This article reviews the overall significance of the concept of community participation in health with respect to endemic diseases. It also observes how changes in Latin American society during the past forty years have forced radical changes in the notion of participation. The article describes changes in society and analyzes participation in the Cold War context, with four modalities of participation: as ideological manipulation, as cheap labor, as medical care facilitation, and as subversion. It then reviews participation in the context of the crisis of ideologies and describes two modalities: participation as a grassroots movement and as popular promotion. Finally, it interprets the forms participation takes in the context of economic adjustment programs, and from there it describes participation as both a complement to the State and a form of privatization. The article concludes with a proposal for participation as a mechanism to expand and extend democracy; in this sense, it highlights participation as a means of criticism of power, a fomenter of democratic organization, and a mechanism of transformation for the health sector.