Beyond Tokenism: Advancing Patient and Public Partnerships in Health Policy

Abstract Patient and public involvement (PPI) has become a defining principle of contemporary health governance, emphasizing inclusivity, transparency, and shared accountability. Yet in many systems, engagement remains tokenistic, characterized by consultation without influence or participation without power. This case study explores how health systems can move beyond tokenism toward genuine partnership, drawing on evidence from the United Kingdom’s Better Births program, Canada’s Strategy for Patient-Oriented Research (SPOR), Ghana’s Community-Based Health Planning and Services (CHPS), and Brazil’s participatory health councils. Using Arnstein’s Ladder of Participation as a guiding framework, the study identifies trust, institutional commitment, and resource investment as the main factors that enable meaningful collaboration. Examples from both high- and low-income contexts demonstrate that structural reform, political will, and cultural humility are essential for sustaining co-production. When communities and professionals collaborate as equals, health systems become more responsive, equitable, and legitimate, reaffirming partnership as both an ethical responsibility and a strategic foundation for effective health governance. Information © The Author 2026