Public health planning has
historically tended to be a top-down process, based on expert
identification of priorities and the strategies to address them.
This is intensified by curative medical systems that are hierarchical,
mystified and paternalistic to clients, that have been built
on traditions of clinical autonomy in decision-making and that
are poorly prepared for taking on other interests in decision-making.
Communities for their part
often lack the capacity to engage in these competing spheres
of authority. They lack the 'language', information, cohesion
and organizational structures to do so. They can become disempowered
and distrustful in the process.