Citizenship and empowerment: a remedy for citizen participation in health reform

The article begins by identifying the shared features of participation, empowerment and citizenship by reviewing the literature and grounding the discussion in the case study in health reform in one region of British Columbia. The ethnographic case study followed four health planning groups' efforts to foster community participation in developing local community health plans over an 11 month period. Data were also collected through interviews with participants, and focus groups with non-participants. As the article chronicles, despite the best intentions of the health planning groups, their work more closely resembled a social planning orientation than a community development one. The findings suggest that the concepts of citizenship and empowerment are useful in explaining why some individuals engaged in the work of the health planning groups and others did not. The sense of full citizenship—enjoying the formal status and substantive effects of civil, political and social rights as an equal member of the community—distinguished participants from non-participants. The article concludes with a discussion of the findings from the case study in terms of informing the theory and practice of community development.