Across the country, inequalities in health outcomes reflect the differences in power, resources, and living conditions people face. Because the root drivers of these inequalities lie in housing, local environments, and local economies, local authorities have a central role in tackling them.
However, councils cannot always see how these wider pressures are being experienced day to day. Community insight can reveal where services are falling short, which groups are being missed and how local pressures are interacting. Engaging local voices is therefore essential to tackling health inequalities effectively.
Over the past year, I have evaluated this kind of engagement across six London boroughs: four taking part in NIHR Health Determinants Research Collaboration and two comparator boroughs. This comes as councils and NHS partners begin responding to the Government's Neighbourhood Health Framework, which calls for new ways of working with communities ahead of locally owned neighbourhood health plans from 2027/28.
The best examples I saw gave communities a role before priorities were set, as engagement becomes much more valuable when residents help shape the questions, rather than simply responding to them.
From my research, it was clear residents and community organisations held detailed local knowledge that formal data alone could miss. Councils are increasingly finding ways to bring that knowledge into research and decision-making, but sometimes practical barriers get in the way.
Drawing on my experience, I identified some clear lessons for councils looking to overcome these barriers and turn local insight into action.
Community insight is strongest when it shapes the agenda.
The best examples I saw gave communities a role before priorities were set, as engagement becomes much more valuable when residents help shape the questions, rather than simply responding to them.
In one borough, paid community researchers helped identify research priorities; in another, a collaborative research board gave residents a formal role in deciding which projects should proceed. Importantly, these approaches recognised residents bring expertise that can expose issues missed by conventional evidence.
To facilitate this, councils should step back from an ‘expert' posture to share influence and hear challenge, training middle managers to value community expertise and embed it in day-to-day practice.
Internal systems can make or break good engagement
Even where the ambition was strong, I repeatedly saw internal processes get in the way. Procurement and payment systems designed for large organisations placed a disproportionate burden on small voluntary groups, while departmental silos could prevent information gathered through public health work reaching colleagues in housing or other services.
Small, practical changes can make a significant difference. Pre-funding smaller community organisations can prevent them having to carry financial risk, while lighter-touch procurement and faster payment can stop small organisations being tied up in processes designed for much larger contractors.
I also saw community-led approaches encounter systems designed primarily to control institutional risk – often at the expense of community momentum and trust. Senior leaders must be prepared to challenge processes that protect the organisation at the expense of effective partnership working.
Lastly, I was struck by the importance of people who can work across institutional boundaries. These "ferrymen", or system translators, connect communities, council departments and academic partners, making sure local insight does not get lost as it moves through different organisations. They are particularly valuable where systems operate at different speeds or speak different professional languages.
Trust depends on communities seeing what changes
Perhaps the clearest lesson was that engagement cannot end when the meeting does. Residents need to see the results of their participation, including where it changes a decision or where action is not possible.
That also means responding when engagement brings immediate problems to light. Asking residents to discuss long-term health inequalities while issues such as damp, broken lifts or food insecurity remain unresolved can quickly undermine confidence in the process. Creating clear routes for those concerns to reach the right part of the council is essential for building credible, longer-term relationships.
Fair payment matters for the same reason: paying people properly for lived-experience contributions recognises their value and helps include those unable to volunteer their time for free.
Taken together, these lessons show what meaningful engagement requires in practice: insight that can move across departments, partners that can participate without being held back by council processes, and residents who feel valued and can see that their contribution leads somewhere. As neighbourhood health plans develop, these are the foundations councils will need to build on.
Sophie Cloutterbuck is Local Policy Innovation Partnership Place Fellow and Director of London Engagement and the London Met Lab at London Metropolitan University
