Several years ago, during an interview with Michael Phillips, author of The Seven Laws of Money (Random House, 1974), he described how a friend had taught him a system for coming up with the seven laws of anything. To illustrate, he led me through a series of questions, and we came up with the seven laws of selfcare.

• The First Law: You are already your own doctor.

  Research shows that people provide their own illness care between 80 and 98 percent of the time. The difference in the figures cited reflect how major a health problem has to be to qualify as an illness. In one recent study' people were asked to list all the health problems they'd experienced within the past two weeks. The average person turned out to have had 4.5 problems during that period. That works out to 117 health problems per year. But the average person makes only about two to three doctor visits per year. The percentage of preventive care that is self-provided probably runs well above 99 percent. These figures make it clear that self-care is—and has always been—our predominant form of health care.

• The Second Law: Laypeople could do even more for themselves if they had access to currently-available health tools, skills, support, and information. People go to the doctor when the tools, skills, information and support available to them are not sufficient to deal with a health problem. But there are many ways to obtain these needed resources without going through a health professional.

  Many people go to the doctor for regular blood pressure checks, yet with today's electronic cuffs, it is literally child's play to take your own blood pressure at home. In many cases the information and support a person needs could more appropriately be provided by a friend, neighbor, or self-help group. And many of the day-to-day skills of doctoring—from examining an eardrum to testing one's urine—can now be easily learned and safely done at home. Many of the most promising opportunities for improving our health care system involve finding ways of making health tools, information, skills, and support available through lay channels.

• The Third Law: Our most powerful health resources are our spouse, family, friends and our social networks and communities. An overwhelming body of research suggests that for most of us, our number one health risk factor is not eating, exercise, smoking, or wearing seat belts—it is our social support system. One study2 found that people with few friends, family, and social links had 2.5 times the risk of death as those in the same neighborhood who had a wealth of friends and many close social ties.

• The Fourth Law: Health is not the absence of disease. There is a continuum of wellness/ illness states. Prevention means focusing on health concerns and behaviors while they are still on the wellness side of the spectrum, long before they progress to more pronounced symptoms, disease, and disability.

• The Fifth Law: What's best for your health depends—at least in part—on your belief system. Health is a part of culture, and different people have different cultures. It has been well established that the remedies people believe in are much more effective—at least for them. Thus a self-care oriented health care system must be a diverse system, a health care smorgasbord offering "different strokes for different folks."

• The Sixth Law: The principal goal of a health care system should be to help people take care of themselves.

  Those of us who reached adulthood during the last few decades were brought up to overestimate the effectiveness and safety of professional medical care and to seriously underestimate our own potential for keeping ourselves healthy, managing our illness problems, and taking an active role when working with health professionals. We need to seek out and support those health workers and consumer groups who see it as their number one priority to provide encouragement and support for our self-care efforts and to increase our level of health responsibility and competence.

• The Seventh Law: Health is a regenerative function.

  We have been taught to think of health problems as inevitable breakdowns which can be repaired by professionals—like a car that needs new tires or a rebuilt carburetor. Thus we tend to ignore our health until a problem becomes an emergency. Then we attempt heroic solutions: the coronary care unit, bypass surgery, heart transplant.

  The human body has almost unbelievable recuperative and healing powers. But to operate at their optimal levels, these powers require constant nourishment and care: a healthy diet, regular exercise, a healthful environment, the support of others, a meaningful life, and a good measure of self understanding. The body has its own wisdom, but it must be listened to, understood and trusted.

  Health is like the soil—if it is properly cared for over a long period of time it can replenish itself and can provide us with a bounty beyond our wildest imaginings. But if ignored, depleted, and exploited, it will soon lose its ability to sustain life.

Thanks to David Werner and Robert Rodale for discussions which contributed to this column.

REFERENCES

I. Helter, Harry et al. Health Care Practices and Perceptions: A Consumer Survey of Self-Medication, Harry Heller Research Corporation, 1984.

2. Berkman, Lisa F. and S. Leonard Syme, "Social Networks, Host Resistance, and Mortality," American Journal of Epidemiology, Vol. 109, No. 2, pp. 186-204.