Reducing health inequalities remains a challenge for policy makers across the world. Beginning from Lewin’s famous dictum that “there is nothing as practical as a good theory”, this paper begins from an appreciative discussion of ‘fundamental cause theory’, emphasizing the elegance of its theoretical encapsulation of the challenge, the relevance of its critical focus for action, and its potential to support the practical mobilisation of knowledge in generating change. Moreover, it is argued that recent developments in the theory, provide an opportunity for further theoretical development focused more clearly on the concept of power (Dickie et al. 2015). A critical focus on power as the essential element in maintaining, increasing or reducing social and economic inequalities – including health inequalities – can both enhance the coherence of the theory, and also enhance the capacity to challenge the roots of health inequalities at different levels and scales. This paper provides an initial contribution by proposing a framework to help to identify the most important sources, forms and positions of power, as well as the social spaces in which they operate. Subsequent work could usefully test, elaborate and adapt this framework, or indeed ultimately replace it with something better, to help focus actions to reduce inequalities.

Classic pragmatism laid the foundations for a practice-based notion of citizenship that views democracy as a fragile accomplishment in need of constant self-actualisation. This article revisits this heritage to explore different notions of pluralism and democratic participation developed over the last century. Drawing on James and Dewey, the article interrogates how different understandings of democracy deal with pluralism and the meaning of democratic life. The focus is on three prominent models in contemporary democratic theory and practice, namely: representative, participatory and deliberative. The purpose is to review different ways of thinking and enacting citizen participation and explore key distinctions, overlaps and productive tensions. The conclusion argues that a vibrant democratic ecology requires combining the practices that underpin these models in order to develop deeper, and more sustainable, forms of citizenship and democratic life.

This paper examines the way in which innovation in science policy in the UK over the last 25 years has been built around a discourse of changing preferences for modes of communication with citizens. The discussion, framed in debates and developments that deal with deliberative democracy and public engagement, draws on discourse analysis of key policy documents, statements made by members of the science policy network, and on interviews with public engagement practitioners. The relationship between science and society emerges as a 25-year old project of crisis management organised into three distinct models: public understanding of science, public engagement, and public dialogue. The analysis questions the existing narrative of progress and evolution constructed around key switch points, highlights the overwhelming influence of public understanding of science approaches, and attends to the question of the viability of public dialogue as the mainstream activity in science communication and policy-making.

Participatory forms of governance are increasingly institutionalised in democracies around the world. Yet, we know little about how public officials work to embed participatory governance. This article draws on a decade of mixed methods research with practitioners at the frontlines of democratic innovation. Scotland is undergoing democratic renewal through the interplay between state and civil society around three agendas: public service reform, social justice, and community empowerment. Legislation now mandates or supports participatory and deliberative processes. Scotland is thus a fruitful site to study the work of embedding participatory governance. This paper investigates tensions between radical aspirations and pragmatic challenges. Exploring participatory activism amongst officials shows the liminality of institutionalization processes, which troubles simplistic narratives about empowerment versus co-optation. The analysis shows significant but limited progress for participatory governance in Scotland. But this work is ongoing, as activist officials are developing ways of turning radical aspiration into critical pragmatism.

Participatory and deliberative processes have proliferated over recent decades in public administration. These seek to increase the effectiveness and democratic quality of policy making by involving citizens in policy. However, these have mainly operated at local levels of governance, and democratic theorists and practitioners have developed an ambition to scale these up in order to democratize higher tiers of government. This paper draws policy lessons from research on a “multi-level” process that held a similar ambition. The Sustainable Communities Act sought to integrate the results of various locally organized citizen deliberations within the policy development processes of central UK government. In doing so, it aimed to democratize central government problem definition and agenda-setting processes. The paper distinguishes between achievements and failures explained by process design, and more fundamental obstacles to do with broader contextual factors. As such, it identifies lessons for the amelioration of design features, while recognizing constraints that are often beyond the agency of local practitioners. The findings offer practical insights for policy workers and democratic reformers seeking to institutionalize participatory and deliberative innovations.

Participatory budgeting (PB), citizens deliberating among themselves and with officials to decide how to allocate funds for public goods, has been increasingly implemented across Europe and worldwide. While PB is recommended as good practice by the World Bank and the United Nations, with potential to improve health and wellbeing, it is unclear what evaluations have been conducted on the impact of PB on health and wellbeing. For this scoping review, we searched 21 databases with no restrictions on publication date or language. The search term ‘participatory budget’ was used as the relevant global label for the intervention of interest. Studies were included if they reported original analysis of health, social, political, or economic and budgetary outcomes of PB. We examined the study design, analysis, outcomes and location of included articles. Findings are reported narratively. From 1458 identified references, 37 studies were included. The majority of evaluations (n = 24) were of PB in South America, seven were in Europe. Most evaluations were case studies (n = 23) conducting ethnography and surveys, focussing on political outcomes such as participation in PB or impacts on political activities. All of the quantitative observational studies analysing population level data, except one in Russia, were conducted in South America. Despite increasing interest in PB, evaluations applying robust methods to analyse health and wellbeing outcomes are scarce, particularly beyond Brazil. Therefore, implementation of PB schemes should be accompanied by rigorous qualitative and quantitative evaluation to identify impacts and the processes by which they are realised.