Public participation in socioeconomic decision-making in the UK and Scotland: lessons for a ‘democratic rejuvenation’ to tackle health inequalities

Baillie, Anna (2026) Public participation in socioeconomic decision-making in the UK and Scotland: lessons for a ‘democratic rejuvenation’ to tackle health inequalities. PhD thesis, University of Glasgow.

Abstract

Public participation is of increasing interest to the health inequalities research community, particularly in the UK. Driven by a perceived ‘policy stalemate’ characterised by an observed gap between contemporary knowledge on what might reduce inequalities in health and the actual policy action taken by governments, theorists are now advocating for the potential role of the public in provoking more effective interventions. Indeed, qualitative research suggests that, although often considered to be resistant to more progressive policy reforms, ‘the public’ can hold perspectives on health inequalities that are nuanced and multi-layered, and that this is particularly true for people with lived experience of disadvantage. Alongside this, in recent decades, there has been an international participatory and deliberative wave sweeping across institutional decision-making, resulting in new or different opportunities and mechanisms for citizens to input into policymaking. Emerging from this trend are ‘democratic innovations’, which incorporate mini-publics, participatory budgeting, collaborative governance and referenda. Informed by the central ideals of deliberative democracy, it has been argued that these citizen-centred participatory-deliberative processes might provide a space for rational-critical debate on complicated issues like health inequalities, and as such potentially take aim at deep rooted inequalities in political voice whilst at the same time producing more egalitarian policy action. In short, a ‘democratic rejuvenation’.

Recognising that public participation has long existed in the UK and beyond, this thesis aims to investigate the lessons that current participatory practice might hold for any anticipated ‘democratic rejuvenation’ to tackle health inequalities. It aims:
• To explore how public participation currently fits into socio-economic policymaking in the UK and Scotland, in particular the purpose it serves and the policy level at which it operates;
• To investigate and better understand how the design and delivery of public participation processes interacts with social and political inequalities.

In order to explore these aims, a Systematic Scoping Review of participatory-deliberative processes in policymaking related to income insecurity in the UK was conducted. The findings of this Review then informed the selection of two participatory-deliberative processes taking place in different socio-economic policy settings in Scotland as the subjects of a Dual Case Study. Multiple sources of qualitative data were collated for each case and then analysed to explore and understand the realities of embedding public participation in policymaking which connects to health inequalities. The analysis for both the studies presented in this thesis was underpinned by a conceptual framework specifically developed for both.

The findings presented here provide a sense check for those seeking to increase public participation in policymaking in the UK and Scotland, specifically for those who view it as a potential mechanism through which inequalities might be redressed. Both studies revealed a common gulf between the intended ambitions of the participatory-deliberative processes analysed and the reality of participatory policymaking in practice. These collective high expectations produced ‘fantastical’ notions of what public participation is and does, which were often characterised by segregation from policy settings and, crucially, from contemporary knowledge and evidence. This suggests that any ‘democratic rejuvenation’ must confront the challenges unearthed here, and reimagine participatory practice in more realistic, but as such, potentially more impactful, terms.

Confronting the challenges identified in this research requires better articulation of the purpose of public participation within policy settings, and how this connects to conceptualisations of representativeness – underpinned by explicit recognition of the limitations of both. Relatedly, there appears to be work to be done to explore the tensions between different forms of participation and in particular around the notion of ‘lived experience’ and its different meanings and usage within policy and research spaces. In addition, it is necessary to properly locate public participation within the broader political and social systems in which it is taking place. This requires centring power and privilege and the many ways that socially advantaged individuals, groups and organisations exert (at times invisible) influence on policymaking. Theories of power as a fundamental cause of health inequalities and epistemic injustice appear particularly useful tools for this work, alongside the active search for stories of success, which may provide further lessons on how to overcome or mitigate some of these challenges and take steps towards a more fruitful ‘democratic rejuvenation’ to tackle health inequalities.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Subjects: H Social Sciences > HV Social pathology. Social and public welfare; R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
• Colleges/Schools: College of Medical Veterinary and Life Sciences
• Supervisor's Name: Fergie, Dr. Gillian, Mackenzie, Professor Mhairi, Skivington, Dr. Kathryn and Lewis, Dr. Ruth
• Date of Award: 2026
• Depositing User: Theses Team
• Unique ID: glathesis:2026-86123
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 15 Jul 2026 13:14
• Last Modified: 15 Jul 2026 13:22
• Thesis DOI: 10.5525/gla.thesis.86123
• URI: https://theses.gla.ac.uk/id/eprint/86123

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