Voluntarism, defensive localism and spaces of resistance to health care restructuring

Abstract

This paper examines the evolving role of volunteers and the voluntary sector in shaping community responses to structural change in health care systems. It contributes to the emerging understanding of the different forms voluntarism can take within and among places, including as a space of resistance to contemporary restructuring initiatives such as regionalization. Within the geographies of voluntarism literature, however, little attention has been directed towards interrogating the local dynamics of such voluntarism, especially as it is reflected in public discourse. We address this deficiency through a media-based case study of public reaction to the recent implementation of Ontario’s Local Health Integration Networks (a type of regional health authority). Specifically, we examine a decade of newspaper coverage in a mid-size Canadian city region to document and characterize how the activities of volunteers and voluntary sector organizations in the community are portrayed in light of the structural imperatives to integrate health care services and regionalize health care governance. The media findings reveal a suite of public concerns and related activities, with the voluntary sector called upon in various ways to defend the autonomy of the community against the perceived threats to local services, employment and vulnerable populations. We interpret the evident complexity of voluntary sector resistance as a form of ‘defensive localism’ and discuss implications for developing informed policy on health care restructuring and for advancing knowledge on the local geographies of voluntarism.