Accountable communities: how norms and values affect health system change

Economic forces, policy initiatives, and technological change push markets along what some hypothesize is a common evolutionary path. Observations from twelve sites, however, indicate that the pace and direction of change are highly variable across markets. Other forces, internal and unique to a community, help to explain this variation. These forces emanate from the underlying history, culture, and values of a community and in part dictate the response of various players to the more common forces. This paper explores the mechanisms through which these forces operate and their relationship to health system change.