A guiding principle of international primary health care since the 1970s is contained in the slogan, ‘community participation in health’. In practice, however, national and local political considerations are often decisive in the implementation of health policies. Dr Morgan shows how ‘community participation’ was sacrificed to competing political priorities even in Costa Rica, a country known for its dedication to health care. Focusing on a banana-growing community, she documents and analyses the process by which local health policy is politicised. Her sophisticated case study sets a detailed rural ethnography in both a national and international context. This book will be of great interest to medical anthropologists, planners, and anyone concerned with international health and development policy.