Youth participation in public health: from presence to power

Abstract

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Across Europe, the need to strengthen social participation is increasingly recognised as a core component of public health governance. The recent WHO Resolution on Social Participation for Universal Health Coverage (WHA77, 2024) formalises this shift, urging health systems to establish sustained, structured, and accountable mechanisms enabling communities to influence decisions. Yet one group remains inadequately engaged despite being profoundly affected by today’s health challenges: young people.

Participation as a governance function, not a gesture

Classic theories such as Arnstein’s ‘Ladder of Citizen Participation’ highlight the distinction between symbolic inclusion and shared decision-making. Much youth engagement still sits in the lower rungs of this ladder. Feedback is collected, but impact on the policy cycle remains minimal. Meaningful participation requires investment in public-sector capacity, clarity of purpose, and stable institutional architecture. These requirements apply even more strongly when engaging adolescents and early-career professionals, whose presence is often welcomed but rarely supported through formal governance pathways.

Why youth participation matters: evidence over symbolism

The case for youth involvement is well-established. Public health research shows that integrating youth perspectives increases policy relevance, strengthens trust, and improves responses to rapidly evolving determinants such as digital environments, climate anxiety, sexuality, and mental health. The United Nations definition of meaningful youth engagement emphasizes autonomy, influence, and co-responsibility, elements often missing from existing frameworks.

Youth participation is also an equity question. Young people disproportionately experience social and health inequalities, from precarious employment to mental health burdens. Their lived experience constitutes expertise in its own right, complementing quantitative data and professional analysis.

When young people are excluded from the spaces where social and societal issues are debated, this has consequences for their wellbeing. It affects their sense of agency and belonging, fuels frustration and disengagement, and weakens trust in institutions, factors closely linked to mental and social health outcomes. Ensuring meaningful participation is therefore not only a governance principle, but also a preventive measure: it strengthens resilience, reduces polarisation, and supports the conditions under which young people can thrive. In this sense, participation itself becomes a determinant of health.

Evidence from research: participation improves science

Participatory and co-production approaches have reshaped public health research. Studies have demonstrated that when communities- especially young people- co-design research tools and priorities, outcomes are more relevant and implementation more effective. EUPHA is also partner of the EARLY project (EARLY (evaluating, identifying and reducing determinants of mental health conditions in youth)—The European Public Health Association), that aims at providing robust and representative data on youth mental health across the European region, and to design, implement, and evaluate evidence-based interventions. But we need to do better, not to do for youth, without them. The recent French MENTALO (MENTALO. https://etude-mentalo.fr/) study illustrates this approach: co-developed with young people, it reached unprecedented participation and produced insights grounded in the realities of youth mental health. This model aligns with the growing shift toward participatory epidemiology, youth advisory boards, and community-led indicators.

Barriers persist, and they are systemic

Across literature on participatory governance, recurring barriers include lack of methodological guidance, weak institutional legitimacy, and structural power imbalances. Youth engagement faces additional challenges stemming from adult-centric institutional cultures and limited adaptation to youth-preferred communication channels. Importantly, these obstacles rarely originate from young people themselves but from governance architectures not designed for their participation.

Strengthening structures: the role of EUPHAnxt

Within the European context, one emerging structure designed to address these gaps is EUPHAnxt, the network for students and early-career professionals in public health. Beyond offering training, mentoring, and conference support, EUPHAnxt provides a platform that aligns with the principles of meaningful participation: continuity, capacity-building, and shared ownership. Its involvement in conference planning, plenary design, scientific sessions, and mentoring activities demonstrates a shift from ad hoc youth inclusion toward structured, institutionalised engagement.

However, as participation research reminds us, visibility and transparency are essential components of legitimacy. When youth contributions are embedded early in processes—co-designing programme content, shaping narratives, contributing scientific expertise- their influence may be substantial yet insufficiently communicated to the wider community. Strengthening communication about youth and early-career involvement, and clarifying the governance roles they occupy, may therefore enhance external recognition of their contribution and address perceptions of insufficient representation. This is consistent with the broader evidence that participation must be both meaningful and visibly acknowledged to generate trust and accountability.

Towards a new generation of participation in Europe

EUPHAnxt’s expanding role, and emerging youth-led networks across the WHO European Region collectively demonstrate a shift toward co-production in public health. The challenge ahead is not to involve young people more often, but to embed their participation into the governance, research, and implementation cycles in ways that are deliberative, transparent, and institutionally supported.

As Europe faces intertwined crises, from mental health to climate to digital misinformation, youth participation cannot remain an accessory to public health governance. It is a necessary condition for developing more equitable, resilient, and legitimate health systems.