Micro macro integration: Reframing primary healthcare practice and community development in health

• Published in: Critical public health Vol. 17; no. 2; pp. 171 - 182
• Main Authors: Legge, David G., Gleeson, Deborah H., Wilson, Gai, Wright, Maria, McBride, Tony, Butler, Paul, Stagoll, Onella
• Format: Journal Article
• Language: English
• Published: Routledge 01.06.2007
• Subjects: Community developement; Community Development; Constraints; Determinants; Health; Health Problems; Macro-Micro links; micro macro integration; Needs; Primary Health Care; Social integration; Strategic planning; Structural analysis
• ISSN: 0958-1596; 1469-3682
• DOI: 10.1080/09581590601045196

The idea of micro macro integration (MMI) provides a useful framework for thinking about primary healthcare (PHC) and community development in health (CD). PHC and CD are important strategies for addressing the structural determinants of health. They are each based on a powerful logic and have a significant body of support. However, while exemplary, even inspiring, instances of practice are common, attempts to replicate models of good practice (or 'scale up') often flounder. As frameworks for analysing this paradox, both PHC and CD have limitations, partly because they are overburdened with different and conflicting meanings. This paper explores an alternative framework based on a common aspiration of both PHC and CD: to effect change at both the micro level (meeting the immediate health needs of individuals, families and communities) and also at the macro level (of political, economic and social structures). The MMI framework assumes that health issues can be analysed at different levels of scale and of term (from the micro to the macro); that objectives and strategies can be conceived at these different levels; and that a coherent programme of activities can be conceived and implemented which addresses both the immediate and local problems and the larger scale and longer term phenomena that reproduce those patterns of need. The idea of MMI is less ambitious than either PHC or CD but (partly because of this) has value as a framework for analysing barriers to good practice.