Abstract
This article addresses the issue of the interface between public health and clinical health within the context of the search for networking approaches geared to a more integrated delivery of health services. The articulation of an operative interface is complicated by the fact that the definition of networking modalities involves complex intra- and interdisciplinary and intra- and interorganizational systems across which a new transversal dynamics of intervention practices and exchanges between service structures must be established. A better understanding of the situation is reached by shedding light on the rationale underlying the organizational methods that form the bases of the interface between these two sectors of activity. The Quebec experience demonstrates that neither the structural-functionalist approach, which emphasizes remodelling establishment structures and functions as determinants of integration, nor the structural-constructivist approach, which prioritizes distinct fields of practice in public health and clinical health, adequately serves the purpose of networking and integration. Consequently, a theoretical reframing is imperative. In this regard, structuration theory, which fosters the simultaneous study of methods of inter-structure coordination and inter-actor cooperation, paves the way for a better understanding of the situation and, in turn, to the emergence of new integration possibilities.
Article PDF
Similar content being viewed by others
References
P. Adam C. Herzlich (1994) Sociologie de la maladie et de la médecine Nathan Université Paris 127
P. Bergeron F. Gagnon (1994) ‘La prise en charge étatique de la santé’ V. Lemieux P. Bergeron C. Bégin G. Bélanger (Eds) Le système de santé au Québec. Organisations, acteurs et enjeux Les Presses de l’Université Laval Sainte-Foy (Quebec) 9–32
P. Bergeron F. Gagnon (2003) ‘La prise en charge étatique de la santé au Québec: émergence et transformations’ V. Lemieux P. Bergeron C. Bégin G. Bélanger (Eds) Le système de santé au Québec Organisations, acteurs et enjeux Les Presses de l’Université Laval Sainte-Foy (Québec) 7–33
P. Bourdieu (1980) Le sens pratique Editions de minuit Paris
P. Bourdieu (1987) Choses dites Editions de minuit Paris
P. Bourdieu (1994) Raisons pratiques Editions du seuil Paris
W.F. Boyce (2001) ArticleTitle‘Disadvantaged Persons’ Participation in health Promotion Projects: Some Structural Dimensions’ Social Science and Medicine 52 IssueID10 1551–1564 Occurrence Handle10.1016/S0277-9536(00)00268-9 Occurrence Handle1:STN:280:DC%2BD3M3itVyhtA%3D%3D Occurrence Handle11314851
R. Cameron R. Walker M. Gough P. McDonald (2000) ArticleTitle‘Linking Public Health Science and Practice: An Example from the Canadian Heart Health Initiative’ International Journal of Health Care Quality Assurance 13 IssueID6/7 i–vii
C. Chaix-Couturier I. Durand.-Zaleski D. Jolly P. Durieux (2000) ArticleTitle‘Effects of Financial Incentives on Medical Practice: Result from a Systematic Review of Literature and Methodological Issues’ International Journal for Quality in Health Care 12 IssueID(2 133–142 Occurrence Handle10.1093/intqhc/12.2.133 Occurrence Handle1:STN:280:DC%2BD3cvhvValsQ%3D%3D Occurrence Handle10830670
Collège des médecins du Québec: 1998, ‘Nouveaux défis professionnels pour le médecin des années 2000’, Rapport et recommandations de la Commission sur l’exercice de la médecine des années 2000 suivis des engagements du Collège des médecins du Québec, p. 56.
A. Elster C.M. Callan (2002) ArticleTitle‘Physician Roles in Medicine-Public Health Collaboration Future Directions of the American Medical Association’. American Journal of Preventive Medicine 22 IssueID3 211–213
R.G. Evans (1984) Strained Mercy: The Economics of Canadian Health Care Butterworths Toronto
N. Freemantle (2000) ArticleTitle‘Implementation Strategies’ Family Practice 17 IssueIDSuppl.1 S7–10 Occurrence Handle10.1093/fampra/17.suppl_1.S7 Occurrence Handle10735261
M. Foucault (1979) ‘La politique de la santé au XVIIIesiècle’ M. Foucault B. Barrett-Kriegel A. Thalamy F. Béguin B. Fortier (Eds) Les machines à guérir (aux origines de l’hôpital moderne) Mardaga Belgique 7–17
F. Gagnon P. Bergeron (1999) ‘Le champ contemporain de la santé publique’ C. Bégin P. Bergeron P.-G. Forest V. Lemieux (Eds) Le système de santé québécois: un modèle en transformation Les Presses de l’Université de Montréal Montreal
A. Giddens (1971) Capitalism and Modern Social Theory Cambridge University Press Cambridge
A. Giddens (1979) Central Problems in Social Theory University of California Press Berkeley, CA
Giddens, A.: 1987, La constitution de la société (trans. by M. Audet of The Constitution of Society, 1984). Paris: PUF.
L.R. Gravois T. Garvin (2003) ArticleTitle‘Moving from Information Transfer to Information Exchange in Health and Health Care’ Social Science and Medicine 56 IssueID3 449–464 Occurrence Handle10.1016/S0277-9536(02)00045-X
Grémy, F.: 1997, ‘Filières et réseaux. Vers l’organisation et la coordination du système de soins’, Gestions Hospitalières juin-juillet, 433–438.
Grenier, C.: 2003, ‘Rôle de l’objet intermédiaire pour mieux comprendre la structuration d’un réseau organisationnel et technologique d’acteurs – cas d’un réseau de soin’, Presentation at the colloquium of AIM – Association Information et Management, Grenoble.
E.T. Hawk S.M. Lippman (2000) ArticleTitle‘Primary Cancer Prevention Trials’ Hematology/Oncology Clinics of North America 14 IssueID4 809–830 Occurrence Handle10.1016/S0889-8588(05)70313-0 Occurrence Handle1:STN:280:DC%2BD3M%2FosVWrtw%3D%3D Occurrence Handle10949775
Hulscher, M.E.J.L., M. Wensing, T. van der Weijden, and R. Grol: 2004, ‘Interventions to Implement Prevention in Primary Care’ (Cochrane Review), in: The Cochrane Library, Issue 2, Chichester, UK.
P. Lehoux C. Sicotte J.L. Denis M. Berg A. Lacroix (2002) ArticleTitle‘The Theory of Use Behind Telemedicine: How Compatible with Physicians’ Clinical Routine?’ Social Science and Medicine 54 IssueID6 889–904 Occurrence Handle10.1016/S0277-9536(01)00063-6 Occurrence Handle1:STN:280:DC%2BD383ls1Sisg%3D%3D Occurrence Handle11996023
M. Lynch (1998) ArticleTitle‘Financial Incentives and Primary care Provision in Britain: Do General Practitioners Maximise their Income?’ Developments in Health Economics and Public Policy 6 191–210 Occurrence Handle1:STN:280:DC%2BD3M%2FgtFKgtQ%3D%3D Occurrence Handle10662404
S. Macintyre A. Ellaway S. Cummins (2002) ArticleTitle‘Place Effects on Health: How Can We Conceptualise, Operationalise and Measure Them?’ Social Science and Medicine 55 IssueID1 125–139 Occurrence Handle10.1016/S0277-9536(01)00214-3 Occurrence Handle12137182
Massé, R. and L. Gilbert: 2003, Quebec Public Health Program, Quebec City: Direction générale de la santé publique, Ministère de la Santé et des Services sociaux.
K. McPherson (2001) ArticleTitle‘For and Against Public Health does not Need to Be Led by Doctors’ BMJ 322 1593–1596
R. Pampalon (1994) ‘La santé des Québécois et des Québécoises’ V. Lemieux P. Bergeron C. Bégin G. Bélanger (Eds) Le système de santé au Québec. Organisations acteurs et enjeux Les Presses de l’Université Laval Sainte-Foy (Quebec) 33–52
T. Parsons (1937) The Structure of Social Action McGraw-Hill New York, NY
T. Parsons E.A. Shils (2001) Toward a General Theory of Action Transaction Publishers New Brunswick, NJ
Quebec National Assembly (2001). Public Health Act Bill 36 (2001, Chapter 60). Province of Quebec: Quebec p. 45.
D. Raphael (1998) ArticleTitle‘Public Health Responses to Health Inequalities’ Canadian Journal of Public Health 89 IssueID6 380–381 Occurrence Handle1:STN:280:DyaK1M7isFeiug%3D%3D
A. Richardson M. Sutherland E. Wells L. Toop L. Plumridge (2002) ArticleTitle‘Factors Affecting General Practitioner Involvement in a Randomised Controlled Trial in Primary Care’ New Zealand Medical Journal 115 IssueID1151 153–155 Occurrence Handle12033481
Rojot, J.: 1998, ‘La théorie de la structuration’, Revue de gestion des ressources humaines 26–27, 5–20.
L. Shi B. Starfield R. Politzer J. Regan (2002) ArticleTitle‘Primary Care, Self-rated Health, and Reductions in Social Disparities in Health’ Health Services Research 37 IssueID3 529–550 Occurrence Handle10.1111/1475-6773.t01-1-00036 Occurrence Handle12132594
M. Sutton (2002) ArticleTitle‘Vertical and Horizontal Aspects of Socio-economic Inequity in General Practitioner Contacts in Scotland’ Health Economics 11 IssueID6 537–549 Occurrence Handle10.1002/hec.752 Occurrence Handle12203756
W. Tousijn (2002) ArticleTitle‘Medical Dominance in Italy: A Partial Decline’ Social Science and Medicine 55 IssueID5 733–741 Occurrence Handle10.1016/S0277-9536(01)00199-X Occurrence Handle12190267
P. Tovey J. Adams (2001) ArticleTitle‘Primary Care as Intersecting Social Worlds’ Social Science and Medicine 52 IssueID5 695–706 Occurrence Handle10.1016/S0277-9536(00)00179-9 Occurrence Handle1:STN:280:DC%2BD3M7otFSjtw%3D%3D Occurrence Handle11218174
J. Turgeon H. Anctil (1994) ‘Le Ministère et le réseau public’ V. Lemieux P. Bergeron C. Bégin G. Bélanger (Eds) Le système de santé au Québec. Organisations, acteurs et enjeux Les Presses de l’Université Laval Sainte-Foy (Quebec) 79–106
Turgeon, J.: 1999, ‘Les réseaux intégrés : Un concept flou mais adapté à l’environnement virtuel de la prochaine décennie’, Presentation at the XXXVe congrès-exposition de l’Association des hôpitaux du Québec, Palais des Congrès de Montréal, 19–20 May.
H. Hout Particlevan M. Vernooij-Dassen K. Bakker M. Blom R. Grol (2000) ArticleTitle‘General Practitioners on Dementia: Tasks, Practices and Obstacles’ Patient Education and Counseling 39 IssueID2–3 219–225 Occurrence Handle10.1016/S0738-3991(99)00034-8 Occurrence Handle11040721
T.L. Visscher J.C. Seidell (2001) ArticleTitle‘The Public Health Impact of Obesity’ Annual Review of Public Health 22 355–75 Occurrence Handle10.1146/annurev.publhealth.22.1.355 Occurrence Handle1:STN:280:DC%2BD3M7os1Oguw%3D%3D Occurrence Handle11274526
C.C. Wee R.S. Phillips H.R. Burstin E.F. Cook A.L. Puopolo T.A. Brennan J.S. Haas (2001) ArticleTitle‘Influence of Financial Productivity Incentives on the use of Preventive Care’ American Journal of Medicine 110 IssueID3 181–187 Occurrence Handle10.1016/S0002-9343(00)00692-6 Occurrence Handle1:STN:280:DC%2BD3M7ls1yrsQ%3D%3D Occurrence Handle11182103
D. Wilkin S. Gillam K. Smith (2001) ArticleTitle‘Tackling Organisational Change in the New NHS’ BMJ 322 IssueID7300 1464–1467 Occurrence Handle10.1136/bmj.322.7300.1464 Occurrence Handle1:STN:280:DC%2BD3MzksFSqsg%3D%3D Occurrence Handle11408304
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
St-Pierre, M., Reinharz, D. & Gauthier, JB. Organizing the Public Health-clinical Health Interface: Theoretical Bases. Med Health Care Philos 9, 97–106 (2006). https://doi.org/10.1007/s11019-005-3602-8
Issue Date:
DOI: https://doi.org/10.1007/s11019-005-3602-8