The lay resource in health and health care

In our preoccupation with developing professional health careservices, we have lost sight of the contribution of lay peopleto their own health care. Indeed, health care has become synonymouswith professional care. Recently, however, studies in Europeand North America suggest that the lay resource in health careconstitutes at least 85% of all health care provided. As ourknowledge of the world of lay health care expands, there isan emerging appreciation of multiple levels of lay self care,including behaviours relating to promotion, prevention, minorillnesses and injury treatment, chronic disease care, and rehabilitation.These activities appear to derive from an eclectic conceptualbase that incorporates both allopathic and non-allopathic values,beliefs, and care-giving approaches. Furthermore, there is evidenceof patterns of lay health care where care functions tend tobe selectively distributed among discrete elements of the layhealth care "system", comprised of individuals, the immediatefamily, the extended family, friends, mutual aid groups, layvoluntary organizations, and religious organizations. There remain, however, serious conceptual and methodologicallimitations in defining, observing, evaluating and interpretingthe extent, quality and impact of the lay health resource. Itis not, by and large, a regulated or officially sanctioned resource,so baseline data are not routinely available. Research methodsuseful in accounting for the lay system need further developmentand must be sensitive to often very subtle social and culturalaspects of lay health care. Many questions remain regardingdemographic and social variations on the self-care theme. Several factors are proposed as important in enhancing self-care.Chief among these are: The shift in disease patterns from acuteto chronic; increased access to an effective self-care technology;widening public demand for more personal control in health;and the general health information explosion that has contributedto demystify the hitherto sacrosanct domain of medical care.Research on self-care remains on a frontier of knowledge.