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

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  • Baum, Fran
  • Ziersch, Anna
  • Freeman, Toby
  • Javanparast, Sara
  • Henderson, Julie
  • Mackean, Tamara

Abstract

The 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 view. The result of the interplay between competing interests and the distribution of power is a selective PHC system that is not likely to change without radical shifts in power and perspectives.

Suggested Citation

  • Baum, Fran & Ziersch, Anna & Freeman, Toby & Javanparast, Sara & Henderson, Julie & Mackean, Tamara, 2020. "Strife of Interests: Constraints on integrated and co-ordinated comprehensive PHC in Australia," Social Science & Medicine, Elsevier, vol. 248(C).
    • Handle: RePEc:eee:socmed:v:248:y:2020:i:c:s0277953620300435
    DOI: 10.1016/j.socscimed.2020.112824
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    References listed on IDEAS

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    1. Baum, Fran & Freeman, Toby & Sanders, David & Labonté, Ronald & Lawless, Angela & Javanparast, Sara, 2016. "Comprehensive primary health care under neo-liberalism in Australia," Social Science & Medicine, Elsevier, vol. 168(C), pages 43-52.
    2. Harvey, David, 2007. "A Brief History of Neoliberalism," OUP Catalogue, Oxford University Press, number 9780199283279.
    3. Sara Javanparast & Janny Maddern & Fran Baum & Toby Freeman & Angela Lawless & Ronald Labonté & David Sanders, 2018. "Change management in an environment of ongoing primary health care system reform: A case study of Australian primary health care services," International Journal of Health Planning and Management, Wiley Blackwell, vol. 33(1), pages 76-88, January.
    4. Hall, Peter A. & Taylor, Rosemary C. R., 1996. "Political science and the three new institutionalisms," MPIfG Discussion Paper 96/6, Max Planck Institute for the Study of Societies.
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    1. Freeman, Toby & Baum, Fran & Javanparast, Sara & Ziersch, Anna & Mackean, Tamara & Windle, Alice, 2021. "Challenges facing primary health care in federated government systems: Implementation of Primary Health Networks in Australian states and territories," Health Policy, Elsevier, vol. 125(4), pages 495-503.

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