Partnerships, primary health care and health inequalities: problems and possibilities

Abstract

Partnerships have become a widespread tool for coordinating the disconnected components of primary health care. They are based on network modes of governing which are seen as less susceptible to power disparities and as being more democratic than hierarchies, and more inclusive and egalitarian than markets. This paper examines whether government mandated partnerships, which mix network characteristics with aspects of hierarchies and markets, can contribute to ameliorating the effects of inequities and their impacts on health. Partnerships have benefits but are complicated and time consuming. They have theoretical appeal in addressing health problems which require solutions that reach beyond traditional health boundaries to be more interconnected and inclusive. Evaluations of partnerships in the UK indicate their substantial coordination benefits. But reducing the impact of inequities also requires shifting to a conception of health that emphasises the social and environmental context. This is the case even where partnerships have political support and health inequalities are on the agenda. Partnerships are not a quick fix, but they are a necessary component of tackling the impacts of inequities on health. They create possibilities for reducing the impacts of inequities on health by providing a platform on which additional measures can be built.