Morgan L M
Department of Sociology and Anthropology, Mount Holyoke College, South Hadley, MA 01075-1426, USA.
Health Policy Plan. 2001 Sep;16(3):221-30. doi: 10.1093/heapol/16.3.221.
The concept of community participation continues to capture the attention of international health policymakers and analysts nearly a quarter of a century after it was formally introduced at the Alma Ata Conference. This paper reviews trends in the participation literature of the 1990s, drawing examples primarily from Latin America. The following topics are discussed: sustainability, new methods for operationalizing and evaluating participation, the significance of local and cultural variability in determining outcomes, participatory self-determination as raised in the social movements literature, the increasing importance of intersectoral linkages, and continuing impediments posed by biomedical ideologies and systems. While the rhetoric and practice of participation have become fully integrated into mainstream health and development discourses, the paper concludes that ideological and political disagreements continue to divide pragmatists, who favour utilitarian models of participation, from activists, who prefer empowerment models.
在阿拉木图会议正式提出社区参与概念近四分之一个世纪后，这一概念仍继续吸引着国际卫生政策制定者和分析人士的关注。本文回顾了20世纪90年代参与文献的趋势，主要从拉丁美洲选取实例。讨论了以下主题：可持续性、实施和评估参与的新方法、地方和文化差异在决定结果方面的重要性、社会运动文献中提出的参与式自决、部门间联系日益增加的重要性，以及生物医学意识形态和体系造成的持续障碍。虽然参与的言辞和实践已完全融入主流卫生与发展话语中，但本文的结论是，意识形态和政治分歧继续将支持功利主义参与模式的实用主义者与倾向赋权模式的积极分子区分开来。
