Interaction between consumers and providers of health services: new roles and their implications

In the last few years, there has been an active effort in Italy to involve the population in solving health problems at the community level. This movement had its origin in the industrial setting, where workers succeeded in promoting legislation which gives them control over matters affecting their health. This experience lead to the development of a health education methodology based on the following principles: (a) the assessment of health needs must be based on the subjective experience of the people who have acquired knowledge and interest in health problems; (b) the evaluation of health needs by professionals serves to complement and integrate the assessment of needs as experienced by the community; (c) the self-diagnosis of the community -- in particular of homogenous community groups exposed to similar health risks and experiencing the same needs--and the diagnosis of the professionals must undergo cross-validation and be accepted by both parties; (d) on the basis of this mutual agreement, community health programmes should be planned and carried out jointly by the professionals and the people.