Abstract
Equity in health and health care is animportant issue. It has been proposed that thepursuit of equity in health care is beinghampered by the dominance of individualism inhealth care practices. This paper explores theway in which communitarian ideals and practicesmight lend themselves to the pursuit of equity.Communitarians acknowledge, respect and fosterthe bonds that unite and identify communities.The paper argues that, to achieve equity inhealth care, these bonds need to be recognisedand harnessed rather than ignored. The notionof individual autonomy in the context of thecommunity is examined. Alternative concepts ofautonomy – social autonomy and communityautonomy – are seen to be more respectful andnurturing of both the individual and thecommunity. Moreover, these concepts appeardesirable for the pursuit of health care equitygoals. The paper concludes with some thoughtsabout how equity in Australia's health caresystem can reasonably progress within acommunitarian vision. Disadvantaged communitiesare discussed throughout, in particular,Australian Aboriginal communities.
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References
Anderson, I. (1994) Powers of Health. Arena June'July, 32–36.
Anderson, R. (1990). Human Behaviour in the Social Environment. New York: Aldine De Gruyter.
Australian Institute of Health and Welfare (1998) Australia's Health 1998: The Sixth Biennial Health Report of the Australian Institute of Health and Welfare (pp. 38–40). Canberra: AIHW.
Avineri, S. and de-Shalit, A. (1992) Introduction. In S. Avineri and A. de-Shalit (Eds.), Communitarianism and Individualism. New York: Oxford University Press.
Barclay, L. (1999) Autonomy and the Social Self. In C. Mackenzie and N. Stoljar (Eds.), Relational Autonomy: Feminist Perspectives on Autonomy, Agency, and the Social Self. New York: Oxford University Press.
Baum, F. (1998). Ideology, Politics, Ethics and Public Health. In F. Baum (Ed.), The New Public Health: An Australian Perspective. Melbourne: Oxford University Press.
Beauchamp, D.E. (1985). Community: The Neglected Tradition of Public Health. Hastings Center Report 15(6), 28–36.
Broome, J (1991). Weighing Goods. Oxford: Blackwell.
Callahan, D. (1990). What Kind of Life: The Limits of Medical Progress. New York: Simon and Schuster.
Comino, E. and Howell, S. (1999). The Facts. In E. Harris, P. Sainsbury and D. Nutbeam (Eds.), Perspectives on Health Inequity. Sydney: The Australian Centre for Health Promotion.
Coombs, H.C. (1994). Aboriginal Autonomy: Issues and Strategies. Melbourne: Cambridge University Press.
Culyer, A.J., van Doorslaer, E. and Wagstaff, A. (1992) Comment: Utilisation as a Measure of Equity. Journal of Health Economics 11, 93–98.
Donaldson, C. and Gerard, K. (1993) The Economics of Health Care Financing. The Visible Hand. Basingstoke: Macmillian.
Emanuel, E. (1991). The Ends of Human Life: Medical Ethics in a Liberal Polity. Cambridge, MA: Harvard University Press.
Etzioni, A. (1991). A Responsive Society. San Francisco: Jossey-Bass.
Fagan, P. (1991). Self-determination in Action. In J. Reid and P. Trompf (Eds.), The Health of Aboriginal Australia. Sydney: Harcourt Brace Jovanovich.
Frazer, E. (1999). The Problems of Communitarian Politics: Unity and Conflict. New York: Oxford University Press.
Habermas, J. (1994). Struggles for Recognition in the Democratic Constitutional State. In A. Gutmann (Ed.), Multiculturalism: Examining the Politics of Recognition. New Jersey: Princeton University Press.
Hawe, P. (1994). Capturing the Meaning of ‘community’ in Community Intervention Evaluation: Some Contributions from Community Psychology. Health Promotion International 9(3), 199–210.
Health Department of Western Australia (1998) Review of Primary Medical Services to Remote Area Aboriginal Communities. Western Australia: The Office of Aboriginal Health.
Hillery, G.A. (1955) Definitions of Community: Areas of Agreement. Rural Sociology 20(2), 111–123.
Houston, S. (2001) Cultural Security, Discussion Paper, Health Department of Western Australia, Perth.
Houtepen, R. and Meulen R.T. (2000) The Expectation(s) of Solidarity: Matters of Social Justice, Responsibility and Identity in the Reconstruction of the Health Care System. Health Care Analysis 8, 355–376.
Ivers, R., Palmer, A., Jan, S. and Mooney, G. (1997) Issues Relating to Access to Health Services by Aboriginal and Torres Strait Islander People. Discussion Paper 1/97. Department of Public Health and Community Medicine, University of Sydney: Sydney.
Jensen, U.J. and Mooney, G. (1990). Changing Values: Autonomy and Paternalism in Medicine and Health Care. In U.J. Jensen and G. Mooney (Eds.), Changing Values in Medical and Health Care Decision Making. plChichester: John Wiley.
Kenny, S. (1994). Developing Communities for the Future: Community Development in Australia. plSouth Melbourne: Thomas Nelson Australia.
Kenny, S. (1996). Contestations of Community Development in Australia. Community Development Journal vn 31 (2), 104–113.
Krasnik, A. (1996). The Concept of Equity in Health services Research. Scandinavian Journal of Social Medicine 14(1), 2–7.
Laila, G. (1999). Access to Health Care. The Journal of Nursing Scholarship 31(1), 13–19.
Lairson, D.R., Hindson, P. and Hauquitz, A. (1995) Equity of Health Care in Australia. Social Science and Medicine 41(4), 475–482.
Lindbladh, E., Lyttkens, C., Hanson, B. and Ostergren, P. (1998) Equity is Out of Fashion? An Essay on Autonomy and Health Policy in the Individualized Society. Social Science and Medicine 46, 1017–1025.
MacIntyre, A. (1992) Justice as a Virtue. In S. Avineri and A. de-Shalit (Eds.), Communitarianism and Individualism. New York: Oxford University Press.
Mackenzie, C. and Stoljar, N. (1999) Introduction: Autonomy Refigured. In C. Mackenzie and N. Stoljar (Eds.), Relational Autonomy: Feminist Perspectives on Autonomy, Agency, and the Social Self. New York: Oxford University Press.
Margolis, H. (1982) Selfishness, Altruism and Rationality: A Theory of Social Choice. Cambridge: Cambridge University Press.
Marmot, M. and Wilkinson, R.G. (Eds.) (1999) Social Determinants of Health. Oxford: Oxford University Press.
Mooney, G. (1996) And Now for Vertical Equity? Some Concerns Arising from Aboriginal Health in Australia. Health Economics 5, 99–103.
Mooney, G. (1998) “Communitarian Claims” as an Ethical Basis for Allocating Health Care Resources. Social Science and Medicine 47, 1171–1180.
Mooney, G. and Wiseman, V. (1999) A ‘Constitution’ for Health Services. Journal of Health Services Research and Policy 4(4), 195–196.
Nord, E., Richardson, J., Street, A., Kuhse, H. and Singer, P. (1995). Maximising Health Benefits vs Egalitarianism: An Australian Survey of Health Issues. Social Science and Medicine 41, 1429–1437.
Robertson, A. (1998) Critical Reflections on the Politics of Need: Implications for Public Health. Social Science and Medicine 47(10), 1419–1430.
Saggers, S. and Gray, D. (1991) Aboriginal Health and Society: The Traditional and Contemporary Aboriginal Struggle for Better Health. Sydney: Allen and Unwin.
Sandel, M. (1992) The Procedural Republic and the Unencumbered Self. In S. Avineri and A. de-Shalit (Eds.), Communitarianism and Individualism. New York: Oxford University Press.
Schafer, A. (1994) Comments on Birch and Abelson's “Is Reasonable Access What We Want?” International Journal of Health Services 24(2), 373–375.
Schlesinger, M. (1997) Paradigms Lost: The Persisting Search for Community in U.S. Health Policy. Journal of Health Politics, Policy and Law 22(4), 937–992.
Sen, A. (1985) Commodities and Capabilities. plAmsterdam: North Holland.
Sen, A. (1993) Capability and Well-being. In M. Nussbaum and A. Sen (Eds.), The Quality of Life. Oxford: Clarendon Press.
Shaw, M. Dorling, D. and Davey-Smith, G. (1999). Poverty, Social Exclusion, and Minorities. In M. Marmot and R.G. Wilkinson (Eds.), Social Determinants of Health. Oxford: Oxford University Press.
Susser, M. (1993) Health as a Human Right: An Epidemiologist's Perspective on the Public Health. American Journal of Public Health 83(3), 418–426.
Taylor, C. (1992) Atomism. In S. Avineri and A. de-Shalit (Eds.), Communitarianism and Individualism. New York: Oxford University Press.
Taylor, C. (1994) The Politics of Recognition. In A. Gutmann (Ed.), Multiculturalism: Examining the Politics of Recognition. plNew Jersey: Princeton University Press.
Tesh, S. (1994) Hidden Arguments: Political Ideology and Disease Prevention. New Brunswick: Rutgers University Press.
Weiss, P. (1995a) Feminism and Communitarianism: Comparing Critiques of Liberalism. In P. Weiss and M. Friedman (Eds.), Feminism and Community. Philadelphia: Temple University Press.
Whitehead, M. (1998) Diffusion of Ideas on Social Inequalities in Health: A European Perspective. The Milbank Quarterly 76, 469–492.
Wiseman, V. (1999) Culture, Self-rated Health and Resource Allocation Decision-making. Health Care Analysis 7, 207–223.
Wiseman, V. (2000) Community Values in Resource allocation Decision Making. Discussion Paper 6/2000. A Discussion Paper Series on Priority Setting in Health Care. Sydney: SPHERe, University of Sydney (in press).
Yen, I.H. and Syme, S.L. (1999) The Social Environment and Health: A Discussion of the Epidemiologic Literature. Annual Reviews of Public Health 20, 287–308.
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Black, M., Mooney, G. Equity in Health Care from a Communitarian Standpoint. Health Care Analysis 10, 193–208 (2002). https://doi.org/10.1023/A:1016583100955
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DOI: https://doi.org/10.1023/A:1016583100955