Participation: myths, realities and prognosis.

The prospects for increased participatory approaches in health arenas has to recognise not only the encouraging developments (e.g. the "rights" legislation, global health program approaches, social action acceptability, growth in community advocacy skills, freedom of information legislation) but also the persistence of some long-standing impediments (e.g. entenched medical dominance, antagonistic bureaucratic cultures, a centralist supremacy, an intractable political economy of health, inhibitory professional paradigms). There are wide variations between societies in the way these developments and impediments are traded off or balanced, ultimately depending upon how such issues as the sharing of knowledge and skills, information access, challenges to power and practics paradigms are being recognised and resolved in specific contexts.