Community participation in Quebec's health system: a strategy to curtail community empowerment?

Since the beginning of the 1970s, the province of Quebec has undergone a major reform of its health and social services system. Following this reform, the state has become a major protagonist, and the participation of the population is a built-in element in the system, guaranteed by law. Now, about 20 years later, there is a major effort to reorganize health services, in the wake of a "dewelfarization" mood that has reached Canada and Quebec. This article reviews the successes and pitfalls of public participation in Quebec's health system, presents the way in which participation is dealt with in current reform proposals, and draws lessons for people in many countries who have recently been encouraged to jump onto the bandwagon of participation as a strategy to promote the health of populations.