The governance required to act on social determinants is not possible without a new culture of participation that ensures accountability and equity. Facilitating participation can help safeguard equity as a principle and ensure its inclusion in public policies. The participation of communities and civil society groups in the design of public policies, in the monitoring of their implementation, and in their evaluation is essential to action on social determinants. There are many examples whereby participation has resulted in greater emphasis on health, ranging from various experiences with participatory budgeting to youth-driven advocacy such as the 'Nine is Mine' campaign by children in India.
Participation is therefore a key intervention to strengthen political sustainability at national and global levels and to ensure that policies and interventions reflect people’s needs. Countries such as Brazil and Thailand that have had recent success in reducing health inequities have placed renewed emphasis on this dimension of participation. Sustaining necessary action on social determinants across a range of sectors, particularly ensuring that services are responsive to the needs of disadvantaged populations, is extremely difficult without broader societal involvement. Participation conceived in this way has intrinsic value in respecting people’s autonomy and right to be involved in decisions that affect them. For action on social determinants, participation is part of the overall goal itself: improved agency, well-being, dignity, and quality of life for all members of society. However, the participation of communities in policy-making can also be instrumental in driving new initiatives, increasing accountability, and sustaining change.
Facilitating participation