184 Australian Health Review May 2007 Vol 31 No 2 Meeting Needs for Ongoing Care Aust Health Rev ISSN: 0156-5788 1 May 2007 31 2 184-192 ©Aust Health Rev 2007 www.aushealthre- view.com.au Meeting Needs for Ongoing Care Abstract Chronic condition self-management is promoted internationally as not only a possible solution to the health problems of our increasingly chronically ill and ageing population, but as part of a new wave of consumer-led and volunteer-managed health care initiatives. Consumers are now indicating that they want to be more involved in the management of their lives and their health care options, while, especially in rural and smaller communities in Australia, a shortage of clinicians means that health care is rapidly changing. This emphasis on self-management raises crucial questions about where consumer action and control in health care should end and where clinical and medical inter- vention might begin. Hence, as in the case of Sisyphus and his rock, the self-management pro- cess is a difficult and demanding one that poses major challenges and loads for health system reformers and represents a struggle in which new difficulties are constantly emerging. This paper examines some implications of new self-management approaches to chronic illness from an ideological perspective and highlights key elements that underpin the effort to promote health-related lifestyle change. While peer-led self-management programs may assist certain individuals to live engaged and meaningful lives, the essential social and economic determinants of health and wellbeing mean that these programs are not the answer to our urgent need for major reform in the health care arena. Rather, self- management, from an ideological perspective, represents a minor adjustment to the fabric of our Aust Health Rev 2007: 31(2): 184–192 health system. THERE HAS BEEN MUCH DISCUSSION about the efficacy of chronic illness management pro- grams, care planning, regular health assess- ments, preventive primary health care and the Peter W Harvey, PhD, Senior Lecturer Rural Clinical School, The University of Adelaide, Whyalla Norrie, SA. Barbara M Docherty, NZRN, MCNA(NZ), PostGradDipHealthScience(Primary Health Care), National Director, Training and Development Services (TADS), Brief Interventions for Harmful Behaviour Department of General Practice and Primary Heath Care, School of Population Health, University of Auckland, Auckland, New Zealand. Correspondence: Dr Peter W Harvey, Rural Clinical School, The University of Adelaide, Nicolson Avenue, Whyalla Norrie, SA 5608. peter.harvey@unisa.edu.au Sisyphus and self-management: the chronic condition self-management paradox Peter W Harvey and Barbara M Docherty What is known about the topic? Self-management has been considered to be an effective approach to the management of chronic conditions. What does this paper add? This paper questions some of the basic premises of self-management in health care using the analogy of Sisyphus, who was condemned to continually roll a rock up a hill. Concern is expressed that self- management that is solely focused on the involvement of people in the management of their lives and their chronic conditions equates to “rock rolling” as it does not address a more revolutionary community approach to health system reform and development. What are the implications for practitioners? The authors suggest that through system-level consumer collaboration and cooperation it is possible for health professionals, consumers and carers to develop a comprehensive team to enable the translation of medical approaches to care into more holistic approaches. In these approaches a wider range of factors impacting on consumer health and wellbeing would be considered in illness management and treatment.