Daniel Pearmain Head of Policy and Research at People's Health Trust

In this blog, Daniel Pearmain, Evaluation and Learning Manager for People’s Health Trust, explores the findings and discusses what we can learn from it about how to design joint decision-making going forward.

The What Works Centre for Wellbeing has recently published some important research about participatory decision-making: 'Joint decision-making, co-production and meaningful community participation: What works'.

The report helps to show how best to use the opportunities to come together, make decisions and share power, with some important observations about how best to make this work.

The report shows that there are a range of potential benefits from community involvement in decision-making, for both participants and their wider communities. It explains how joint decision-making interventions can be successful in enhancing local conditions and resisting threats to the area, such as the potential for the retreat of neighbourhood services and facilities.

The benefits can impact on the social determinants of health and wellbeing, including the physical conditions in which people live, social relationships, individual physical and mental health, community health, individual wellbeing, and community-wide levels of wellbeing. This process can also attract more resources to the neighbourhood, helping to create better places to live.

However, when done poorly, joint decision-making processes can have negative impacts, including frustration and loss of trust. The report’s emphasis on how meaningful involvement is critical to the success of joint decision-making is important. When opportunities to work collaboratively are available to communities, they need to also support a genuine transfer of power and control.

The report provides clear evidence about what’s important in the processes of co-production. It explains that the depth of engagement to support joint-decision making initiatives – the extent to which people’s voices are given a platform to be aired - is really important. At People’s Health Trust, we have seen that for joint decision-making to become a meaningful process that leads to improved community wellbeing, people need to feel supported, have opportunities to grow in confidence, and are encouraged to develop their knowledge and skills.

At the heart of this is the need to equalise power relationships within joint decision-making. It often seems to be how things are done, rather than simply what is done, that makes the difference to these power dynamics. There is strong evidence to show that when groups are given the chance to make decisions collectively, it can have a powerful positive impact on the wider social determinants of health for those involved.

But the reverse is also true. The report highlights evidence demonstrating the potential joint decision-making processes have to deliver harmful impacts if they are not well constructed.

Often, the nature of joint decision-making takes its starting point from very unequal power relationships and rebalancing these can take time. The Trust’s Active Communities grant funding programme has demonstrated that it can take up to two years for a group to build the confidence to start feeling more control collectively.

Because of this, sometimes it’s important to consider what the right ‘moment’ is to involve people in joint decision-making. This is really critical to avoid the frustration that can come from processes that aren’t sufficiently supportive, or lack follow-through on commitments made within them.

How well policy-makers and other decision-makers absorb these critical points will determine how effectively joint decision-making can produce increased community wellbeing outcomes on a bigger scale going forward.

Time, commitment to the process of equalising power, and patience are required if we truly want joint decision-making to deliver the benefits in social determinants of health that this evidence review demonstrates are possible.


To read the full report from What Works Centre for Wellbeing on joint decision-making, click here.

This blog first appeared on the What Works Centre for Wellbeing website, and to read that, click here.

To find out more about the Trust's evaluation and learning work, read about our impact here.

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