Abstract

Rethinking the Practices of Social Democratic Governance in Health Care in B.C.: Some Lessons from Other Jurisdictions

Marcy Cohen

A number of recent discussions about the future of social democracy in Canada have focused on the importance of developing more participatory forms of governance in response to the erosion of democratic vitality and in particular the loss of government programs that entrench a more egalitarian distribution of societal resources. These discussions have not, however, been translated into a concrete analysis of how public sector governance might be organized differently. For example:

• How does the public sector system (i.e. the network of direct and indirect governmental agencies) itself constrain the development of more participatory forms of democracy?
• What are the forms of democratic governance that will garner support from a broad cross section of the non-elite groups and individuals for a progressive policy agenda and sustain that support in the face of opposition from more established interests?
• How can these more active forms of civic participation and engagement increase the effectiveness, creativity and competence of government?
• What needs to change in the relationship between the elected officials and the public service, and in the structure and organization of the public service itself to sustain support these more democratic forms of governance?

In order to address these questions with some specificity, this paper reviews the key innovations that were introduced in four jurisdictions where efforts to democratize the mechanisms of governance have been relatively successful. The four jurisdictions include two municipal governments -- the Greater London Council, 1981-1986 and Porto Alegre Brazil, 1986 to the present -- and two state governments -- Cerara Brazil, 1989-1995 and Kerela India, 1996 to the present. The evidence from these jurisdictions suggests that more entrenched forms of civic participation and engagement increase the effectiveness of public sector systems in some very specific ways and therefore lend legitimacy to and reaffirm the role of “the activist state.”

In final section of the paper, the lessons that can be drawn from these four examples are then applied to the experience with health care reform in British Columbia over the 1990’s. I argue that the NDP would have been much more successful in achieving its health reform objectives if it had transformed the mechanisms of governance in some very specific ways building on the experiences from these four jurisdictions. Strategies for engaging non-elite groups and individuals in health policy decisions at the local and provincial level and new ways of working within and across the public sector (broadly defined) were required to mobilize sufficient support to sustain progressive health reform initiatives in the face of opposition from established institutional interests.

Bio

For the last seven years I have worked as the senior research and policy co-ordinator for the Hospital Employees Union, the largest health care union in British Columbia. Prior to that I worked as a consultant with the NDP government in the area of labour market programming and was the national representative for women’s organizations on the Canadian Labour Force Development Board. I have a Masters of Education in Sociology from OISE and have completed all my course work for a Ph.D. also from OISE.

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