Cultural and structural influences in the creation of and participation in community health programmes

Community participation in health care programmes is considered axiomatic in health development. Cultural and structural influences are discussed in relation to community participation with the intention of highlighting some critical issues affecting its generation and sustainability. These influences include structurally defined perspectives and perceptions of community participation, limitations of the necessary supportive systems, the structural and cultural factors of marginalization, community stratification and organization, mobilization, and the political context. It is concluded that given these factors against a situation of a financial and economic crisis, of economic restructuring and the values of competition and individualization, community participation will be increasingly difficult to generate and sustain. © 1992.