Social participation in health in Brazil and England: inclusion, representation and authority

Abstract

Aim This article offers a brief description and analysis of public participation in health in Brazil and England in order to highlight different motivators and tensions within an acceptance of participation as official policy.Sources ⁄ methods The article draws on a range of research in both countries and an analysis of official documents relating to participation. It is based on collaboration between researchers deriving from broad programmes of work on public participation in which the authors are involved.Argument There is a tension between different principles underpinning collective public involvement in health both within and between countries. Different aspirations or claims have been made about what such participation will achieve and there are trade-offs between design principles that have consequences for issues such as who takes part and thus also for what can be achieved. The democratic origins of public participation are more evident in the Brazilian situation than in England, but there are still questions about the inclusivity of the practices through which this is achieved. The English picture is both more diverse and dynamic, but formal decision-making power of participatory forums is less than in Brazil. Whilst social justice claims for participation have been made in both countries, there is as yet limited evidence that these have been realized. Social participation in health in Brazil and EnglandGreater public participation in policy-making is evident in countries of the global North and South. Health services and policy-making are the focus of such participation in many countries where political systems and cultures, demography and the balance between state, private and NGO action on health is hugely varied. This paper draws on collaboration between researchers in England and Brazil to offer a comparative analysis of the way in which collective participation in health policy-making has developed and the different principles and purposes on which this is built. We identify four purposes that are evident to different degrees at different times and in each country: (i) deepening

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