Decision-Making in Health: Northern and Rural Health Planning

Abstract

Community decision-making for health is both simple and complex. The involvement of community members in identifying health issues and seeking solutions to problems should lead to more effective and more appropriate health planning. However, all too often political, financial and geographic barriers may impede the progress of this decision-making process. The democratization of health with the inherent empowerment of and participation by communities thus would result in health care which is culturally appropriate and acceptable to the people. Yet, the difficulties of finding a common definition of health, a clear definition of community and a consensus on the degree of authority for the decisions made make this a complex process. Whether a community defines health as the absence of illness or a general state of well being will determine the scope and breadth of services included in the planning process. If health is defined in terms of the absence of disease then the “conventional” health agencies and services will be included such as hospitals, clinics and public health units. However, if health is defined as general well-being, then housing, agriculture, recreation and all aspects of the community which influence health may be seen as necessary within the planning process. In either case, whichever definition is to be used the members of the community must have a clear understanding so that they may make informed decisions about participation.The same need for clarity is necessary in the definition of the community. The community may be determined simply by geographical area (vast or small), or it may it be based on political grounds, ethnicity or special interest.¹