Regarding health promotion and disease prevention, public health professionals and policymakers decide whether to implement or finance an initiative in the best-case scenario or, in some cases, financial departments or less knowledgeable decision-makers judge whether a program should continue or be discontinued. However, the people most affected – citizens – rarely shape these choices. At Invest4Health, we believe this needs to change.
Health investments are not just about budgets and financial models. They directly impact people’s lives, communities, and their healthcare services. If decision-makers overlook real-life experiences, they risk investing in solutions that may not work in practice or prioritise interventions based on incorrect assumptions. Citizens bring valuable perspectives on what is needed, what barriers may exist in implementation at the community level, and what solutions could be the most effective to reach and retain our target groups and, most importantly, to respond to actual needs.
How Invest4Health involves citizens
To ensure that public voices are heard, we have established a Citizen Patient Advisory Group (CPAG). The 11 members were selected through an open call and interviews. The group helps us understand the real-world impact of our project and provides advice on how to make health financing more effective and fair.
At our recent CPAG meeting, we discussed improving public engagement in health investment decisions. Some key takeaways included:
Avoiding tokenism – Everyone agreed that citizen involvement should be meaningful, not just symbolic. Engagement limits the group’s ability to influence decisions if it happens too late. The challenge involves CPAG members while keeping up with the project’s fast-moving or sometimes slow-moving and complex nature.
Making the project’s goals and our communication clear – Understanding complex projects, their key concepts, and how different aspects connect is not always easy. We need to ensure our project is understandable not only for the ‘usual suspects’ but also for the general public. To achieve this, we must learn how to engage people effectively, simplify our messages, and make information accessible. Engagement, simplicity, and accessibility are core principles in this process.
Turning feedback into action – A primary concern was that public feedback is sometimes gathered but not used in decision-making. If citizen voices are ignored, it damages trust. The project and any local initiative should have straightforward ways to show how feedback is being used and report back to CPAG members on the impact of their input.
Better communication – Effective communication is key to ensuring that the goals and results of health initiatives are accessible to everyone, including citizens. Some concepts, such as “Smart Capacitating Investment” in Invest4Health, need more straightforward explanations if we want people to understand what we do. Involving our CPAG members in the research publications or creating lay summaries of project results can help bridge the gap between technical language and the public’s understanding. Additionally, using tools like videos, case studies, and clear messaging ensures that important findings are communicated in a way that resonates with diverse audiences.
Improving public and patient involvement – The group emphasized the need for clear structures to ensure citizen input is heard and actively shapes decisions. They also discussed how technical language and complex processes can make participation difficult for some people. Using an appropriate structure and simplifying communication can help reach more diverse groups. Additionally, compensating citizen advisors for their time was identified as a key priority.
Long-term citizen engagement – Several members highlighted that public involvement in health projects is often short-term, ending when the project does. They suggested ways to keep patient and citizen groups engaged beyond the lifetime of projects like Invest4Health, ensuring their voices remain heard in spin-off and other future health initiatives.
Looking ahead
Citizen engagement is an ongoing process, and our consortium is committed to continuous learning and improvement. The insights from this meeting and the other ways that CPAG members contribute will help make Invest4Health more inclusive, transparent, and impactful. As Invest4Health moves forward, we aim to strengthen our engagement with citizens on all fronts—for example, in research activities, co-governance model building, training, advocacy, and within our test beds in Galicia, North Rhine-Westphalia, Skåne, and Wales. By working together, we can ensure that future health investments truly meet the needs of the people they are meant to serve.
