Collective participation in health in Valle del Huasco, Northern Chile: a critical ethnography of institutional spaces for participation and social movements in a context of environmental conflict

Community participation in health is considered by governments and international organisations an essential strategy for tackling health inequalities. However, research in community participation has shown an increasing gap between normative assumptions on participation and empirical findings. Furthermore, there is some evidence of detrimental consequences on local communities related to participation. This led some scholars to propose that more attention be put on social movements, in contrast to relatively isolated formal spaces for participation, to understand better their potential to tackle health inequalities. In Chile, participation has been a transversal strategy within health institutions since the return to democracy. The main mechanism for participation corresponds to local health councils in every primary health care centre. Huasco, a territory in Northern Chile, has been affected by rapid and profound socioeconomic transformations, with negative consequences on the environment and people’s health. As such, local health councils coexist with social movements aimed at protecting collective health. This research examines the role of local health councils in a context of environmental conflict, and how these spaces for participation interact with social movements. It also looks at how broader socioeconomic conditions affect participation in health and social movements. For this, I conducted a nine-month critical ethnography in Huasco. The main finding of this study is that local health councils often legitimise existing socioeconomic conditions, specifically the role of provincial industries, due to the economic dependency of local population and public services on these industries. Additionally, emergence of social movements in Huasco relates to the limited scope of formal spaces for participation, and the gradual delegitimation of political authorities. This conflicting interaction between local health councils and social movements corresponds to a historically contingent and open process. The study of social movements in the field of collective participation and public health provides an adequate theoretical framework for addressing these issues.