We talk a lot about the importance of patients “owning” their own health. By this, we usually mean that a person understands and accepts any health conditions they have, and consciously works to make the lifestyle changes needed to live well with them. A patient who owns his health is not likely to believe in a magic cure, but rather know that adherence to treatment, eating well, sleeping soundly, and moving often are crucial to the best outcomes.
Recently I participated in a health policy training, and someone asked a medical anthropologist who was leading a session why we don’t expect patients in developing countries who receive aid to have this level of “ownership” of their health. The instructor instantly and simply said, “That’s such an American idea. No one else thinks that way.”
Well, the guy’s got a point. I don’t usually think about it, but there is something very American about the idea of controlling one’s own destiny through hard work and perseverance. Think about:
- The prevalence of the Protestant work ethic, focusing on tasks over emotions and relationships, in American corporate culture
- The cultural fetish for the “self-made” or those who “pulled themselves up by their bootstraps“
- The enduring admiration for Transcendentalist writers and thinkers like Ralph Waldo Emerson and Henry David Thoreau, who prized self-reliance, individualism, and the use of a middle name
This is an example of how our implicit cultural believes are at the very core of how we think about health and health care. I work with these matters every day, but never before considered how much the concept of self-ownership is influenced by my American-ness.
Here’s the thing, though. I don’t think wanting patients to own their health is a wrong approach. It seems like the right idea for our culture, and I think some version of it could be the right idea in other cultures too. It’s a matter of tweaking what ownership means so that it fits the other beliefs people hold.
I saw one experience of this when I worked on a project in India for people with diabetes. We quickly learned that health was managed at a family level, and any successful intervention would incorporate at least the main caregiver (usually a spouse or adult child). The patient was asked to take no less personal responsibility than someone in the US might be, and the caregiver was not asked to impose rules or try to control the patient. Rather, it was understood that they were joint decision-makers in matters related to the patient’s health, each with some tasks under their sphere of control. Ownership of health meant they needed to work in concert toward a shared goal.
Moving forward, I’m going to challenge myself to be more aware of how my American bias toward self-reliance and control might be shading my work with health behavior change.