Health Care: A Community Concern?

At the provincial inquiries some members of the public had expressed concerns about lack of involvement of community members in policy development, other than as taxpayers providing revenues for social redistribution. These concerns had been there from the 1960s onwards. But as was pointed out earlier, power in organizations tends to be associated with formal authority or technical expertise. There are, of course, some community members who can use the informal and non-formal systems of power (i.e., knowing how to get the system to respond to their demands or getting their ideas across through social networking). The collectivist welfare state and its health care system are organizations where such power struggles go on. ¹

The focus of the Canadian federal welfare state in the 1940s was financial redistribution, and so community involvement was not a special issue for that government until after the Organization for Economic Cooperation and Development (OECD) conference in 1980 on The Welfare State in Crisis (1981), which suggested that the Westminster parliamentary countries could profit by broadening their discussions with economic policy makers. Concurrently Canada was working on its human rights policies (1968-83). These challenged the idea that income support and expert service delivery were all that was necessary for a satisfactory collectivist social organization. Acceptance of all other citizens as equals was as important as providing a social minimum and funding universal social programs. The concept of partnerships at a number of different levels became a new issue. And one issue in partnerships was community involvement.

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