Background and Objectives:
For over thirty years we have known that social, environmental and political factors are the primary causes of health inequities[i] [1], yet policy efforts to improve these have largely failed[ii] [2]. To address this, recent initiatives have aimed to create ‘healthier’ policies by incorporating public perspectives in their design. While there has been increasing scholarship on public and patient involvement in healthcare delivery, there remains a lack of evidence on how public participation can affect health equity outside of healthcare settings.

Methods:
This research examines how participatory processes affect health equity through changes to non-healthcare governance (such as social housing or infrastructure spending). This research was undertaken through qualitative comparison of four cases in the UK and Australia using two forms of public participation: health impact assessment and citizens’ juries.

Results:
The participatory processes generated governance and interpersonal outcomes. Outcomes were largely influenced by the context in which the process took place and the expectations of participants. Despite limited evidence of direct improvements to health, changes in governance structures that influence the social determinants of health have the potential to improve health equity.

Conclusion:
Though evidence on public participation often focuses on perfecting the form, this research found that the technology was less relevant than other context-specific features. This comparative research can help to develop a better understanding of how public participation can improve health equity through examination of the mechanisms and context in which they take place.