Participatory-deliberative processes in UK policymaking related to income insecurity as a determinant of health: a scoping review.

Background: Deepening democratic engagement in socio-economic policy domains is of increasing interest to the health inequalities research community. However, there is a recognised gap between theory and the practical application of public participation. Viewing income security as a fundamental determinant of health, this Review investigates how, when and where participatory-deliberative processes (PDPs) were applied in policymaking connected to income, in the UK, from Jan 2007-June 2022.

Methods: The Review applied the PRIMSA-ScR checklist. Searches were conducted in: EconLit, SOC Index, Sociological Abstracts, MedLine; and grey literature sources: BASE database, government, NGO websites for articles related to PDPs in income-related policymaking in the UK, published after 1 January 2007. Articles were synthesised through a conceptual framework combining Whitehead's typology of actions to tackle health inequalities and Smith's categorisation of democratic goods.

Findings: The Review found 20 articles relating to 13 PDPs. A majority of PDPs took place in Scottish Government/ Parliament or at Local Authority /NHS Trust level in England and Wales. A variety of types of PDPs were used by policymaking institutions across a range of socio-economic domains, with varying degrees of information provided about participants and policy outcomes.

Discussion and conclusions: Findings demonstrate a multitude of disconnects between participatory rhetoric and reality. There is no evidence of PDPs influencing macro socio-economic policymaking, with participatory decision-making instead dispersed across less empowered, downstream spaces. Democratising socio-economic policy domains requires critical reflection on the fractured nature of participatory policymaking, the locus of decision-making power and how inclusion is realised in participation spaces.