‘Desire trails’ and Health Service entry systems

In town planning the ‘desire trail’ is the track across the park made by people making their own way in the absence of, or in spite of, made pathways. After a point we tend simply to use the most obviously used paths (eg Helbing et al 2001). Planners can use these as the basis of constructed pathways. Rather than working against them they can stabilise organically occuring patterns of movement.

Is it possible to make similar observations of people attempting to access health services? In recent years considerable resources have been put into coralling entry systems by delineating Health Dept preferred ‘pathways to care’ or advertising 1800/1300 telephone numbers. In both cases the organisation is attempting to prescribe how their service will be accessed. This can cut off natural methods of entry.

Typically we access services based on the referral of people we know or people we trust, friends family or our GP. Dr Gail Winkworth at the Australian Catholic University in Canberra has shown that  people without these  linkages will be much less likely to use health services. What helps them is when their GP, Centrelink contact or public housing contact links them to services and providers. Those workers refer to other workers they themselves know and or trust. In a sense, these linking people, our friends, family and trusted professional relationships are the ‘desire trails’ into health services.

When a government department proscribes these entry pathways, insisting on a phone number, often to to a Call Centre, there is no longer any person-person linkage.  For those of us able to afford private practitioners we can continue to phone the practitioner directly or drop in to make an appointment at the suggestion of people we trust.

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