Efforts to improve public health are increasingly recognising the crucial role that local communities play in shaping health outcomes. Rather than relying solely on traditional healthcare systems, a growing emphasis is being placed on empowering communities to take initiative in identifying challenges and creating tailored solutions that reflect their unique social, economic, and environmental circumstances. Active involvement from communities not only enhances the relevance of health interventions but also strengthens their sustainability over time.
This policy paper brings together six examples from across OECD countries. The examples span different national and regional contexts and share a common emphasis on local participation, shared decision-making, and inclusive collaboration. Five of the six initiatives presented have been evaluated. The evaluation results demonstrate that partnerships between residents, public institutions, healthcare professionals, and non-governmental organisations can improve health and well-being outcomes in communities when their members are treated as equal partners in the process. For each example, the paper briefly describes the context and key elements of the initiative and extracts relevant policy lessons for policy makers.
Through these examples, the paper highlights the importance of taking action in different policy areas:
Consulting communities to design effective policies. In one of the highlighted cases, Austria implemented a participatory strategy process that led to the development of a recommendation paper outlining ten bundles of measures aimed at improving health and quality of life for all residents. This participatory approach involving experts, stakeholders, decision makers, and the general public allowed for a bottom-up articulation of public health priorities, which later guided the thematic direction of Austria’s health promotion strategy and the multiannual work programmes.
Collaboration across different levels of government as a tool to strengthen community action. Regional and central governments have taken active roles in supporting local efforts, not just by providing financial resources but also by fostering co‑ordination and offering technical support. In Spain’s Valencian Community and Switzerland’s Canton of Zurich, government bodies have collaborated closely with local actors, setting up systems that facilitate co‑operation and help to ensure that initiatives meet shared goals. These examples highlight how higher-level authorities can reinforce grassroots initiatives without overshadowing them.
Establishing robust networks at the local level contributes to community-based projects, as shown through examples from Aragon, Spain, and a nonprofit-led initiative (EPODE/JOGG) working in both France and the Netherlands, where local actors were brought together to form dynamic networks that drove forward health promotion activities. These networks enabled a strong collaboration to foster co‑ordinated initiatives and pool resources among stakeholders and local communities, amplifying the impact of each initiative.
Understanding the results of these efforts requires rigorous evaluation. One such project is Grünau Moves in Germany, which integrated monitoring and assessment into the core of its design. By conducting an initial need assessment and by tracking progress throughout the implementation process, organisers were able to make adjustments along the way and ensure the initiative’s continued relevance and effectiveness. This case illustrates how evaluation is not an afterthought but an essential part of planning and executing health-related projects.
Several overarching themes and policy lessons emerge from these varied examples.
It is vital to develop both immediate and longer-term objectives when designing health promotion initiatives. Doing so ensures that short-term activities contribute meaningfully to a broader vision for public health. Equally important is involving a wide range of community stakeholders in setting these goals, especially those directly affected by the issues being addressed. Early involvement increases the likelihood of success by building trust and fostering a sense of ownership.
Clearly defining the responsibilities of different levels of government is another critical element. When central and regional authorities understand their roles – whether providing funding, offering training, or leading awareness campaigns – they can better support local actors and avoid duplication or conflict. This clarity helps maintain political will and a consistent approach in community health initiatives.
Collaboration across sectors is essential for making community action work. Effective partnerships may involve institutions such as universities, health agencies, municipalities, and civil society groups. Co‑ordinated efforts, as seen in the EPODE/JOGG initiative or the structured collaboration in Zurich, show how linking various actors can strengthen planning, implementation, and knowledge sharing. At the municipal level, co‑ordinated teams – including healthcare workers, technicians, and community organisers – can create mechanisms that reflect local diversity and strengthen inclusivity.
Special attention must be paid to engaging marginalised or disadvantaged populations. These groups are often at higher risk of being excluded from community initiatives, which can inadvertently deepen existing inequalities. Programmes that make deliberate efforts to reach these populations, as in Austria’s strategic consultations or Germany’s community-based work in disadvantaged neighbourhoods, demonstrate how inclusivity enhances both the equity and effectiveness of interventions.
Finally, ongoing learning through monitoring and evaluation is a defining feature of successful initiatives. A well-structured evaluation process not only measures progress but also facilitates continuous improvement and adaptation to evolving contexts and community needs.
In conclusion, the policy paper presents evidence that involving communities in shaping their health landscapes is not only beneficial but necessary. The case studies affirm that meaningful participation, strong partnerships, and inclusive planning are fundamental to achieving lasting improvements in health and well-being. As societies strive to build healthier, more resilient, and more equitable futures, placing communities at the centre of health strategies offers a promising path forward.