Health Care: A Community Concern?
Developments in the Organization of Canadian Health Care Services

Anne Crichton, Ann Robertson, Christine Gordon, and Wendy Farrant

About the Book

Developed within the context of the expansion of the Canadian welfare state in the years following the Great Depression, the present organization of Canadian health care delivery is now in serious need of reform. This book documents the causes and effects of changes made in this century to Canada's health care policy. Particular emphasis is placed on the decades following 1940, the years in which Canada moved away from an individualistic entrepreneurial medical care system, first toward a collectivist biomedical model and then to a social model for health care.

The changing roles of federal, provincial, and municipal government are explored, as are recent trends away from crisis-oriented health care toward an approach that stresses promotion of health. The authors argue that the original collectivist model restricted community members from participation in the decision-making process. Leaving health policy decisions in the hands of politicians and bureaucrats has led to a system that is poorly coordinated and often poorly managed. They propose a shift away from the "welfare state" model toward what has been called the "welfare society," in which there is greater participation of individuals and communities. They advocate partnership with business and research communities and reform and restructuring through regionalization.

About the Authors

Anne Crichton, PhD, taught health policy at the University of British Columbia from 1969 to 1985. Since retiring, she has been writing on the Canadian and Australian health care systems. She has served on the Vancouver Regional Health Board and is now doing research on this regional board's evolution.

Ann Robertson, PhD, has been an assistant professor in the Department of Behavioural Sciences at the University of Toronto since 1993. Her research interests include health promotion, women's health, aging policy and new methodologies for community-based research. She has worked in community development as a Seniors' Wellness Coordinator for the Vancouver Health Department.

Christine Gordon, MSc, has worked for a number of years as a consultant in health and social policy and community development. She has been engaged in social change movements, including anti-poverty activism, the promotion of equal opportunity, and disability rights. She is a founder of the B.C. Health Communities Network, the Global Health Network, and the B.C. Coalition for Health Care Reform.

Wendy Farrant, PhD, worked as a health promotion researcher at the University of Victoria from 1989 until her death in 1993. Formerly senior lecturer at St. Mary's Hospital, Paddington, England, she also did consultancy work for the government of British Columbia and the B.C. Social Planning and Research Council.

Table of Contents

1. Themes of the Book
2. The Context of Health Policy Development
3. Canada's Publicly Financed Health Care System Evolves
4. Service Delivery Systems and their Responses to the Need for Change to a Collective Care Organization
5. Developing Control by Formal Authorities
6. Research on Organizational Issues
7. Reform and Restructuring
8. Afterword

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