Exclusion of the self from the self care in a today of gaps: reflections and recommendations

Igiene e Sanità Pubblica 2025; 98 (5): 236-238

Letter to the Editor

Miguel Angel Cardozo-Montilla
Scientific research and science popularization, Caraballeda, Venezuela.
cardozomontillamiguel@gmail.com
ORCID: 0000-0002-6893-8551

Keywords: self care, health services accessibility, health policy, health communication, health literacy.

Dear Editor,

In a world which the disparities in access to health services are not problems that only concern minorities, vulnerable populations and societies with the lowest levels of development, the self care is an issue that transcends all borders and, therefore, constitutes together with others strategies the core of the global priorities, a need that, for instance, intersects the set of targets of the third goal of the 2030 agenda for sustainable development¹ within which the progress both in reducing maternal mortality across the world, that went from 228 to 197 deaths per 100 000 live births between 2015 and 2023, and in achieving universal health coverage has been exiguous².

It is not wrong to affirm that the foregoing priority is continually confirmed beyond the experiences of those groups. A near example of this fact is given by the recent statements of the president of the Italian National Institute of Statistics relative to the health care provided to the Italian population in 2024, from which 9,9 % desisted from consuming services for reasons like length of waiting lists, the main reason for 6,8 % of Italians, and economic difficulties³, and taking into account that Italy, according to the current classification proposed by the World Bank⁴, is a high-income economy, the panorama of less advantaged countries speaks of self care as a common goal whose achievement is becoming increasingly urgent. In effect, the World Health Organization (WHO)⁵ recognizes and recommends it as one of the key components of the efforts of nations aimed precisely at the materialization of universal health coverage, for which several health-related activities has been established as good practices, for instance the digital health.

The WHO⁶ also highlights the importance of health literacy and the availability of appropriate technology, especially that which facilitates access to the internet, as two of the factors that play a fundamental role in carrying out those activities. Nevertheless, their situation in global society is a reality of gaps. This is demonstrated by data from various sources on smartphone ownership, collected in a heterogeneous group of countries and analyzed by the World Bank⁷, which present a reality of great gaps and challenges, with contrasts in said possession, evidenced by extremes such as 97 % in South Korea compared to 42 % in Nigeria and 32 % in India, and with others from viewpoints like gender disparities and costs.

Now, pondering of these and other facts, combined with the imperative to broaden the range of individual, institutional, local, national and international options that integrate political, technical, scientific and social efforts, and with the necessity to move from the already sufficient diagnoses to concrete actions, makes appropriate the following recommendations:

1. Find actors with real possibilities and capacities for influence, from their own contribution of distinct resources, to other actors with the same or even greater availability of such resources; this as part of an ongoing process of building a network of positive influences that maintains the smoothness of the flow of material resources and a huge variety of intangible assets, like highly specific skills and social connections, that, when combined, make the projects relating to self care promotion, health and digital literacy, availability of technology, among others things, more feasible.
2. Employ that same type of logic to the dissemination of messages about the importance of self care that are capable of having a strong impact on all social strata and of guiding them towards performances that create skills and habits in this matter, always keeping in mind the fundamental role that play in effective mass communication the credibility and the selection of media, of which social networks are one of the broadest, most direct and most cost-effective options. Their success will depend on the skill with which best practical paths are identified amid the universe of wrong praxes and unethical behaviors that hinder the “digital” dynamics of global society.
3. Take advantage of the work already done by international institutions and translated into various products for all decision-making spheres is a recommendation regarding self care activities that may seem of little value, however the benefits of using such material are potentially enormous, because its adaptation to different contexts is less expensive and easier than the production of, probably, similar options. The resources of the WHO and the World Bank cited here represent, for example, investments, skilled labor and time consumption that it makes no sense to duplicate.
4. Since research on digital literacy – a type of literacy that nowadays, if required, must precede health literacy, which in turn is a necessary condition for the effective undertaking of self care – makes it impossible in many cases to use precisely digital media for identify real needs or with evaluative purposes, and given what valid scientific information on access to technologies like smartphones and also on access to the internet is needed to provide the decision-makers useful inputs aimed at improving the capacity for effective self care activities, multinational scientific efforts could be assumed by networks of partners with the financial autonomy and local resources to realize their national projects, yet coordinated for the systematic quantitative and qualitative fusion of data obtained from diverse studies.

The efforts addressed to creating greater social capacities for expanding self care, as a set of positive habits, essential skills and effective interventions, must turn through coherent policies into networks of activities in which collaboration and a systematized matrix of resources become the axis of a shared way of doing things. The recommendations provided here can help achieve this goal, and while these may seem like very simple proposals, their simplicity could be the key to the feasibility of many actions that remain as tasks to be performed, linked to goals to be achieved, and the actions and the achievement of goals, beyond narrow political will, must begin.

When the world needed an immediate solution to the COVID-19 problem, both unlimited resources and support from the highest levels, from democracies and tyrannies, arose without a “but.” The reason: the entire global economy was collapsing and with it the interests of political groups. After that clear demonstration of “yes, it is possible,” chronic diseases such as cancer, diabetes and various cardiovascular conditions, and communicable diseases like HIV infections, to mention just a few health problems, continue their long journey with almost no obstacles.

Amid this reality, a considerable dose of pragmatism is required. Self care with the self.

Yours faithfully,

Miguel Angel Cardozo-Montilla

References

1. United Nations. Transforming our world: the 2030 agenda for sustainable development. Adopted by the General Assembly on 25 September 2015 (resolution 70/1). [New York: United Nations]; 2015 Oct 21. A/RES/70/1.
2. United Nations Department of Economic and Social Affairs. The Sustainable Development Goals report 2025. Revision August 2025. New York; 2025.
3. Istat, il 10% degli italiani non si cura: la prima causa sono le liste d’attesa. RaiNews; 2025 Nov 6 [cited 2025 Nov 6]. Available from: https://www.rainews.it/articoli/2025/11/istat-10-italiani-non-si-cura-la-prima-causa-sono-le-lunghe-liste-attesa–5f90624b-57ba-47e6-bc6f-3bb8e33caabe.html
4. World Bank country and lending groups. In: The World Bank: IBRD-IDA. Washington: World Bank Group; [2025] [cited 2025 Nov 6]. Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups
5. WHO guideline on self-care interventions for health and well-being, 2022 revision. Geneva: World Health Organization; 2022.
6. World Health Organization. Global strategy on digital health 2020-2025. Geneva: World Health Organization; 2021.
7. Amin R, Gallegos D. Affordable devices for all innovative financing solutions and policy options to bridge global digital divides. Washington: World Bank Group; 2023.

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