Promoting health equity through social participation and citizen engagement
- The problem: Citizen engagement in health policymaking is often limited and unequal, failing to include hard-to-reach populations. This can result in policies that do not fully reflect public needs and can reinforce existing power imbalances.
- Why it matters: Inclusive social participation reduces health inequalities, improves transparency, and builds trust, leading to policies that better serve the health and wellbeing of everyone.
- The way forward: Policymakers should promote structured, regular engagement mechanisms, such as citizen panels and health committees. By fostering inclusive, meaningful participation at all levels, policies will better align with the diverse perspectives and needs of the community.
Promoting health equity through social participation and citizen engagement
With rising public unrest, it is evident that citizens need a greater role in health decisions. Engaging communities in policymaking can lead to fairer, more effective health policies that reflect real needs and improve health equity. However, achieving inclusive participation is challenging and requires specific strategies, resources, and commitment from policymakers.
What is social protection?
Social participation empowers communities and civil society by enabling inclusive involvement in health-related decisions at all policy levels.
What is citizen engagement?
Citizen engagement is an active and deliberative process led by decision-makers which ensures that diverse perspectives within a country are recognised.
When effectively implemented, health policymakers can empower citizens and develop responsive, equitable policies that enhance physical and mental health.
Co-developing policies with communities ensures they reflect real needs, gain endorsement, and are sustainable long-term. The World Health Organization (WHO) highlights that social participation in health decision-making is vital for universal health coverage, reducing health inequalities, improving intervention efficiency, and fostering transparency, trust, and resilience.
However, designing equitable participation processes remains challenging, especially during times of polarisation and digitisation, which require dedicated approaches and resources.
Challenges in citizen engagement
- Mobilising citizens to take part in participatory processes is complex and time-consuming, particularly in engaging hard-to-reach individuals and delivering truly inclusive participation.
- Not everyone has equal access to information and opportunities.
- Participatory processes may not always meet citizens' expectations and can maintain unequal power relations and exclusions.
- Decision-makers often struggle to implement meaningful participation that goes beyond tokenistic consultation.
- Assessing the success of participation activities can be difficult due to unclear goals, challenges in evaluating suggestions, and inadequate measurement tools.
Engaging equitably in health decision-making
To drive and evaluate social participation in health, the WHO outlines three key principles: Inclusivity, Intensity, and Influence. Each principle offers a pathway for decision-makers to promote equity in health engagement.
Inclusivity
Ensure accessible venues and diverse participant selection, using trusted community members to enhance outreach and address power imbalances.
Intensity
Promote active participation methods and provide clear, high-quality information to capture input effectively.
Influence
Clearly communicate outcomes and expectations from the start, ensuring participants receive feedback on how their contributions lead to meaningful action.
Equitable engagement requires careful planning, considering constraints like budget and time, and recognising that each context is unique.
For instance, in places with limited trust in institutions, starting at a local level might be more effective than a national approach. Engagement processes should also be tailored to different policymaking stages.
Policymakers must create structured mechanisms to engage civil society, especially to gather insights from vulnerable groups often overlooked. Civil society plays a vital intermediary role, connecting governments with hard-to-reach populations.
How EU and international policies shape social participation and citizen engagement in Europe
Several EU and international activities help involve citizens and stakeholders in decision-making processes. These include:
- The European Pillar of Social Rights (EPSR): Outlines 20 principles for a strong, inclusive, and opportunity-driven social EU. Principle 8 highlights social dialogue as crucial for good health and improving working and living conditions.
- Several health initiatives: Programs like Europe’s Beating Cancer Plan, Healthier Together for noncommunicable diseases (NCDs), and the EU Mental Health initiative promote stakeholder involvement through online platforms, collaborative networks, and events, all facilitated by the EU Health Policy Platform.
- The EU Youth Strategy (2019-2027): Focuses on youth empowerment and participation in policymaking, aiming to enhance policy decisions impacting young people across sectors.
Making it happen in European States
Portugal
The Portuguese National Health Council, established in 2017, serves as a social participation mechanism, uniting civil society, health authorities, and academia. It offers non-binding health policy recommendations to enhance transparency and incorporate user voices.
Slovenia
Slovenia improved health promotion centers (2017–2020) to coordinate stakeholders and reduce health disparities. Health professionals can better address the needs of vulnerable populations by building trust and offering support for equal access to care.
Italy
The Citizen Council for Health in Tuscany fosters citizen involvement in health service design. Since 2018, over 1,000 citizens have participated in discussions on topics like waiting lists and clinical risks, with plans to increase youth participation.
Pathways to Progress
To advance health equity, EuroHealthNet recommends that policymakers and public health authorities:
- Acknowledge democratic principles as the foundation of EU Member States.
- Implement regular participatory processes to foster dialogue using health committees, citizen panels, and collaborative approaches that directly influence decision-making at local levels.
- Promote inclusivity by ensuring everyone has the tools and information to engage meaningfully, addressing practical needs like childcare and transportation.
- Engage civil society by creating mechanisms for input in policy planning and equipping community groups to shape health policy.
- Demonstrate outcomes of participatory activities, showcasing how citizen involvement enhances health, equity, and wellbeing.
- Build capacity among health authorities to facilitate inclusive engagement, ensuring adequate resources and training for effective participation.
Related resources
European Pillar of Social Rights Flashcard Tool
A guide for public health professionals and decision-makers
Improving health equity in Europe
Priorities for the 2024-2029 EU policy landscape
An Economy of Wellbeing for Health Equity
Fostering a transition towards healthier, more inclusive, and sustainable societies