Informed self-care
People can and should take the lead in their own health care.
People can and should take the lead in their own health care.
- Health care is not only everyone's right, but everyone's responsibility.
- Informed self-care should be the main goal of any health program or activity.
- Ordinary people provided with clear, simple information can prevent and treat most common health problems in their own homes — earlier, cheaper, and often better than can doctors.
- Medical knowledge should not be the guarded secret of a select few, but should be freely shared by everyone.
- People with little formal education can be trusted as much as those with a lot. And they are just as smart.
- Basic health care should not be delivered, but encouraged.
A part of informed self-care is knowing one's own limits. [One must learn] not only what to do, but when to seek help [— and how to navigate health care and billing systems, the legal system, and benefit programs. And one must know] what to do in the meantime — even for very serious problems.
— David Werner (1977, 1992), Where There Is No Doctor. Berkeley: Hesperian.
- Each community needs to find its own solutions to its own problems. There are no easy or 'universal' answers that can be brought in from outside.
- Human factors (more than technical ones) are what make community activities fail or succeed.
- To serve those whose needs are greatest, community programs must make every effort to help the weak gain and keep control. (Sometimes this may mean refusing or limiting assistance from those in positions of power—whether inside or outside the community).
- To be healthy is to be self-reliant.
— David Werner and Bill Bower (1982), Helping Health Workers Learn. Berkeley: Hesperian.
Independent living
Independent Living is a philosophy and a movement of people with disabilities.
Independent Living is a philosophy and a movement of people with disabilities who work for self-determination, equal opportunities and self-respect. Independent Living does not mean that we want to do everything by ourselves and do not need anybody or that we want to live in isolation. Independent Living means that we demand the same choices and control in our everyday lives that our non-disabled brothers and sisters, neighbors and friends take for granted. We want to grow up in our families, go to the neighborhood school, use the same bus as our neighbors, work in jobs that are in line with our education and interests, and start families of our own.
Since we are the best experts on our needs, we need to show the solutions we want, need to be in charge of our lives, think and speak for ourselves — just as everybody else. To this end we must support and learn from each other, organize ourselves and work for political changes that lead to the legal protection of our human and civil rights.
We are profoundly ordinary people sharing the same need to feel included, recognized and loved.
— Adolf Ratzka, 2005
Recovery
Recovery is a movement and an attitude towards addictions, trauma, and psychiatric labeling.
Four major dimensions support a life in recovery:
Health: … making informed, healthy choices that support physical and emotional wellbeing.
Home: a stable and safe place to live;
Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and
Community: relationships and social networks that provide support, friendship, love, and hope.Guiding Principles of Recovery:
- Recovery emerges from hope
- Recovery is person-driven
- Recovery occurs via many pathways
- Recovery is holistic
- Recovery is supported by peers and allies
- Recovery is supported through relationship and social networks
- Recovery is culturally-based and influenced
- Recovery is supported by addressing trauma
- Recovery involves individual, family, and community strengths and responsibility
- Recovery is based on respect
— See http://blog.samhsa.gov/2012/03/23/defintion-of-recovery-updated/
Community accountability
People impacted by crime and interpersonal violence can successfully address it without resorting to mob justice, criminalization, biomedicalization, or nonprofitization.
Community accountability is a community-based strategy, rather than a police/prison-based strategy, to address violence within our communities. Community accountability is a process in which a community – a group of friends, a family, a church, a workplace, an apartment complex, a neighborhood, etc – work together to do the following things:
- Create and affirm values & practices that resist abuse and oppression and encourage safety, support, and accountability
- Develop sustainable strategies to address community members' abusive behavior, creating a process for them to account for their actions and transform their behavior
- Commit to ongoing development of all members of the community, and the community itself, to transform the political conditions that reinforce oppression and violence
- Provide safety & support to community members who are violently targeted that respects their self-determination
— see http://www.incite-national.org/page/community-accountability
Community accountability strategies [are ways to] respond to harm without creating more harm — to survivors of violence, the imprisoned, their children and families, the communities they are removed from and returned to, and the schools, social programs, and parks and recreation facilities that continue to suffer budget cuts.
— Julia C Opara, Afterword: After the Juggernaut Crashes. Social Justice 37(4), 2011 (p. 134)
Harm reduction
Self-care, independent living, recovery, and accountability are facilitated by helping people develop the resources, strategies, and motivation to reduce immediate and structural harms.
Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.
Harm reduction incorporates a spectrum of strategies from safer use, to managed use, to abstinence to meet drug users "where they're at," addressing conditions of use along with the use itself. Harm reduction demands that interventions and policies designed to serve drug users reflect specific individual and community needs.
— See http://harmreduction.org/about-us/principles-of-harm-reduction/
Harm reduction concepts and approaches are applicable far beyond drug users. For instance, a seat belt is a harm reduction measure for people who use cars.
It is particularly applicable to health work in communities where excess illness, injury, and death correlate with structural harms like racism.
[Unlike most epidemiologists, many] people of color with heart disease … directly attribute their own or others' illness to the multiple effects of racial discrimination in education, housing, employment, and everyday life. These effects range from the emotional and physical experiences of stress and suppression, to the damage to one's sense of self, to the drive to work extremely hard to overcome stereotypes and succeed in white- and male-dominated domains.
Some epidemiologists do at times invoke structural dynamics as possible sources for racial inequalities in CVD. But most often these scientists interpret the meanings of racial differences through a cultural prism in which racial disparities are attributed to cultural differences. Researchers repeatedly refer to differences of a "cultural" or "ethnic" nature, ones they perceive to be related to customary beliefs and practices of a racially or ethnically defined minority group: "their thinking process, how they make decisions," "cultural habits of how they eat, whether they exercise, those kinds of things."
— Janet K. Shim (2010). The Stratified Biomedicalization of Heart Disease: Expert and Lay Perspectives on Racial and Class Inequality. In Biomedicalization: Technoscience, Health, and Illness in the U.S. Adele E. Clarke et al., eds. Durham, Duke University Press, 218-241
Social change on a systemic/policy level — universal healthcare, for example — would make the most substantial impact on the health of … patients, but community level change is the next best thing…. For this reason [Common Ground Health] Clinic volunteers argue that a "political push" running alongside their provision of services is necessary to improve patient health. Early on it became clear that they would have to choose between being outwardly political and losing their non-profit tax exempt status, or find ways to affect the community without overt politics. They chose the latter, doing so through the provision of healthcare and facilitating the growth of community voice and resources.
If many aspects of the individual's health status are beyond their control, what is the role of individual-oriented interventions? The answer is that … individual interventions are targeted at counteracting and validating the damage that the existing system has done on an emotional level, and ensuring that the individual's concrete, immediate needs are met — diagnosis and treatment of illness, providing free medications, stress management, etc. Until the causes of stress can be removed through social action, healthcare … can restore an ill patient's agency and increase their ability to fight for themselves — so healthcare becomes a tool for "survival pending revolution," as the Black Panthers phrased it.
— Rachel Judith Stern (2007). "This is Solidarity," Not Biomedicine: The Common Ground Health Clinic and Discursive Intervention in Racial and Ethnic Health Inequalities. BA thesis: Harvard College, Social Science department.
