Are we the “Gods of the Gaps”?

When asked what PHNs are meant to do I often find myself saying that we exist to “fill gaps in the local health system”.   This satisfies most people as we seem to share a universal appreciation that while our health system is good not everyone is able to get what they need.

However, reflecting on the use of the term “gap” I became aware that it carried some major connotations:

  • A gap is something that can be filled to improve a thing that is inherently sound
  • A crack is something different- it implies imminent collapse!
  • How many gaps do you need to call it a crack?
  • If you plug just a few gaps will this stop things from crumbling if the foundations are giving way?

Thought starters:

  1. If we just focus on gap-filling we may miss the opportunity to reinforce the fabric of the local health system.  Reform is not about gap-filling although it may be necessary as a short-term measure.
  2. A focus on gaps implies a world-view that far-reaching change is not needed.  We just need to sort things for the few who are missing out.

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