Health Care: A Community Concern?

By Anne Crichton; Ann Robertson et al. | Go to book overview

CHAPTER 20

Health Promotion: Development of
a Demonstration Strategy

In the previous chapter on organization theory and its applications, the concepts of Bartunek and Reis (1988) about the modification of organizations through first and second order change were discussed. The application of theory to first order change was explored in looking at transorganizational development of subsectors of the health care system. However consideration of second order change was not dealt with there. It will be recalled that Bartunek and Reis said:

The major difference between first and second order organizational change is in whether or not a particular framework for understanding is altered. In first order change the framework remains the same but in second order change it shifts in some way. The alterations of the framework in second order change have an effect on the assessment of change ... Because the primary shift in second order change is the framework itself, it is more difficult when this type of change occurs to determine whether the change results in better or worse outcomes than before. (pp. 100-101)

In discussing the development of Canada's health care system it was pointed out that Dr. Maurice Le Clair set up a task force to examine whether access to medical and hospital care was likely to result in better health status outcomes. This task force produced A New Perspective on The Health of Canadians (Canada 1974a) which argued that good health was more closely related to lifestyle, environment and biological risk than to medical and hospital care. However, Canadians wanted access to health services more than anything else at that time (and still do). The Canada Health Act, 1984, closed off the discussions on the issues of universality, comprehensiveness, portability, public administration and equity of access (at least for the 1980s). The federal gov

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