Putting the Politics Back into ?Public Engagement?: Participation, Mobilization and Citizenship in the Shaping of Health Services
Year: 2010
Type: article
Abstract: This article draws on research carried out as part of a ten-year long collaborative international research programme, the Citizenship Development Research Centre. 2 It seeks to offer reflections on some of the emphases and silences in contemporary debates about public participation in the delivery of primary health care services.Through case studies from a diversity of global contexts, we reveal and explore a series of themes with high salience for contemporary debates, which have been underplayed in mainstream understandings of public engagement in health.In part this reflects a persistent disconnect between literatures and understandings of institutionalised participation in the governance and management of health, and of mobilization and activism -a division which this article suggests is unproductive and needs to be overcome.As our cases show, practices and trajectories of public engagement and citizenship in relation to health are necessarily plural, contingent and constantly being negotiated across different spaces and in different encounters and engagements.We begin by considering some of the ways in which publics and citizens and their involvement have been framed in debates about health in the global north and the south.This leads us to identify four themes.The first is the importance of recognising the multiple sites in which public and citizen engagement takes place, beyond the official spaces into which citizens are invited to participate. 2 The Development Research Centre on Citizenship, Participation and Accountability (Citizenship DRC) is an international research partnership exploring new forms of citizenship that will help make rights real, working with research institutions and civil society organizations in Angola, Bangladesh, Brazil, India, Nigeria, South Africa and the UK (http://www.drc-citizenship.org/About_us/index.htm.)The Citizenship DRC is based at the Institute of Development Studies (IDS), University of Sussex and funded by the UK Department for International Development (DFID).The second is the need to look more closely at cultures, contexts and practices of engagement, including a sharper focus on tactics and styles.The third is the significance of recognising differentiated notions or 'summonings' (Newman and Clarke 2009) of publics, and 'differentiated citizenships' (Holsten 2009).The fourth is the importance of the politics of knowledge, both in terms of the framing of health issues and what kinds of knowledge are valued and legitimised in different fora.We then elaborate these themes through a series of health-focused case studies from Bangladesh, Brazil, South Africa and the UK.We conclude by exploring some of the challenges for negotiating health citizenship. Understandings of Health CitizenshipTwo broad, parallel literatures have addressed questions of public engagement and citizenship in relation to health.The first focuses on mechanisms for engaging citizens, generally as 'users' or 'consumers', in the delivery of primary health services.These include a relatively long-standing strand of work on 'community participation' with its roots in 1980s efforts to reform the delivery of basic health services, and the emergence of policy concern with 'public involvement' over the last decade or so.More recently, this has come to be complemented, mainly in literatures from the US, Canada and Europe, with a focus on public participation and deliberation in higher-level health planning processes.The second focuses on health activism and mobilization.This ranges from the documentation of activist experience, to applications of social movement theory to health activism.More recently, there has been an emergence of interest in 'therapeutic citizenships' and in work addressing questions of identity and knowledge in an era of bio-politics.Public health, almost by definition, involves ideas and issues that have been made public -but in diverse ways, as mediated by diverse sets of political actors and institutions, and involving diverse representations (Nichter 2008, Parker andHarper 2006).'Publicness' in health refers to how particular combinations of things, ideas, issues, people, relationships, practices and sites have been made public, and 'publics' refers to those identifications with or membership of the collectivities that form the subjects expected to take an interest in such public issues (Newman and Clarke 2009: 2).The meanings and implications of health publicness and their specific publics (subjects) are channelled through particular
Authors: Melissa Leach, Andréa Cornwall
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W156596968