Participatory budgeting (PB) is a democratic innovation that enables residents to participate directly and collectively decide how to spend public money in their community. Research demonstrates PB improves social well-being through governance, citizens’ participation, empowerment, and improved democracy. Since 2000, PB has increasingly been used in the UK in community development approaches for improving health and well-being outcomes for people living in deprived communities. Yet little is known about how and why PB may impact health and well-being in deprived communities of the UK. This PhD study sought to explore and explain how the application of PB in the Well London programme impacted the health and well-being of people living in a deprived community in London.
The study employed a qualitative case study design adopting the constructivist grounded theory (CGT) methodology of Charmaz (2006) to explore critical themes from interviews with stakeholders of the Well London programme in Haringey Borough. Forty-one stakeholders engaged in planning, co-designing, co-commissioning and co-delivering, or benefitted from three interventions commissioned through PB participated in this study between March 2017 and April 2018.
A cross-case analysis revealed six pathways through which PB improved health, particularly for the underserved. PB maximised participation and meaningful engagement; enhanced direct demand and response to the community’s needs; individual and collective ownership; action on the social determinants of health; and creative partnership working. These pathways were moderated by the democratic and flexible approach of the PB ethos, particularly the inclusion of residents’ voices in the planning and delivery of the interventions. Residents were motivated to act as agents to change their lives by building positive relationships based on social inclusion and integration. As a result, residents’ self-esteem, sense of belonging, self-confidence, self-worth, and individual sense of belonging and community spirit increased. Residents gained a new zeal and agency to tackle the social determinants of health as they understood them in their lives.
When done correctly, PB can promote health and well-being and build more robust and resilient communities through community-centred democratic decision-making. Interventions should aim to increase critical consciousness, health literacy, and the capacity in deprived communities to tackle life-course issues that prevent residents from enjoying good health and reduce structural barriers to accessing services or interventions to improve health and reduce inequalities. The outcomes of this study have policy and practice implications for strengthening the design, commissioning, and delivery of health interventions in deprived communities of high-income countries.