Molina-Rodríguez J F, Daquilema M, Gómez-Bautista C
Escuela de Salud Pública de México, Instituto Nacional de Salud Pública, Cuernavaca.
Salud Publica Mex. 1992 Nov-Dec;34(6):660-9.
One of the basic foundations for the operation of health programs is the social participation of the population in actions going from planning to evaluation, promotion and control of actions related with their own health. In the work, we present the results of a preliminary and partial evaluation of an ongoing autopromoting health project in the communities of Lázaro Cárdenas and Las Limas, in the Municipality of Simojovel, Chiapas, México. The basic goal of this work is to identify factors derived from the relations of localities with the State and, on the other hand, from socioeconomic conditions of the populations, which favor or hinder the development of social participation in their own health projects. This is a comparative study, type before and after, within and between localities, intended to measure the effect of a health program with community participation in two communities having divergent relations with the State. For this, we carried out a socioeconomic and prevalent morbidity survey before and after the implementation of social participation in health actions. We also characterized social participation in health actions and identified the type of State intervention in the localities through governmental programs and institutions. The results convey the notion that the health program contributes to enhance hygienic sanitary conditions of the population and decrease the frequency of such ailments as diarrhea and parasitic diseases; social participation is more active in Lázaro Cárdenas than in Las Limas. State interventions in the communities are given through social programs and institutions in a mandatory way, with no opportunity for community participation in decision-making. The conclusion is that the demographic organization of the community and autopromotion favor the participation in health actions, while the presence of the State through political repression and actions delivered through social programs promote dependence and paternalism, hindering the ample social participation in actions for health.
健康项目运作的基本基础之一是民众在从规划到评估、促进以及控制与其自身健康相关行动的过程中的社会参与。在这项工作中，我们展示了对墨西哥恰帕斯州西莫霍韦尔市拉萨罗·卡德纳斯和拉斯利马斯社区正在进行的自我促进健康项目的初步和部分评估结果。这项工作的基本目标是确定源自地方与州关系以及另一方面源自民众社会经济状况的因素，这些因素促进或阻碍了社会参与自身健康项目的发展。这是一项前后对比研究，在地方内部和地方之间进行，旨在衡量一个有社区参与的健康项目在与州关系不同的两个社区中的效果。为此，我们在实施健康行动的社会参与之前和之后进行了社会经济和普遍发病率调查。我们还对健康行动中的社会参与进行了特征描述，并通过政府项目和机构确定了州在地方的干预类型。结果表明，健康项目有助于改善民众的卫生条件，并降低腹泻和寄生虫病等疾病的发病率；拉萨罗·卡德纳斯的社会参与比拉斯利马斯更活跃。州对社区的干预是通过社会项目和机构以强制方式进行的，没有社区参与决策的机会。结论是，社区的人口组织和自我促进有利于参与健康行动，而州通过政治压制以及通过社会项目实施的行动的存在则促进了依赖和家长作风，阻碍了社会对健康行动的充分参与。
