Pour le français

The debate over the future of Canada's health system has bogged down into a stand-off between two options: the public or the private sector as designer, provider, manager, and insurer. This attitude overlooks another, critically important alternative: the potential for community ownership of health care solutions and their implementation.

This Special Edition of Making Waves magazine starts to reframe the national dialogue by outlining the case for a vast expansion of community-level capacity and authority in our health sector. It will be available in English and French to a great many people and organizations active in the health care sector - providers, policy-makers, managers, and educators - as well as to our regular subscribers.

Making Waves is published quarterly by the Canadian Centre for Community Renewal. It is written by and for people trying to revitalize struggling communities and help marginalized groups improve their overall quality of life. It is the only periodical on CED currently published in North America, and is read by professionals and activists in this field across Canada.

Note: Community-controlled health care is an issue that's as controversial as it is strategic. We need your support for an extended press run, so many more practitioners, policy-makers, and other citizens become alert to this Third Way forward. If you're not a current subscriber - or if you want to make sure many other people receive this Special Edition - click here to purchase print copies (only $5/copy plus postage and applicable tax). Over 1500 copies have now be purchased. You can also click here for magazine subscription rates.

Scroll down this page to tour the contents in portable document format (PDF).

CONTENTS

We gratefully acknowledge the support this Special Edition has received from Canadian Rural Partnerships, Desjardins Financial Security, Nova Scotia Co-operative Council, The Co-operators, Connecting People for Health Co-operative, and the Canadian Co-operative Association.

Webpage banner photo courtesy of Multicultural Health Brokers Co-operative, Edmonton. Magazine cover photo courtesy of South Riverdale Community Health Centre, Toronto.

Editorial: A Third Way Forward
The debate over the future of Canada's health system has bogged down into a stand-off between two options: the public or the private sector as designer, provider, manager, and insurer. Neither is capable of the task in the absence of a third actor - citizens who organize and control health care delivery in their towns and neighbourhoods. In this Special Edition, a spectrum of authors outline the case for a vast expansion of community-level capacity and authority in our health sector. Read this article now.

Complete Solutions
While a terrific money-saver, centralization has hamstrung health care in many small towns. Now what? Not much, unless residents do it themselves. In Port Alberni and Nelson, B.C. citizens have translated health care problems into opportunities, rallied local resources, and used co-operatives to create the local solutions that health bureaucrats cannot. Read this article now.

Primary Health Care at the Crossroads
Given the way private, for-profit business - in the guise of clinic chains, for example - is encroaching on the health care system, you might think there's only one way to fix it. In health care co-ops, as Québec demonstrates, we have an option that can serve people better as well as build local initiative, competence, democracy, and mutuality. When it comes to health care, we have to manufacture some dissent, pronto. Read this article now.

A Big Job, Getting Bigger
The role communities should play in Canadians' health is a really old issue, stretching back to the days of smallpox epidemics. Since then - and usually at the public's behest - charities, Western medicine, then government and business have assumed more and more control over health care. Still, the need and capacity of communities to take care of themselves just won't go away. Read this article now.

Re-Evaluating Health Care
What would a "patient-centric" system of health care actually look like? Not like our current one, whose measures of self-evaluation are so much about the cost of care, not its effect on patients' comfort, ability, and lifespan. An essential re-orientation of health care is necessary, and will only occur once structural change attunes health providers to the expectations of well-informed patients. Read this article now.

Natural Allies
For two groups devoted to community engagement and well-being, community health centres and CED practitioners do a lot of work beside, but not with each other. They should. With the trend towards a corporate-led "society of consumers" in high gear, CHCs and CED are natural allies in the fight for housing, employment, inclusion, and other social determinants of health. Read this article now.

Community Ownership of Health Care Assets
Communities have a perfect right to own specialized assets and know how to finance them. Unlike recreation centres or cultural complexes, however, health care assets sometimes trip people up. They forget that their capital investment is only as good - or safe from "appropriation" - as their plan for covering the costs of operation. Read this article now.

Thinking Globally, Acting Locally about Health Reform
A primary purpose of health care reform must be to reduce the unconscionable disparities in health experienced by different groups of Canadians. It's an agenda that has more to do with social and economic policy, than health. But a significant component lies in a reconfiguration of Regional Health Authorities, so they serve as facilitators of community engagement and experimentation in health care. Read this article now.

Health Co-ops & the Future of Medicare
Might health care co-ops be another way to erode Medicare? Just the opposite. By enabling citizens to get out and close local gaps in the delivery of publicly-insured services, co-ops make Medicare work better. They reduce the disparities in health service that the state cannot and that private business will not address. Read this article now.

Come Together Now
Unions and co-operatives have a long and bumpy history, despite their common commitment to community action and mutual aid. Yet the record of the health care sector shows how co-ops can be vehicles of citizen empowerment, social justice, and exemplary service, sustaining Medicare, not degrading it. The need for unionists and co-operators to collaborate in health service delivery is great, like the opportunity. Read this article now.

The Co-op Experiment
Over the last 50 years, Canada's efforts to ensure universality of access to quality health care have inadvertently robbed the health system of its ability to respond to the needs and demands of patients and providers. The consumer health co-operative does present a means for restoring flexibility - but it also could endanger universality. To find that balance between flexibility and universality we must take pains in weighing co-op options and in applying them. Read this article now.

Community Connections
How far could community control of health care go? Very far, says John Ginn. Its potential is evident in services to promote the self-management of care, in disease prevention, in emergency rooms, and in long-term residential care. Whether they are delivered by co-ops or private business, for-profit or nonprofit, locally-designed and -managed services are already achieving excellent outcomes. Read this article now.

The Best Way to Predict the Future is to Invent It!
The aging of Canadians, the rising costs of health care, and the blossoming of computer and internet technology make it imperative that governments "open the can" on health care. Too long has it been the preserve of medical professionals and bureaucrats. Policy and legislation must strive to engage a far greater range of citizens in the creation of health care solutions, especially by means of organizations that communities own and control. Read this article now.

We extend our sincere thanks to the following for serving as guest-editors of this edition:

• Tim Agg, Executive Director, PLEA Community Services Society of BC
• John Restakis, British Columbia Co-operative Association
• Dr. David Zitner, Director, Medical Informatics, Dalhousie University
• Dianne Kelderman, Chief Executive Officer, Nova Scotia Co-operative Council
• Barb Stevenson, Alberni Valley Housing and Healthcare Co-operative
• Jean-Pierre Girard, Associate Researcher, Institut de recherche et d'éducation pour les coopératives et les mutuelles de l'Université de Sherbrooke (IRECUS)
• Dr. Ray Rupert, Doctors Care Cooperative Inc., Toronto

TO SUBSCRIBE