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Authors: Françoise Barten1, Marco Akerman2, Daniel Becker3, Sharon Friel4, Trevor Hancock5, ... - page 17 / 47





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it also illustrates that health in Villa El Salvador is not conceived as a cross-sectoral issue subject to decisions made by every sector, rather it is a spatial issue related to the living and working conditions in each neighbourhood. Apparently health in Villa is considered as a sector (theme) and - probably because of legitimate concerns of the inhabitants after years of neglect- perceived mainly in terms of the provision of health services.  

With regard to the situation in Europe, Sintomer et al (2008: 175) conclude that participatory budgeting has not yet achieved those outcomes that politicians and activists may have expected, and wonder if this is just a matter of time or related to different contextual variables? “A window of opportunity” as in Porto Alegre cannot be created ex nihilo, and the institutional kit of participatory budgeting alone hardly produces the same outcomes in Europe as it does in Brazil”.

It is worth noting that the six different ideal-types or procedures (see footnote 20) produced rather different results and outcomes, based upon e.g. the history and tradition of participation. It was found that above all in two models:  the “Porto Alegre in Europe” and “the Community Funds at neighbourhood and city level” an empowered participatory governance could develop. In these ideal-types and cities, participation implied also decision-making power (p.175). Social justice, however was only enhanced in some cities – especially in Spain and in Italy – where a serious process with clear rules of the game, an active civil society and a cooperative local government led to considerable results. In some cities, the process was labelled participatory budgeting,  but citizens were not even consulted

In all the other procedural models22 there may be participatory governance, but “it can hardly be called empowered: the proximity, participation and consultation over public finances are only consultative” (Sintomer et al, 2008:175). It prevents the creation of a “strong public” with increased control over the underlying social determinants of health inequity.  

The public/private negotiating table was found to provide “a decisional power to the participatory device”, but “can hardly make fundamental political and social changes possible”; as “the imperative of consensus is very high and one cannot speak of a cooperative resolution of real conflicts” (Sintomer et al, 2008:175). Within a context of considerable

22 The ideal-types: “Proximity participation”, “Consultation on public finances”, “Participation of organized interests”, “the public-private negotiating table” (Sintomer el al, 2008: 175)

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