Healthcare cultures and the implementation of WHA77.2: from measurement to institutional change

Resolution WHA77.2 establishes an unprecedented mandate for meaningful social participation in health decision-making. The resolution, and the operational guidance that preceded it, already address representation, power, deliberation, feedback, policy influence, and evaluation. Implementation therefore raises a question that further measures alone cannot settle: how participatory knowledge can come to shape the routine organization of healthcare. Building on recent proposals for assessing co-design, we recommend that implementation extend from the participatory space into the healthcare cultures that incorporate its recommendations. These cultures shape which needs become institutionally legible, whose knowledge carries authority, and which responses are delivered. Participation becomes transformative when it reshapes these arrangements. This perspective expands the current measurement framework by linking participatory integrity and decision uptake to cultural enactment in routine care.