Health governance, medical pluralism and the politics of integration : a legal theory for increasing access to healthcare
University of British Columbia
Doctor of Philosophy - PhD
This thesis investigates why and how extant systems of health governance and the associated boundaries of legitimacy imposed by these systems impact on the realization of key healthcare objectives. It contends that while purporting to represent a universally valid approach to healthcare delivery, the transposed laws/institutions that underlie these governance systems are of themselves designed to address health and health systems-related problems through methods often unsuited to the unique experiential dynamics that ought to shape governance in any given society. This thesis responds to this disparity between governance regimes and societal realities by advancing dual healthcare reform initiatives. First, it espouses the concept of medical integration—consistent with the recommendations of the World Health Organization, which involves the systemic synthesis of indigenous, complementary, alternative and biomedical healthcare resources. Second, since medical integration faces legal complications—which are products of decontextualized governance systems that are incompatible with the pluralistic nature of healthcare usage/delivery in underserved populations – this thesis proposes that health equity is dependent on a new approach to governance sustained by a reformed legal process in which legal policies reflect socio-economic, geo-cultural, and political-historical dynamics. Drawing insights from Lon Fuller‘s interactional law theory and Felix Cohen‘s functional jurisprudence, this study propounds a theory of integral governance—herein denoted as Integrated Governance—which offers a legal and institutional framework for medical integration. Integrated Governance is first a theory of law centering on the institutionalization of laws that embody empirical trends and a theory of democratic governance advancing an interactive and interdependent relationship between the state, health professionals of multiple healthcare paradigms, consumers, and relevant non-state actors. The thesis applies research outcomes from two Canadian cities and four Nigerian urban and rural communities to support its contentions. By identifying in both countries prevalent clinical practices that complement trends in consumer healthcare behaviour, and highlighting disparities between these practices/trends and extant governance regimes, the research substantiates the underlying thesis of this study – that this disparity represents a failure of governance. The research further supports the thesis that governance must be restructured to produce functional healthcare institutions that address the needs of legal subjects.
Law, Faculty of