BMC Public Health 2004, 4 http://www.biomedcentral.com/1471-2458/4/11 Background Health promotion, self care and community participation The international health promotion (HP) movement had its origin in the document "A new perspective on the health of the Canadians" published in 1974 under the leadership of Marc Lalonde, the then Minister of Health and Welfare Canada [1]. The report was primarily an out- come of growing concerns in Canadian government cir- cles about the rising cost of health care and lack of proportionate rise in the health status of Canadians. For the first time in this report, a major government had acknowledged the limitations of modern medicine and health care systems in improving the health status of the population. It emphasized the role of HP as a key strategy for improving health through a holistic approach consist- ing of not only a medical dimension but also psychologi- cal, social and economic dimensions. Major outcomes of this document in Canada included rapid growth of pro- grammes aimed at lifestyle featuring social marketing and health education programmes, refinement of HP practices in communities and grassroots levels, and the creation of a federal Health Promotion Directorate in 1978 [2]. Immediately following the Lalonde report, similar reports were published by the Governments of UK, US and Swe- den [3]. The Ottawa charter, an important milestone in HP prac- tice worldwide, defines HP as the process of enabling peo- ple to increase control over, and to improve, their health. Five key strategies for HP action in the charter are building healthy public policy, creating supportive environments, strengthening community action, developing personal skills and reorienting health services [4]. During the same period, the growing interest in self care (SC) and community participation (CP) was primarily an outcome of similar concerns about the limitations of pro- fessional health system in improving health. SC is defined as a process whereby a lay person functions on his/her behalf in HP and prevention and in disease detection and treatment at the level of primary health resource in the health care system [5]. Community participation (CP) emphasizes the "bottom up" approach in planning and implementation of development programmes including health development, where people are seen as active par- ticipants, compared to the conventional "top down" approach, where people are considered as passive recipi- ents of programmes designed for them by professionals and Government officials [6]. The underlying themes of both these issues are the involvement and empowerment of people in promoting and caring for their own health. In this article, origin and development in these areas are discussed based on the literature review from Pubmed search using key words like self care, community partici- pation and health promotion. Policy level documents, publications of different international and national health agencies in these areas have been reviewed. Some papers and documents were also downloaded from the internet. These theoretical and conceptual resources, pol- icy level documents guide scientific and social policy dis- cussions about promoting the health of the individuals, families and communities in developing countries. There is a growing body of evidence from the developed world that these activities indeed lead to improvement in the health status of the population. This provides a strong rationale for initiating such activities in the developing countries as well. Programme elements for SC and CP are proposed as examples that might be included when designing a HP programme in developing countries. The potential and pitfall of the proposed programme is discussed. SC: The most dominant and universal form of primary care SC is not a new phenomenon. Care to sick individuals has always been provided primarily by the self and the family in all societies throughout history [7]. Current interest sur- rounding SC can be traced back to the 1960s and 1970s. During the 1970s, the limitations of the professional health system were highlighted. The contribution of mod- ern medicine in improving the health status of people was critically appraised and questioned. It was shown that mortality rates in England and Wales declined long before the advent of modern medical care during the twentieth century [8]. The negative consequences of modern medi- cal care were exposed [9]. Professional health systems in most countries were paternalistic and people shared a state of powerlessness in it. Efforts to exercise more con- trol over one's health and health care matters gained momentum in many countries of Western Europe and North America [10]. In the US, renewed interest in SC was rooted in the tradi- tional American values of self-reliance, individualism, anti-elitism and popular democracy. Social movements like the Women's movement was one of the first examples of SC and the book "Our bodies, Ourselves" (The Boston Women Health Book Collective, 1971) was one of the first tools developed to promote SC among women [11]. For several reasons including the shift of pattern from infectious to chronic diseases, the change from a cure to care philosophy, the escalating cost of medical care and the rise of individualism, SC continued to grow ever since [12]. A review of literature on SC in last three decades indicates that studies on SC were broadly focussed on two areas: SC for common and chronic illnesses. A large number of studies across different countries, using a variety of Page 2 of 12 (page number not for citation purposes)