The expression 'self healthcare' is not one that slips easily off the tongue. It describes a particular approach to health promotion that is the subject of this book. The first three chapters set out the history of health promotion policy, which, until the 1990s, largely ignored the needs of older people. The philosophy of self-health is that it is no good simply telling people what they should do to improve their health. People need access to resources, support in translating ideas into practice, good information, ability to make choices, and opportunities to participate and develop appropriate skills.
The author briefly describes five projects in the UK, Canada, the US and Israel that have used the concept to promote the health of older people. It is interesting to see that one project developed a programme for 'mental fitness' in response to the views of participants. The impact of the projects is brought to life by quotes from older people, illustrating the indivisibility of health and social well being. The importance of considering the context of people's lives and the wider environmental and political issues is underlined. While a move to institutional care is for most older people an undesirable option, for someone accustomed to communal life on a kibbutz, for example, adapting to life alone can seem equally unappealing.
The largest part of the book is concerned with a detailed description and evaluation of the self health care in old age project, established by the Beth Johnson Foundation in the mid1980s. For those with an interest in the history of health policy, it is interesting to note that the then Department of Health and Social Security was sceptical about involving older people themselves in health promotion activities. Failing to get sponsorship in the UK, it obtained EU funding through a programme to combat poverty.
The project has four interlinking elements:
a peer health counselling scheme;
a telephone link service to support people considered at risk in the community;
health-related courses and activities; and a 'senior health' shop.
For anyone thinking of setting up this type of scheme the book provides a very rich picture of how things work, the people attracted to the project and the resulting changes in older people's behaviour and well being.
The impact on the volunteers is also considered and the learning for paid staff. Case studies illustrate the backgrounds of participants and their experiences of the project. While the outcomes are positive for participants, problems in attracting men and people from minority ethnic groups are cited. The failure to involve older people as researchers is seen as an oversight.
Given the emphasis on preventing ill-health in older people and the value of 'one-stop shops' in the recent NHS plan, this book is timely. The final section sets out a detailed checklist of practice considerations and goes on to explore health policy implications.
Anyone aiming to provide community-based health promotion activities for older people should find this useful.