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University of Calgary Press University of Calgary Press Open Access Books

1997

Health Care: A Community Concern? Developments

in the Organization of Canadian Health Services

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

University of Calgary Press

Crichton, A., Robertson, A., Gordon, C. & Farrant, W. "Health Care: A Community Concern?

Developments in the Organization of Canadian Health Services". University of Calgary Press,

Calgary, Alberta, 1997.

http://hdl.handle.net/1880/48648

book

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HEALTH CARE: A COMMUNITY CONCERN? by Anne Crichton, Ann Robertson, Christine Gordon, and Wendy Farrant ISBN 978-1-55238-572-2

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Preface and Acknowledgments

This book was developed in response to a call for research grant submis­sions to the National Health Research and Development Program (NHRDP) in 1989. NHRDP asked for researchers to come forward if they were inter­ested in examining the literature on specific strategies for strengthening com­munity health services. In making this examination, it was said that atten­tion should be given to documentation of effective linkage and collabora­tion between:

• social and health community-based services; • community-based and institutional services; • community-based services and the education, social services, munici­

pat housing, judicial and the voluntary sectors; • multidisciplinary models of delivery of community services. (pp. 1-2)

As welt the economic impact, both in the short and long term, of mov­ing towards "models of service delivery which demonstrate the effective link­age and collaboration between community-based services for primary care, disease prevention and health promotion" should be analyzed under the general heading "strengthening community health services" (p. 3).

It was decided to seek a grant to look at "organizational models for com­munity services" under these terms of reference.

There are a number of different reasons for the delays in publishing the information collected. However, those delays may have been fortuitous in that new stages of organizational development have been reached recently and we have been able to incorporate a discussion of these changes in the final chapters.

The basic literature review was funded by a National Health Research Foundation Grant 5-52047-2522. This paid for research assistance and secre­tarial help, with $tOOO for overhead which was to include cost of paper, phone calls, etc. There was no allowance for travel. We have tried to pro­vide examples from as many provinces as possible while recognizing that we are most familiar with what is going on in British Columbia. Since it

xiii

xiv / Health Care: A Community Concern?

seemed to be impossible to locate all the important materials without visit­ing informants in the other provinces, the project was supported with travel monies from a University of British Columbia Research Fund for the Com­parative Study of Health Systems. This enabled brief visits to be made to other provinces and to Victoria, British Columbia to find materials which were used for this and other research projects on Canadian health care. We are most grateful to those people who provided free accommodation and fitted their schedules to our hectic travel timetable.

The chapters were written by four different authors with four different styles, so there is some unevenness in the overall presentation. Chapters 12 and 13 were written by Ann Robertson, Chapter 11 by Christine Gordon and Chapter 10 by Wendy Farrant who died two years ago. Anne Crichton planned the book and wrote the other chapters. Ann Robertson helped with the editing. Despite the unevenness in styles, it was thought best to permit each author's own thinking to come through.

We must thank particularly our eleven consultants who opened doors in their special areas of expertise and helped us to understand their approach to problems: Mr. Michael Clague, then Executive Director, Social Planning & Research

Council BC, 106 - 2182 West 12th Avenue, Vancouver, BC V6K 2N4 Mr. Alan G. Campbell, then Acting Director, Mental Health Services, Minis­

try of Health, Victoria, BC V8W 3C8 Dr. Garry Curtis, then Director Policy Planning and Legislation, Ministry of

Health, Victoria, BC V8W 3C8 Dr. Robert G. Evans, Professor, Department of Economics, University of Brit­

ish Columbia, Vancouver, BC V6T 1W5 Dr. Peter J. Frost, Professor, University of British Columbia, Faculty of Com­

merce and Business Administration, Henry Angus Building, University of British Columbia, Vancouver, BC V6T 1W5

Dr. Clyde Hertzman, Associate Professor, Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC V6T 1W5

Dr. A. Hister, General Practitioner, 2737 West 4th Avenue, Vancouver, BC Dr. Lyn Jongbloed, Associate Professor, School of Rehabilitation Medicine,

University of British Columbia, Vancouver, BC V6T 1W5 Dr. Perry RW. Kendall, then Medical Health Officer, City of Toronto, Public

Health Department, City Hall, 7th Floor East Tower, Toronto, ON M5H 2N2

Mr. Paul Pallen, then Assistant Deputy Minister, Ministry of Health, 1515 Blanshard Street, Victoria, BC V8R 4R7

Ms. Rita Stern, then Director, Health Promotion Directorate, 750 Cambie Street, Suite 425, Vancouver, BC

Preface and Acknowledgments / xv

We should add to this list Dr. Marc Renaud, Professor, Groupe de re­cherche sur les aspects sociaux de la prevention (GRASP), Universite de Montreal, 2801 rue Edouard Montpetit, Suite 162, Montreal, PQ H3C 3J7, who ensured access to sources in Quebec which would not have been found without his help. Lynda Hessey, Executive Director, Durham District Health Council, enacted the same role in Ontario.

Then, too, we were fortunate in the backing we received from librar­ians, particularly those in the Woodward Library at the University of British Columbia, especially Diana Kent, Elsie de Bruyn and Bill Parker; the British Columbia Health Association Library; the British Columbia Medical Associa­tion Library (through Dr. c.J.c. Mackenzie); Lyn Dunikowski, University of Western Ontario; Jocelyn Boisvin of GRASP; and the Saskatchewan, British Columbia and Nova Scotia provincial health librarians. Lyn Kozun in Regina organized the program of interviews there and provided help in the library.

We also acknowledge the useful comments of three reviewers from the Social Science Federation of Canada, Aid to Scholarly Publications Program and two university press reviewers for their suggestions on revision of the manuscript. This book has been published with the help of a grant from the Humanities and Social Sciences Federation of Canada, using funds provided by the Social Sciences and Humanities Research Council of Canada.

Laurel Slaney typed the manuscript many times. We thank her for her patient cooperation.

Material in Chapters 13-15 was published in Medical Care Review 51, no. 2 (1994): 148-78. Material from Chapter 16 was published in the Canadian Journal ofPublic Health and material from the literature review generally was printed in the International Journal of Health Planning and Management.

A summary of all the literature reviews funded by NHRDP was pub­lished in 1993 under the following titles:

"Service Models in Community Based Health: Some Findings from a Literature Review." Canadian Journal of Public Health 80, no.1 (1995): 26-28.

"A Critical Analysis of Recent Canadian Health Policy: Models for Com­munity Based Services." International Journal of Health Planning and Manage­ment 8 (1993):295-314.

Canadian National Health Research Development Foundation Summaries of Literature Reviews on Strengthening Community Health Services. Ottawa: Supply and Services, 1993.

xvi I Health Care: A Community Concern?

We have listed below, in alphabetical order, those who were willing to be interviewed or to discuss matters by phone and those who sent us mate­rials on request. We were seldom refused help, and many people put them­selves out to provide assistance.

Altman, Dr. Jack Anderson, Dr. Jim Anderson, Dr. Joan Anstee, Pauline Armes, Gord Arsenault, Claude Ashton, Susan Austman, Larry Bardsley, Dr. JoIm Barnes, Marsha Barton, Sherry Bayne, Lilian Beaudin, Marquise Belanger, Dr. J.P. Bell,Faye Birch, Dr. Stephen Blair, Carol Blair, Lynne Blanchet, Dr. Andre Bonham, Dr. Gerry Borden, Lois Boudreau, Franc;oise Brown, Dr. Murray Buhler, Lynn Burgess-Eykelbosh, Ms. Burnside, Dr. Beverly Calkin, Dr. Joy Canadian Advisory Council on the

Status of Women, Halifax Carleton, Michael Carter, Lyndell Chan, Sandra Chappell, Dr. Neena L. Cheung, JoIm CK. Clarke, Glenda Clarke, Nina L.

Clements, Gerrit Colin, Dr. Christine Collins, Dr. Larry R. Copley, Brian Crewson, Herman Crichton, Dr. Andrew Croll, Nancy Croucher, Brenda Culbert, Ian Curtis, Dr. Garry Cutt, Dr. James Desjardins, Ed De Paoli, Lisa Deber, Dr. Raisa Desrosiers, Dr. Georges Dickey, Jo Director, Saskatchewan Housing

Corporation Disken, Sephie Dixon, Dr. Maureen Doctorow, Heather Dobell, Mamie Dunikowski, Lyn Durier-Copp, Dr. Martine Dyck, Dr. Ron Eni, Dr. Godwin Etmanski, Ed Ferguson, Dr. Gordon Finemann, Lynne Finnie, Carol Fisher, Gerry Four Worlds Development Project Francis, Myrna Freeman, Laura Fyke, KJ. Gee, Lynda

Gilbert, David Gilbert, John Gimbel, Howard V. Goldbloom, Dr. R.

Goldsmith, David Gosselin, Dr. Roger Gottlieb, Dr. Benjamin Gray, Dr. John Hahn, Dr. George Hancock, Georgann K. Hancock, Dr. Trevor Harvey, F.W. Havens, Betty Hayes, Dr. Michael Herbert, Dr. Carol Hill, Jessica Hodgson, Maggie Hogan, Dr. K. Hollander, Marcus Hsu, Dr. David Hubbard, Bill Hudson, Dr. Rick Hurley, Dr. Janette A. Hurlock, Dr. Joan James, Paul Jock, Richard Johnston, Bonnie Joseph, Rhea Judge, Dr. Ken Jutras, Dr. Sylvie Kallstrom, Lisa Kane, Dr. Robert Kazanjian, Dr. Arminee Keams, Brian Keddy, Marilyn Kelly, Ann Kelly, Doug Kendall, Dr. D.A. Khazen, Dr. Roch Knox, Marilyn Koch, David

Preface and Acknowledgments / xvii

Kyle, Beverly Labreche, Marie Lamontagne, Francine Landry, Paul Landry, Dr. Paul Lariviere, Claude Layton, Diane Leblanc, Eugene Lemarre, Helene Lemay, Patricia Lentjes, Donna Leon, Judith Leslie, James Levenick, Karen Lexchin, Dr. Joel Lindsay, Jannie Lovelace, Chris Loxton, Robin, Rights Advocate MacDonald, Phyllis Macintosh, Malcolm Marcantonio, Loree Marriott, John Marshall, Dr. Victor W. Martin, Dr. David Martin, John Martin, Sharon Mathias, Cheryl McAllister, Heather McCrea, Wendy McCrick, Donna MacDonald, Phyllis McDonald, Dr. W.E. McFarlane, Dianne McFarland, Mr. McKinnon, Dr. Fred McPherson, Mr. Medd, Dr. Lorna Mills, Karen Mohide, Ann Moir, Carmen Morrison, Laura

xviii / Health Care: A Community Concern?

Moses, Judith A. Mosher, P.S. Nerland, Paul Nestman, Larry Nywering, John O'Brien, Richard Oliver, Dr. Sharon C. O'Neill, Michel Osterkamp, Dennis Pallen,Paul Pascoe, David Peck, Dr. Shaun Perkins, Fran Peters, Gail Peterson, George Picherack, Frances Pineault, Dr. R.

Quigley, Maureen Quinn, Art Quinn, Kevin Ratsoy, M. Bernadet Reilly, Sandra Remple, Dr. Stan Resource Planning Group Inc.

Facilities Management Consultants

Richman, Dr. Alex Rootman, Dr. Irving Rowlands, Geoffrey Rushworth, David Russell, Dr. John Russell, Dr. Terry Ryan, Patricia

Scrivens, Susan Shanfield, Joy Sheps, Dr. Sam Silzer, Dr. Kent Skirnow, Dr. Jan Smith, Dr. John Splane, Dr. RB. Stewart, Marianne Sullivan, Dr. Wayne Sullivan, Dr. Terry Summersgill, W.M. Traversy, Louise Thompson, Dr. A.H. Thompson, Molly Thomson, Dr. Alan D. Thorpe, Ross Todd Dickenson, Angie Tremblay, Roslyn Trimble, Erika R Tsalikis, Dr. George Turner, Shannon Underhill, Theresa Marie Wells, Ross Wesley, Patrick Wharf, Dr. Brian White, Dr. Deena Whittingham, Brenda Wilber, B.D. Willer, Barry Williamson, Dr. Malcolm Willms, Dr. Sharon Manson Wisocky, John Young, Wynne