Strife of Interests: Constraints on integrated and co-ordinated comprehensive PHC in Australia

Publication date: Available online 31 January 2020Source: Social Science & MedicineAuthor(s): Fran Baum, Anna Ziersch, Toby Freeman, Sara Javanparast, Julie Henderson, Tamara MackeanAbstractThe 1978 World Health Organisation Alma Ata Declaration on Primary Health Care (PHC) emphasised a comprehensive view which stressed the importance of cure, prevention, promotion and rehabilitation delivered in a way that involved local communities and considered a social, economic and political perspective on health. Despite this, selective approaches have dominated. This paper asks why this has been the case in Australia through a multi-method study of regional PHC organisations. Interviews with senior policy players, focus groups with non-government organisations and document analysis inform an institutional and power analysis of PHC. The findings indicate that there are different interests competing for attention in PHC but that medical perspectives prove the most powerful and are reinforced by the actors, ideas and institutions that shape PHC. Community perspectives which stress lived experience and social perspectives on health are marginal concerns in the implementation of PHC. The other important interest is that of a neo-liberal perspective on health policy which stresses cost-containment, close measurement of activity and fragmented contracting out of services. This perspective is not compatible with a social determinants of health perspective and can also conflict with a medical ...
Source: Social Science and Medicine - Category: Psychiatry & Psychology Source Type: research