Fighting the System: Citizen Participation as Protest

Abstract

In Chapters 6 and 7 we turn from invited modes of action in health systems — committee work, outreach projects, and the creation of new links to representative democracy — to two uninvited, even actively discouraged, modes of public action. This chapter explores public protest and campaigns within health systems, and the next considers the ways in which private tactics of service use can be understood as public action. Public protests in health systems are an example of ‘contentious politics’, which Tilly and Tarrow (2006, p. 4) define with the following characteristics: the making of claims by one actor; collective action (‘coordinating efforts on behalf of shared interests or programs’); and politics (interactions ‘with agents of governments, either dealing with them directly or engaging in activities bearing on governmental rights, regulations and interests’). The contentious, oppositional orientation of public protests about the decisions of healthcare organisations explains, I argue, why they are rarely considered within academic or policy discussions of citizen participation in health.