DEMOCRATIZING HEALTH. CONSUMER GROUPS IN THE POLICY PROCESS Edited by Hans Lofgren, Evelyne de Leeuw and Michael Leahy 2011 Edward Elgar. ISBN 978 1 84844 784 4 10.1071/AHv36n3_BR1One of the greatest strengths of this book is the quite remarkable spread of contributors from across the globe. The three editors - all from our own Deakin University - are to be congratulated for managing to get such a broad international array of authors and country experiences. And these matter for such a book. They matter first because the issue of democratising health is a genuinely international one; second in any country's agenda for pursuing such democratisation there are lessons to be learned from other countries; and third, as it turns out, experiences across countries vary quite a bit.I enjoyed the book and found it a most useful addition to the literature in this field. In reviewing it, however, I need to declare a particular bias with respect to democratising health. I see citizens as being those who would be involved in such a process and I prefer to draw a clear distinction between citizens and consumers. (I will return to that issue shortly.)The book, for an edited volume with 16 chapters, is very readable. That is quite something when it covers such a range of very different countries from the USA to Malaysia, from Austria to Australia.The book opens with the following statement from the editors:'This book examines the extent to which consumer groups engage in the development of policy affecting their members' health and health care. Such engagement may be referred to as the 'democratisation of health' but, as the contributions to this book show, there are considerable differences between national contexts as to what this means, both in theory and in practice.' (p. 1)The editors suggest that there are two streams to democracy 'the liberal or the social stream' but that, whichever is adopted, democracy 'is perceived rightly or wrongly as the only form of government capable of giving due recognition to human dignity'. (p. 2)Beyond the introductory chapter, Milewa discusses health activism in the age of governance and interestingly concludes that 'health activist groups exist only because their aims have not been met in the context of the political, bureaucratic and medical status quo.' (p. 27)The majority of the other chapters have a specific country focus. For Malaysia, Barraclough and Kai Lit show how, in the wake of the adoption of neo-liberal ideology and policies, including privatisation, the role of consumer groups changed. 'Their role in monitoring 'value for money' and quality of care was intensified by the rapid growth of private hospitals and the more intensive use of medical technology' (p. 164). It was then perhaps inevitable that they became embroiled in 'an ideological challenge to the government's stated goals of reducing the public financing of health care and privatising the public agencies responsible for its delivery' (p. 164).Church and Armstrong worry about the role of citizens in Canada generally, but also specifically with respect to healthcare where they claim that consumer groups have increasingly been driven into 'an unholy alliance with private corporate concerns' (p. 205) and they call for 'a greater sense of organic citizenship' (p. 205) in Canada.There are two chapters on the USA, one by Fox and Lambertson is quite despairing of the role of health consumers to date - but they take heart from the Obama reforms that their voice can make a difference; they end on a positive note, 'If a strong consumer voice continues to develop...this nascent voice [can] gradually weave its way into the fabric of American political dialogue' (p. …
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