What's the goal of your project?

We want to see what kind of self-care programs the four different communities will come up with. What kind of educational processes will they prefer? What content will they consider important? What outcomes will they want to use in measuring the success of the program?

The people in the communities will plan the program?

Right. We'll let it be known, through the community, that there are resources available to set up some kind of a self-care or health-education program, but the organizing and planning will be done with the people in the community. They'll decide how the program is structured, how long it will run, what will be included, and how it will be evaluated. I would anticipate that the four different communities will come up with four very different programs.

After the formal "program" is over, the people involved will continue to learn and to participate in meeting their own health needs. A good self-care program should include not only skill empowerment, but process empowerment. What’s going on in that community that affects people’s health? Maybe it’s environmental pollution. Maybe it’s lack of exercise. Maybe it’s on-the job stress. Whatever it is, it’s the people in the community who should be setting the goals.

Lowell, must lecture and speak about self-care as much as anybody. What kind of reception do you get when you go out to talk about self-care?

I guess the most difficult point to get across is that self-care is not just an extension of health education. We're not just talking about creating some new, canned programs for professionals to run on the unsuspecting masses. We're talking about big changes in professional roles, big changes in role for health consumers. We're talking about shifting the initiative in health care from doctors and other health workers to the individual.

I am less interested in whether self-care will cut down on the use of services than I am in whether it will improve the quality of self-care practice, professional services, and the interaction between the two. Self-care may indeed save us money, but I don't think that should be the main objective of these programs. For a self-care perspective, the enemy is not the disease, but ignorance and powerlessness.

So far, we've been looking at self-care from the point of view of the consumer. How are our doctors going to feel about it?

I think that physicians in primary care will be cautious. Once you empower people to make their own decisions, some people will make decisions other than the one the doctor would have preferred. An empowered consumer might also opt for some kind of care other than that offered by the traditional M.D.

Self-care-educated people will be much more assertive. Their questions will be sharper, they will demand more information, more education. They will ask health workers what they plan to do in much greater detail, and they will expect good answers. They will be more likely to seek different opinions or approaches.

Self-care offers additional degrees of freedom for both health workers and individuals, but it doesn't mean that every individual will be on his or her own in health decision-making. The staunchest advocate of self-care, going in for major surgery, would want to be able to rest his or her trust in the surgeon doing the operation, to go to sleep trusting that everything would be all right. There are times when this parental, assuring role is very appropriate.