This chapter looks at the main justifications for involving members of the public in delivering public health programmes. It draws on findings from the People in Public Health study to present some core reasons why services might wish to involve members of the public (South et al, 2010b). Indeed, there was remarkable consistency around these reasons in the different elements of the study. Some of the emerging themes discussed here will be explored in more depth in the case studies of public health projects in Chapters Six to Nine, but this chapter provides an overview of the main arguments around benefits and value, and also briefly discusses drawbacks. In addition, the issue of the evidence base is tackled by critically examining categorisations of outcomes, as well as economic and moral arguments.

Six key reasons for engaging members of the public in programme delivery

1. To provide an essential bridging function reducing barriers between services and communities, particularly where groups are at risk of social exclusion

The potential for members of the public to act as bridges, improving the connections between health services and communities, forms a strong justification, particularly where health inequalities are present due to poverty or other forms of disadvantage. Bridging is a dominant theme in the case studies in Chapters Six to Nine. In many of the US models, such as Lay Health Advisors, involving lay people in programme delivery is considered a vital strategy for addressing health disparities in underserved and low-income communities, mostly African-American and Hispanic/Latino ( Jackson and Parks, 1997; Bailey et al, 2005; Perez-Escamilla et al, 2008; Fleury et al, 2009). Lay health workers are typically engaged in a range of activities, including health education, outreach, cultural mediation, advocacy, social support and signposting to other services within their communities (Swider, 2002; Andrews et al, 2004; Rhodes et al, 2007). The assumptions are that lay health workers, recruited from local communities, will bring local knowledge and understanding of community norms, cultural competence and access to social networks, and will speak the same language (McQuiston and Uribe, 2001; Rhodes et al, 2007). In some models, there is an explicit aim to identify through community networks what are called ‘natural helpers’ in those communities, who are trusted by community members (Watkins et al, 1994; Jackson and Parks, 1997).