This paper explores the ways in which entertainment-education can promote health or amount to propaganda, based on the writer’s experience of using participatory theatre and drama for health promotion in KwaZulu-Natal, South Africa. The paper states that this does not only apply to the use of traditional cultural forms for conveying messages. Ideological abuse is sometimes hidden or dressed up for highly sophisticated societies. The paper questions how communication strategists recognise, face and deal with these ethical dilemmas?

According to the paper, participatory approaches seek to foster the creativity of individuals and provide a voice for communities that are often silenced. The broader aim is to integrate such programmes within a communication development strategy designed not only to promote healthy living but also to contribute to people’s general well being. All this is linked to even broader aims of promoting democracy and national unity, without the sacrifice of cultural diversity. Participatory approaches posit that health promotion through cultural activity is not a gift from the elite to the masses but something best produced by the community itself. The aim is to mobilise and sensitise people through information, entertainment and opportunities for debate in forms that are accessible and relevant. However, the use of traditional external forms can amount to cultural engineering and in fact become a deliberate policy of strengthening a specific social group through its cultural justification. Indeed, participatory approaches can have the opposite effect to that which is intended. Far from freeing people and democratising society they may in fact integrate them into a hierarchy, transform them into consumers, accentuate social differences and be a useful instrument for ideological domination.

The paper explores these effects - both intended and unintended - and ways of mitigating them. According to Dalrymple, it is important to recognise that culture and tradition are inextricably linked with hierarchy, and like clothes, immediately situate their owners at a point in the social and cultural scale. To tamper with cultural forms might be to affront people’s dignity and humanity. On the other hand, in a rapidly changing society people are seeking the knowledge and skills to drive change and take responsibility for their choices.