Center for the Study of Equity and Governance in Health Systems, Guatemala.
Health Hum Rights. 2009;11(1):37-48.
Social participation has been understood in many different ways, and there are even typologies classifying participation by the degree of a population's control in decision making. Participation can vary from a symbolic act, which does not involve decision making, to processes in which it constitutes the principal tool for redistributing power within a population. This article argues that analyzing social participation from a perspective of power relations requires knowledge of the historical, social, and economic processes that have characterized the social relations in a specific context. Applying such an analysis to Guatemala reveals asymmetrical power relations characterized by a long history of repression and political violence. The armed conflict during the second half of the 20th century had devastating consequences for a large portion of the population as well as the country's social leadership. The ongoing violence resulted in negative psychosocial effects among the population, including mistrust toward institutions and low levels of social and political participation. Although Guatemala made progress in creating spaces for social participation in public policy after signing the Peace Accords in 1996, the country still faces after-effects of the conflict. One important task for the organizations that work in the field of health and the right to health is to help regenerate the social fabric and to rebuild trust between the state and its citizens. Such regeneration involves helping the population gain the skills, knowledge, and information needed in order to participate in and affect formal political processes that are decided and promoted by various public entities, such as the legislative and executive branches, municipal governments, and political parties. This process also applies to other groups that build citizenship through participation, such as neighborhood organizations and school and health committees.
社会参与的形式多种多样，甚至有通过人群在决策中掌控程度进行分类的参与类型学。参与的形式可以从不涉及决策的象征性行为，到作为在人群中重新分配权力的主要工具的过程，各不相同。本文认为，从权力关系的角度分析社会参与，需要了解在特定背景下塑造社会关系的历史、社会和经济进程。将这种分析应用于危地马拉，揭示了权力关系的不对称性，其特点是长期的镇压和政治暴力历史。20 世纪后半叶的武装冲突对大部分人口和该国的社会领导层造成了毁灭性的后果。持续的暴力给民众带来了负面的心理社会影响，包括对机构的不信任和社会政治参与度低。尽管危地马拉在 1996 年签署《和平协定》后，在公共政策中为社会参与创造了空间方面取得了进展，但该国仍在应对冲突的后遗症。在卫生和健康权领域工作的组织的一项重要任务是帮助恢复社会结构，并重建国家与其公民之间的信任。这种恢复涉及帮助民众获得参与和影响由各种公共实体（如立法和行政部门、市政府和政党）决定和推动的正式政治进程所需的技能、知识和信息。这个过程也适用于通过参与来构建公民身份的其他群体，如邻里组织、学校和健康委员会。
