Participation is a form of agency, or purposeful, goal-oriented activity. Individuals and communities participate in activities to improve their health and well-being.

Two views of participation in health.

In the first, more conventional view, planners see participation as a way to improve the delivery of standard services. By getting local people to carry out pre-defined activities, health services can be extended further and will be better accepted. In the second view, participation is seen as a process in which the poor work together to overcome problems and gain more control over their health and their lives.

Assumptions of the conventional view

  • Common interests are the basis of community dynamics — that if everyone works together and cooperates with the health authorities, people's health will improve.
  • Poverty results from the personal shortages or shortcomings of the poor. Therefore, their program's goal is to change people to function more effectively in society. They think that if the poor are provided with more services, greater benefits, and better habits, their standard of living will become healthier. The more people accept and participate in this process, the better.

Assumptions of the radical view

  • Conflicts of interest exist inside and outside the community. It sees these conflicts as an important influence on people's health. It does not deny the value of people cooperating to solve common problems, but it realizes that different persons and social groups have different economic and political positions. Too much emphasis on common interests may prevent people from recognizing and working to resolve the conflicting interests underlying the social causes of poor health.
  • Any community program should start by identifying the main conflicts of interest within the community. It is also important to identify conflicts with forces outside the community and look at the way these relate to conflicts inside the community.
  • Poverty results from a social and economic system that favors the strong at the expense of the weak. Only by gaining political power can the poor face the wealthy as equals and act to change the rules that determine their well-being. Programs with this view work to change society to more effectively meet the people's needs. For this change to take place, people's participation is essential — but on their terms.

What does this mean for public health?

If we look at different health and development projects, we can see that their approaches to community participation range between two opposites.

  • Participation as a way to control people: "How can we get them to do what we want?" "Why not through community participation? We can get a community development block grant."
    • Ex. worksite wellness, healthy eating initiatives, behavioral health, putting a Whole Foods in Englewood.2
  • Participation as a way for people to gain control: "How can we be sure get our mandated breaks every shift?" "Why not join together and support each other in taking them?" "But what will the manager say?" "Nothing, if we stick together."

Between these two opposites there are many intermediate stages. These vary according to

  1. who really does the participating,
  2. the function of the participation, and
  3. the center of power..


This page adapted from: David Werner & Bill Bower (1982), Helping Health Workers Learn. Berkeley: Hesperian. "Hesperian Health Guides encourages others to copy, reproduce, or adapt to meet local needs, any or all parts of this book…, provided that the parts reproduced are distributed free or at cost — not for profit."


Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License