From the goal of regulating to the emancipatory capacity of participation in health

Citizen participation in health has been designed in three conceptually distinct dimensions. The first is related to politics and organization of the health care system. This one represents an extension of democracy, organized in down-top movement from the bases to governments, acting more on the control of the management system than in the definition of health strategies. The second is top-down, from services to the people, conceived as a means of gaining the adherence of individuals to the agendas of health promotion. It represents an extension of medicine in the colonization of life through scientific rationality. The third type is horizontal and reveals the citizen initiative, conceived as groups of 'friends'/families of patients and / or of claiming rights activity.

In Portugal, the bottom-up participation has been rising in legislation, as a formal representation and giving population an advisory role or approval to decision makers, and the descendant participation is programmatic of 'health promotion' and is addressed to specific population groups. The horizontal participation is present but undeveloped. What is the impact of participation in terms of the presence of a plurality of rationalities about production methods of health?

The (sociology of) participation in health focus only in a secondary way on the field of the conceptualization of what is health and medical rationality that supports the therapeutic view - areas that sociology of health focuses. In this area, participation is of (self) – excluding type, present in the sketched 'movement' around the 'alternative medicine' and its holistic look on the individual.

Our empirical research on lay rationalities of health and disease emphasizes the importance of recognizing cultural subjectivity and its assertion within the system. This is the field of participation related to knowledge (scientific - lay) and represents an extension of knowledge.