Archives
Is it Consumer or Community Participation?
Examining the links between 'community' and 'participation'
Judy Taylor
Centre for Rural Health and Community Development, Spencer Gulf Rural Health School, University of South Australia and Adelaide University, Whyalla Norrie, South Australia
David Wilkinson
School of Medicine, University of Queensland, Brisbane, Queensland
Brian Cheers
Associate Professor; Director, Centre for Rural and Regional Development, University of South Australia - Whyalla Campus, SA.
Abstract
In writing about community participation in health, the term 'community' is used loosely and ambiguously. On analysis, it appears that there is a conceptual shift in health policy to thinking about involvement of consumers in health planning and programs rather than communities. This shift is consistent with a managerialist approach to planning health service delivery. Participative processes are perceived as being initiated and directed by health administrators. Participants in the processes are to be 'representative' of health service consumers, rather than whole communities.
However, in many Australian rural communities, there are enduring traditions of community participation in providing governance for local hospitals, developing infrastructure for general practice services, and providing in-kind support. Participation in health services is embedded in the way the community functions. Acknowledging and understanding the ways in which 'community participation' and 'consumer participation' are different may result in more effective participative processes.
Keywords
community participation, consumer participation, rural community, health, sociology
References
Asvall J (2000) The Alma-Ata Declaration: 20 years of impact on the European Region of the World Health Organisation. Primary Health Care 21: 'Everybody's Business' An International Meeting To Celebrate 20 Years After Alma Ata WHO Technical Report Series 809, Appendix 4. Geneva: World Health Organisation.
Abelson J (2001) Understanding the role of contextual influences on local health-care decision making: case study results from Ontario, Canada. Social Science and Medicine 53(6):777-93.
Baum F (1996) Community health services and managerialism. Australian Journal of Primary Health - Interchange 2(4):31-41.
Baum F, Sanderson C and Jolley G (1997) Community participation in action: an analysis of the South Australian Health and Social Welfare Councils. Health Promotion International 12(2):125-34.
Bell K, Couzos S, Daniels J, Hunter P, Mayers N and Murray R (2000) Aboriginal community controlled health services. In Department of Health and Aged Care General practice in Australia 2000 Canberra: Commonwealth of Australia: 75-102.
Brown I (1994) Community and participation for general practice: perceptions of general practitioners and community nurses. Social Science and Medicine 39:335-44.
Bryson L (1992) The Corporate Context For Community Health Sydney: Australian Community Health Association.
Campbell C and McLean C (2002) Ethnic identities, social capital and health inequalities: factors shaping African-Caribbean participation in local community networks in the UK. Social Science and Medicine 55:643-57.
Cheers B and Luloff AE (2001) Rural community development. In Bourke L and Lockie S (eds) Rurality Bites, the Social and Environmental Transformation of Rural Australia Sydney: Pluto Press: 129-42.
Collins Y (2001) The more things change, the more they stay the same: health care in regional Victoria. In Bourke L and Lockie S (eds) Rurality Bites: The Social And Environmental Transformation Of Rural Australia Sydney: Pluto Press: 103-17.
Consumer Focus Collaboration (2000) Improving Health Services Through Consumer Participation: A Resource Guide For Organisations Canberra: Department of Health and Aged Care.
Currie G (1996) Contested terrain: The incomplete closure of managerialism in the health service. Personnel Review 25(5):8-24.
Dwyer J (1989) The politics of participation. Community Health Studies X111(1):59-64.
Dunne P, Patterson C, Kilmartin M and Sladden M (1994) Health service provision in rural and remote areas: a needs analysis. The Medical Journal of Australia 161:160-62.
Eyre R and Gauld R (2003) Community participation in a rural community health trust: the case of Lawrence, New Zealand. Health Promotion International 18(3):189-97.
Fenwick L (2000) Return to Booleroo Times Adelaide: Open Book Publishers.
Hancock L (1999) Health, public sector restructuring and the market state. In Hancock L (ed) Health Policy In The Market State St Leonards NSW: Allen and Unwin: 48-68.
Health Targets Implementation Committee (1988) Health For All Australians: Report Of The Health Targets Implementation (Health For All) Committee To The Australian Health Ministers Canberra: Australian Health Ministers Advisory Council.
Humphreys JS (1993) Planning for services in rural Australia. Regional Journal of Social Issues 27:10-19.
Jewkes R and Murcott A (1996) Meanings of community. Social Science and Medicine 43(4):555-563.
Johnson A and Silburn K (2000) Community and consumer participation in Australian health services: an overview of organisational commitment and participation processes. Australian Health Review 23(3):113-21
Johnson S (1996) Management of primary health care. Australian Journal of Primary Health - Interchange 2(1):98-105.
Kaufman HF (1959) Toward an interactional conception of community. Social Forces 38:8-17.
Keating TP and Calder R (1997) Rural community responses to structural changes in health. Strengthening Health Partnerships In Your Rural Community Adelaide: Forum papers of the National Rural Public Health Forum: 383-90.
Last P, Symes W, Taylor W and Such E (1974) Rural Health in South Australia Adelaide: Hospitals Department, Department of Public Health.
Littlely B and Pengelley J (2002) So sick of waiting: town turns to South Africa for its doctors. Adelaide: Advertiser: 11.
Mahnken JE (2001) Rural nursing and health care reforms: building a social health. Rural and Remote Health 1 (online viewed 23 March 2002) http://rrh.deakin.edu.au.
Menadue J (2003) Health And The Community: The Right To Participate Adelaide: Generational Health Review SA.
Milewa T, Valentine J and Calnan M (1999) Community participation and citizenship in British health care planning: narratives of power and involvement in the changing welfare state. Sociology of Health & Illness 21(4):445-65.
Morgan LM (2001) Community participation in health: perpetual allure, persistent challenge. Health Policy and Planning 16(3):221-30.
National Health Strategy (1993) Healthy Participation: Achieving Greater Public Participation And Accountability In The Australian Health Care System Canberra: National Health Strategy.
Pika Wiya Health Service (1999) Vision Statement Port Augusta: Pika Wiya Health Service Inc.
Rifkin SB (1996) Paradigms lost: toward a new understanding of community participation in health programmes. Acta Tropica 61:79-92.
Ryan N (2001) Reconstructing citizens as consumers: implications for new modes of governance. Australian Journal of Public Administration 60(3):104-9.
Short SD (1989) Community participation or community manipulation, the Illawarra cancer appeal-a-thon. Community Health Studies X111(1):34-8.
Taylor J (2002) Understanding community participation in rural health service development. Rural Social Work 7(2):36-46.
Taylor J (2004) Community Participation In The Organisation Of General Medical Practice: Three Case Studies In South Australia. Unpublished PhD Thesis Adelaide: Division of Health Sciences University of SA.
Walker J (2002) The future of rural health. In Wilkinson D and Blue I (eds) The New Rural Health South Melbourne: Oxford University Press: 299-318.
Wilkinson KP (1991) The Rural Community in America Connecticut: Greenwood Press.
Wilkinson KP (1998) The small-town community: Its character and survival. In Zuber E, Nelson S and Luloff A (eds) Community: A Different Biography University Park, PA: Northeast Regional Centre for Rural Development: 96-103.
World Health Organisation (2000) Primary Health Care 21: Everybody's Business: An International Meeting To Celebrate 20 Years After Alma Ata WHO Technical Report Series 809 Geneva: WHO.
Zakus J and David L (1998) Resource dependency and community participation in primary health care. Social Science of Medicine 46(4-5):475-94.
eContent Home