The Seven Pillars of Self-Care

If you type “self-care” into your web browser’s search engine, chances are you will be overwhelmed with hundreds of articles, blog posts, search engine FAQs, and videos talking about many different versions of self-care. Mainstream media often portrays self-care as bubble baths, visiting a spa, going for a walk, or something else that is relaxing but relatively surface level whereas medical forums would suggest annual check-ups, taking vitamins, and living a healthy lifestyle. The truth is, self-care encompasses all of these things and more.

According to the International Self-Care Foundation (ISF), the creators of the seven pillars of self-care, “self-care is not just an option but a fundamental pillar of overall health.” The ISF shares that there are many elements to lifestyle disease prevention, but at the core is the need for individuals to change their self-care and lifestyle habits. However, there are significant system-based challenges with implementing self-care change:

1. Today’s healthcare systems are effectively “sickness services” oriented more toward treating the sick than preventing disease. Worse still, health systems can encourage reliance on them and complacency toward one’s own health.
2. Self-care is the foundation of healthcare, but it occurs largely outside of formal health and social systems, making it harder for governments to engage in and support it.
3. Self-care can be supported at many different levels – in the family, in the community, in companies, or in the home, but currently, there is little connection or integration.
4. The individual elements of self-care are simple in concept, and some are even basic habits, but they should be approached in an integrated and holistic manner. By contrast, Western medical approaches tend to target one problem at a time.
5. There is much interest and support in the individual elements of self-care, but no natural champions cover the entire self-care space.

In addition to these system-based issues, it is equally difficult for individuals to adopt and sustain good self-care practices. Reasons for individuals not undertaking lifestyle changes include:

• “It” (lifestyle disease) won’t happen to me /the risks are exaggerated
• I’ll start tomorrow, I have bigger problems today/we all die from something
• Lifestyle modification is hard to keep up; I don’t have time/money/energy for it
• If I get sick, I go to the doctor – that’s what I pay my taxes/insurance for

Taking all of this together, it is apparent that while the threats of lifestyle diseases are massive, the challenges of adopting self-care are also massive. This is why the ISF created the Seven Pillars of Self-Care.

Pillar One: Knowledge and Health Literacy

The World Health Organization (WHO) defines health literacy as representing, “The cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways to promote and maintain good health”. Health literacy is important because people with strong health literacy skills enjoy better health and wellbeing, while those with weaker skills tend to engage in riskier behaviors and have poorer health. Good health literacy skills allow an individual to interpret the information they are given about health, to find and use their own sources of health information, and to understand when information is poor or misleading.

Poor health literacy has been shown to result in less healthy choices, riskier behavior, less self-management, poorer overall health, and more hospitalization. Lack of health literacy at a broader level significantly drains human and financial resources in the health system. People are not able to realize their health potential unless they can control the factors that determine their health, and health literacy is one of the strongest predictors of this control. It is significant to note that health literacy is a stronger predictor of an individual’s health than income, employment status, education level, and racial or ethnic group.

Markers of having good health literacy include:

• Understanding that people have an opportunity to protect their own health
• Knowing where to look for health information and how to use it
• Knowledge of health and its determinants
• Knowledge of common diseases and their causes
• Knowledge of the major risk factors of cardiovascular diseases, diabetes, and of other avoidable risks to health
• Understanding self-care, e.g., the seven pillars
• Understanding the value of health screenings at key life points
• Knowing how to use self-care products safely and effectively
• Understanding medicines and vaccines
• Knowing when to seek professional advice
• Knowing how to join, help, and motivate others, such as family members
• Understanding the indirect determinants of health, such as understanding food labeling

Pillar Two: Mental Wellbeing

There are many different definitions of mental wellbeing, but they generally include areas such as life satisfaction, optimism, self-esteem, mastery, feeling in control, having a purpose in life, and a sense of belonging and support. The WHO defines mental health as a state of wellbeing in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to her or his community. The positive dimension of mental health is stressed in the WHO’s definition of health as contained in its constitution: “Health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity.”

Self-awareness, and essential element of mental wellbeing, is the personal, practical application of an individual’s health knowledge (Pillar 1) to their own health situation. This may involve personal or professional assessments, references to records, and undertaking tests. The result is a baseline assessment of their mental and physical state – that is, an individual’s health capital or health status “scorecard”. Agency, another element, is the capacity and intention of an individual to take action based on their knowledge and awareness of their situation and condition – physical and mental.

Self-awareness and agency are important because they provide the basic starting position for all future self-care activities. Everyone has some positive health capital, and it is important to identify these areas of strength. Over time, improvements in health can then be registered against this baseline. This allows an individual to identify and act on areas needing improvement. It is human nature to avoid confronting unpleasant realities – for example, excessive body weight, insufficient exercise, or risks attached to activities such as smoking or alcohol consumption. A baseline assessment and ongoing monitoring of self-care activities help to overcome this tendency to avoid addressing our bad habits.

A lack of self-awareness is the cause of insufficient understanding or motivation to improve one’s health situation which will limit the potential gains that can be achieved through self-care. As with any long-term, challenging goal, if the benefits gained from self-care are not recognized, an individual’s motivation and drive may fade over time. A lack of self-awareness and agency also plays a part in the slow, incremental loss of health that leads to many non-communicable diseases. No one becomes overweight or develops risk factors for non-communicable diseases overnight; these problems develop slowly over years of poor self-care and inadequate self-awareness.

So how do we sufficiently measure and monitor our health? A person with good self-awareness of their health should know and have recorded the general metrics that track levels of health and disease. While a large list, in general, this should include knowledge of:

• Your family’s medical history and any genetic predispositions
• Which vaccinations you have had
• Your resting heart rate and blood pressure
• Your weight, height, and body mass index (BMI) [note: it’s important to remember that BMI was developed almost entirely based on white European men and is not the best indicator of health for diverse populations]
• Your cholesterol levels
• Your HbA1c level (for blood glucose)
• Your mental and emotional health
• Your stress levels
• Your sleep profile
• Your oral health situation
• Your current level of physical activity
• Your diet
• Your risk profile of negative contributing factors, such as how many tobacco cigarettes you smoke per week, or the number of alcoholic units consumed per week

Other useful information that forms part of a strong self-awareness of an individual’s health includes:

• Knowing which screening tests you should undertake and at what age these should begin (e.g., colorectal cancer screening recommendations vary based on age)
• An assessment of your day-to-day hygiene practices (e.g., sneezing, coughing, washing hands after toilet)
• An assessment of your ability to use self-care products and services safely and whether you access professional help appropriately and in a timely manner

Pillar Three: Physical Activity

Physical activity is generally defined as any bodily movement produced by skeletal muscles that requires energy expenditure. It is essential to good health and regular exercise can reduce the risk of many non-communicable diseases. Pillar 3 focuses on the need for, and benefit gained from, regular physical activity. The pillar outlines the levels of activity considered necessary for an individual to remain healthy throughout their lifetime. Physical activity is important because regular moderate-intensity physical activity – such as walking, cycling, or participating in sports – significantly improves health, fitness, and mood.

Being active can reduce the risk of a host of non-communicable illnesses, such as cardiovascular diseases, diabetes, colon and breast cancer, and dementia. Regular activity also has a role in the management of established illnesses. For example, lifestyle changes are almost always the first step in treatment for people diagnosed with diabetes. In addition, physical activity has a range of related benefits, such as reduced stress, increased mental health, improved sleep, and a reduced risk of a hip or vertebral fracture, particularly in older people. It is never too early or too late to start incorporating physical activity into your daily life.

The WHO’s “Global Recommendations on Physical Activity for Health” addressed physical inactivity across three age groups: 5 – 17-year-olds, 18 – 64-year-olds, and those 65 years old and above.

To improve cardiorespiratory and muscular fitness, bone health, and cardiovascular and metabolic health biomarkers, children and adolescents in the 5 – 17-year-old group should:

• Accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity daily
• Gain greater benefit from being active for more than 60 minutes per day
• Generally, focus on aerobic physical activity with vigorous-intensity activities incorporated, including those that strengthen muscle and bone, such as games or sports that include jumping, running, and agility, at least 3 times per week

Adults in the 18 – 64-year-old age-group, should:

• Do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week, or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity
• Perform aerobic activity in bouts of at least 10 minutes duration
• For additional health benefits, increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week
• Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week

Adults aged 65 years or older should follow the same recommendations as those for individuals aged 18 – 64 years. Older adults, with poor mobility, should perform physical activity to enhance balance and prevent falls on 3 or more days per week. When older adults cannot do the recommended amounts of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.

Pillar Four: Healthy Eating

An unhealthy diet is a major risk factor for chronic diseases and generally poorer health. Many international organizations and researchers, including the WHO, have recognized the importance of improving diet in both developed and developing nations. The prevalence of overeating, and consumption of nutrient-poor, calorie-dense foods has led to a global epidemic of obesity: in the last decade the prevalence of obesity has passed that of malnutrition as the primary source of diet-related morbidity. Pillar 4 focuses on the role that diet plays in self-care, maintaining health, and reducing the risk of diet-related non-communicable diseases.

Healthy eating is important because diet is considered one of the two primary risk factors for non-communicable disease, alongside physical activity. Maintaining a healthy diet has been repeatedly shown to have preventative benefits, reducing the risk of many non-communicable diseases. In every country for which data is available, in both developed and developing nations, the determinants of non-communicable disease are largely the same: improving diet and exercise and quitting tobacco use could prevent up to 80% of non-communicable diseases. Like physical activity, dietary changes are also used in the treatment of established illnesses and, as with exercise, it is never too late for an individual to improve their diet and work on eating healthily; the benefits gained from an improved diet are both immediately apparent and lifelong.

For a healthy diet, recommendations for individuals include the following:

• Achieve an energy balance and a healthy weight
• Increase consumption of fruits and vegetables, legumes, whole grains, and nuts
• Limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats and toward the elimination of trans-fatty acids
• Limit the intake of simple sugars
• Limit salt (sodium) consumption from all sources and ensure that most salt consumed is iodized

Pillar Five: Risk Avoidance

Risk mitigation, in terms of health, refers to the avoidance or reduction of behaviors that directly increase the risk of disease or death. Avoiding risk is important because avoiding high-risk behaviors, particularly tobacco smoking and alcohol intake, has been shown to significantly reduce preventable mortality and reduce all-cause mortality. Behaviors that reduce health risks are often some of the most achievable self-care practices. While quitting smoking is difficult, the benefit is significant and immediate, and there are a range of options to aid people. Applying sunscreen products when outdoors is simple, cost-effective, and has a tangible, immediate benefit in that it prevents painful sunburn. The same applies to safe sex, driving safely, drinking in moderation, and many other risk-reducing behaviors. Vaccination, while extremely important, obviously has less immediate and apparent personal benefits. But when it is effective at a population level, the diseases that we vaccinate against no longer circulate, reducing risk to all.

Combined, high-risk behaviors cause a large percentage of deaths worldwide. Smoking causes 15% of deaths in men worldwide and 7% in women. Of the five million smoking-related deaths each year, approximately 10% occur in non-smokers due to second-hand smoke inhalation. Alcohol, in turn, causes 5.9% of all deaths worldwide. Higher-risk behaviors have a high cost to societies and nations, as well as to the individuals who engage in these behaviors. Health budgets are consumed by these behaviors, and reduced employment, productivity, and long-term social consequences, particularly among children, are all well documented because of risky behavior.

Broadly, risk mitigation strategies involve activities such as:

• Making sure you are vaccinated
• Not smoking or quitting smoking
• Practicing safe sex
• Drinking in moderation
• Protecting yourself from the sun
• Driving carefully and wearing a seat belt
• Wearing your helmet when you ride a bicycle

High-risk behaviors are a significant cause of morbidity and mortality. In contrast to other aspects of self-care, such as maintaining a healthy diet, high-risk behaviors have the added detriment in that
they often pose a risk to other individuals who have not engaged in that behavior, such as second-hand smoke inhalation and exposure to dangerous driving.

Pillar Six: Good Hygiene

Hygiene refers to the conditions and practices that help to maintain health and prevent the spread of diseases. Good hygiene practices, therefore, include a specific set of practices associated with this preservation of health, for example, maintaining a clean living and working environment, sterilization of drinking water, handwashing, and preventing the spread of communicable diseases. Pillar 6 focuses on the actions and behaviors that contribute to good hygiene and the prevention of communicable diseases and illnesses. Good hygiene is important because having access to good sanitation increases health, wellbeing, and economic productivity. Inadequate sanitation impacts individuals, households, communities, and countries.

At an individual level, practicing good hygiene reduces the risk of communicable illness spreading, protects the people around you, limits certain forms of non-communicable disease, such as dental cavities, and reduces the economic burden of preventable illness, e.g. days off sick and reduced healthcare spending. Handwashing is probably the most important hygiene practice that individuals can engage in. It is one of the simplest, yet most effective, health behaviors. Proper food preparation is another simple intervention that can reduce communicable disease spread. Most severe diarrheal illnesses in developed nations, such as salmonellosis, giardiasis, and campylobacteriosis, are associated with unsanitary food preparation. Care when using uncooked food and then proper cooking greatly reduces the risk of these illnesses. Regular washing of hands with soap and water for twenty seconds, followed by thorough drying, is universally recommended.

Other hygiene practices include proper food handling and regular oral healthcare, particularly brushing twice daily and flossing at least once daily. When unwell, good self-care hygiene practices include covering the face or mouth when coughing or sneezing.

Pillar Seven: Rational Use of Products and Services

The rational and responsible use of health products and services as part of self-care involves individuals safely and effectively managing their health (and any everyday ailments or minor conditions), where appropriate, with medicines, products, or services. Rational and responsible use of these products or services involves several factors. Firstly, only products and services of safety, quality, and efficacy should be used to self-manage health and wellness. Secondly, when treating an illness, products and services are best used for self-recognizable conditions, and for chronic or recurrent conditions following initial medical diagnosis. Pillar 7 focuses on the knowledgeable, safe, and effective use of health products and services by individuals in order to better manage their own health. Rational and responsible use of products and services is important because the correct use of health products and services – the tools of self-care – is an important element of maintaining health and wellness.

Rational and responsible use of products or services can delay or prevent the development of many conditions and encourage greater independence in managing any illness that does develop. Understanding why and what products a person should use has been shown to strongly empower patients, increase quality of life, and improve self-perceived health. The impact of healthcare products and services is often underestimated. For example, adequate use of fluoride-containing toothpaste, flossing, and fluoridation of drinking water can prevent most dental cavities, yet 60 – 90% of adolescents and almost 100% of adults are affected by dental cavities. Improper use of health products or services can be associated with various types of risks.

It is possible that with more people undertaking self-care and being more self-aware, levels of hypochondria (sometimes referred to as health phobia or health anxiety) may increase. Hypochondria is an excessive preoccupation or fear of having a serious illness. A person measuring their own blood pressure once a week or once a month is undertaking responsible self-care. A person measuring their blood pressure five times a day is not. The risks associated with medicines are well known and can include overuse, misapplication, the use of excessive dosages, prolonged duration of use, drug interactions, and polypharmacy. Irrational use of medicine is a major problem worldwide. WHO estimates that more than half of all medicines are prescribed, dispensed, or sold inappropriately and that half of all patients fail to take them correctly. There may be concerns that self-care could aggravate these risks, but information education and appropriate consultation with health care professionals can help to manage this.

Self-care products and services are the tools of self‐care, supporting health awareness and healthy practices, and may include the use of:

• Prescription medicines (in conjunction with a doctor)
• Nonprescription medicines as-needed
• Preventative health products, e.g. dental care, mosquito netting, sleep aids
• Natural health products, traditional medicines and vitamins, minerals, and supplements
• Devices and diagnostics, e.g. home blood pressure monitors
• Substance control products, e.g. nicotine gum for tobacco cessation
• Wellness services, e.g. nutrition planning, gym memberships
• Health services, e.g. acupuncture, chiropractic, smoking cessation programs

Self-Care on a Budget

While the seven pillars above are essential to improving our health, cost and access to products or services remain the biggest barriers to achieving consistent levels of self-care. Greenpath Financial Wellness shares the following tips for managing self-care on a budget:

• Assess your financial picture and recognize the importance of mental health in financial planning
• Define your self-care priorities and allocate a self-care budget, practicing mindful spending
• Research affordable self-care options and seek out low-cost or free mental health resources
• Reach out for help when you need it, you never know where support may come from

Resources for Support

The International Self-Care Foundation: https://isfglobal.org/

Video on the seven pillars of self-care from Happiful: https://youtu.be/AcdOvtU6Gbw?si=95DPr8YekCh-Rx7B  

Some additional tips for self-care on a budget: https://moneymentors.ca/money-tips/how-to-practice-self-care-on-a-budget/

A list of Ontario’s public libraries which often offer community programs and services that are beneficial to self-care: https://www.ontario.ca/page/ontario-public-libraries

Free helplines that are knowledgeable of local resources: https://www.dcontario.org/locations/

9-8-8 Suicide Crisis Helpline: https://988.ca/

Sources

All information on the seven pillars of self-care is from the International Self-Care Foundation (https://isfglobal.org/).

Greenpath Financial Wellness (2023). Mind over Money: Prioritizing Self-Care on a Budget. https://www.greenpath.com/blog/prioritizing-self-care-on-a-budget/