Democratic participation: a critical element of precautionary public health decision-making.

The precautionary principle is increasingly discussed in debates about threats to health and the environment, particularly when government actions might inhibit free trade. It is gaining recognition as an overarching principle of decision-making, one that underlies efforts for sustainable development. Pronouncements about the precautionary principle have focused generally on the responsibility of government to act in the face of uncertainty and the shifting of burdens onto proponents. This assumes that government will have the resources, knowledge, expertise, and will to act. The role of the public those who may be affected by environmental degradation or their representatives is mostly missing from the discussions. This article outlines a rationale for why participation is critical and explores the theory of citizen participation. The article also describes participatory models used around the world, primarily examples of citizen participation though various models also exist for workers.