied by IRI, was worth just under £2 billion. After a few years of virtually no growth, last year saw the market grow by 4.1 per cent. A summary breakdown of the largest categories in the market is a follows:

Product category Value £m Sales

• Analgesics - 465.4
• Cough/cold/sore throat - 375.4
• Skin treatments - 353.1
• Vitamins and minerals - 295.7
• Gastro-intestinal - 235.9
• Hayfever - 79.2
• Smoking cessation - 77.8

The main categories showing the highest rates of growth include skincare products, topical analgesics, hayfever and smoking cessation products. Increased public interest in preventative and everyday healthcare, together with wider availability through reclassification, are behind the growth seen with hayfever and smoking cessation.

Regulation of OTC products

The production and supply of OTC medicines take place in an environment that is governed by the same regulatory framework that applies to prescription medicines.
Dietary supplements are controlled by food safety and labelling legislation, including a new European Directive that reinforces the safety of such products. A separate Directive has been developed that will bring a more robust regulatory framework for traditional-use herbals.

One major difference in the control of OTC medicines is that, unlike prescription medicines, they may be advertised and promoted to the public and health professionals. There are, though, specific regulations and codes of practice that apply to such advertising, to ensure that the benefits, uses and effects of OTC medicines are communicated in a balanced and responsible way. The Medicines and Healthcare products Regulatory Agency itself closely monitors OTC advertising, working closely with a small number of self-regulatory organisations - like PAGB whose manufacturer member companies must have their consumer adverts pre-vetted by the Association before public use.

Pharmacists, of course, play a vital role in reinforcing regulations by providing everyday expert advice, information and support to consumers when they buy an OTC medicine from their local pharmacy.

The new rise of self-care

Despite the 'culture' of reliance on the health service mentioned earlier, self-care is now definitely on the rise again. This is mainly due to the fact that the government, following The NHS Plan in 2000, has now embraced self-care as one of the five, key service elements alongside primary care, intermediate care and secondary and tertiary care. The rise of self-care, though, is also due to new social factors like individuals becoming more independent-minded and confident as consumers, greater accessibility to health information in the media, and people wanting more choice and control in their lives.

Consumers increasingly want to be involved in managing their health. They value the convenience, independence and feeling of greater control that comes from being able to access medicines over-the-counter. At the same time, though, they do want the support and expertise to call upon, when needed, from pharmacists, GPs and other health specialists.

The government's keenness to encourage the growth of self-care is now unmistakable in all its health policies. One of the strongest signals yet was the appointment within the last year of a national Director of Self-Care, whose role it is to champion and drive the adoption of self-care principles across the health service.

Other major signals include the expansion of NHS Direct and local Walk-In Centres, development of the Expert Patient Programme, reference to self-care in all National Service Frameworks, encouragement of wider availability of OTC medicines, and the introduction of new contracts for GPs and pharmacists that highlight the importance of self-care. For pharmacists, the government's key document, 'A Vision for Pharmacy in the New NHS' (July 2003) stressed how pharmacies are at the core of successful self-care delivery in the future.

Self-care is now happening and moving forward steadily. Pharmacists are already involved but have a wonderful opportunity to embrace the change and enhance their professional status and contribution further. Or, alternatively, watch self-care happen around them.

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