This rapid growth is partly the result of new at-home versions of tools previously available only in the hospital (kidney dialysis equipment, intravenous nutrition. and cancer chemotherapy), the explosive growth of at-home medical testing, (blood pressure, blood sugar, portable EKG monitors) and the emergence of health professionals who work principally in patients' homes.

New at-home devices (exercise machines, exercise videos, relaxation tapes, pulse meters, home whirlpool baths, stationary swimming devices, and computer-based nutrition support systems) now make it possible for the health-active individual to do things at home that were formerly available only at a well-equipped health club.

Trend Four: Health Care as Information Flow. In some ways, the health information explosion has been the most dramatic of all. In 1977, self-care books accounted for only three percent of total nonfiction bestseller hardcover sales. Only four years later the proportion had increased to 23 percent. Self-care bestsellers showed a 1200 percent increase in sales during this period.

Health coverage in periodicals has showed a similar growth. Circulations of health magazines more than doubled between 1970 and 1980.3 There has been an explosion of health information in general publications as well. Three of the nation's most widely-read weekly publications—Time, Newsweek, and the Sunday New York Times—have recently instituted special health sections or editions. The future promises electronic access to elaborate new health databanks through home computers.

Self-Care and The Future of Health. But a continuing trend toward self responsibility is not enough to insure the full flowering of a health care system built around the individual and the family. If the four legs of health care are indeed tools, skills, information, and support, and if, as it seems, the tools and the information available to generations to come will outstrip the imaginations of even the most wild-eyed self-care advocates, then the two most important potential barriers to the development of self-care would be the lack of individual health skills and the lack of professional and social support for self-care.

Thus we are left with two pressing issues of public policy:

• Health literacy—The health education currently offered in our schools does little to equip our children to deal with today's health realities—let alone the future’s. I believe it will take a commitment to health literacy comparable to this nation's earlier commitment to literacy in English to prepare our children to use these new medical devices and to understand the broad range of health information available to them.
• Professional support for self-care— Students aspiring to the health professions should be selected for their aptitude to encourage self-responsibility and to support responsible self-care. All clinicians should be competent in the skills of communication, negotiation, and interpersonal relations. Clinicians in practice should be evaluated regularly by the consumers they serve, and these evaluations should be given considerable weight in determining salary and advancement.

1 Brinkley, Joel, "Physicians Have an Image Problem—It's Too Good, " The New York Times, Feb. 10, 1985,p.6E.

2 Ferguson, Tom, "The Homecare Revolution, "Medical Self-Care, Spring, 1985, No. 25, Pp. 25-30.

3 John Fiorello, Editor, Helping Ourselves to Health: The Self-Care and Personal Health Enhancement Market in the U.S., New York, 1983, The Health Strategy Group, 325 Spring Street, New York NY 10013, p.40.