In public health, is ‘co-design’ the answer to all our problems?

two hands each holding a puzzle piece. Green grass in background.

Leonie M. Short, Seniors Dental Care Australia

In the last ten years, ‘co-design’ has emerged as a hot topic in Australia’s broad public health arena. National Disability Services funded a co-design initiative in 2015, NSW Council of Social Service (NCOSS) promoted the principles of co-design in 2017, and a co-design approach in commissioning was proposed for projects funded by the Australian Department of Health through Primary Health Networks in 2018. A research program for primary care mental health through the Melbourne Medical School also focusses on co-design, and the term was mentioned in many presentations and posters at recent conferences.

Within the co-world, other terms such as co-creation and co-production are also being used. Vargas, et al. (2022) provide definitions and distinctions of these terms from a public health perspective. They argue that co-creation or participatory action is an overarching guiding principle that also encompasses co-design and co-production (Vargas, et al. 2022). This view, including the importance of participatory action, is also championed by Dr Louisa Walsh at La Trobe University. Walsh prefers to use the term ‘participatory methods’ as this emphasises the process itself (rather than a part of the process) and the use of participatory methods (previously referred to as community development).

Yellow background. Words arranged in various fonts and colours. Words include 'co', 'design', participatory', 'health', etc.










In terms of patient leadership, the Consumers Health Forum of Australia has been advocating for decades to put health consumers front and centre of Australia’s health care system. They have partnered with David Gilbert, the founder of InHealth Associates in the United Kingdom, to promote health consumers and patients as experts. In this sense, patient leaders should be placed (and paid) in the same way as health professionals and managers in our health services. Gilbert has trained many patient leaders (and those wanting to promote patient leadership) through training courses in the UK, Canada, New Zealand and Australia.

For those interested in patient leadership in the aged care sector in Australia, my recent article reflected on the Royal Commission into Aged Care Quality and Safety. The piece stressed the importance of patient leadership and ensuring the voices of people with lived experience are heard, considered, and incorporated into decisions made across all levels of organisations. For example, how does the Department of Health and Aged Care’s 2022 development of star ratings for residential care fit into any model of co-design or participatory methods? According to the Spectrum of Public Participation, from the International Association for Public Participation, these star ratings are at the lower levels of information and consultation, rather than at the higher levels of collaborating and partnering with health consumers (IAP2, 2018).

The Consumer Health Forum hosted a webinar on 31 August 2022 that explored what “co-world” means, the roles that consumers can play, avoiding tokenism, and hints for improving consumer partnerships. Forum members can watch the webinar and access a range of excellent resources by Dr Louisa Walsh, Joanna Szczepanska and Callan Rowe.  For anyone wanting to learn more about co-design and participatory methods, the Beyond Sticky Notes website would be a good place to begin. There is also a book by Kelly Ann McKercher about doing co-design and a learning tool designed to assist in learning about co-design.

From a public health perspective, co-design is not the answer to all our problems. However, within the co-world, participatory methods (which include co-design, co-creation, and co-production) enable ordinary people to play an active and decision-making role in health services that affect their lives.


Beyond Sticky Notes. Accessed 9 September 2022.

Commonwealth of Australia. 2018. Co-design in the PHN commissioning context. Canberra: Department of Health and Primary Health Networks.

Consumers Health Forum of Australia (CHF). Accessed on 9 September 2022.

Department of Health and Aged Care. Star ratings for residential aged care. Accessed 9 September 2022.

Gilbert, D. 2020. The Patient Revolution. How we can health the healthcare system. London: Jessica Kingsley Publishers.

InHealth. Accessed on 9 September 2022.

International Association for Public Participation. 2018. IAP2 Spectrum of Public Participation. Accessed 9 September 2022.

Lowe, D., Merner B., Graham-Wisener, L., Walsh, L., Hill, S. 2019. The effects of consumers and health providers working in partnership as an intervention for the promotion of person-centred health services. Cochrane Database of Systematic Reviews. Issue 7. Art. No.: CD013373. DOI: 10.1002/14651858.CD013373

McKercher, K.A.2020. Beyond Sticky Notes: Doing Co-design for Real: Mindsets, methods and movements. Sydney: Inscope Books.

NSW Council of Social Service (NCOSS). 2017. Principles of co-design. Fair Deal Forum. Sydney: NSW Council of Social Service.

Short, L.M. 2022. Patient Leadership in aged Care. Australian Health Review. 46(4), 387. doi:10.1071/AH22162

Sutton-Long, C., Aagaard, K.S., Howard, Z and Tassone, V. 2016. Co-design for community inclusion. Melbourne: Huddle Australia.

University of Melbourne. Co-design Living Labs. Accessed on 9 September 2022

Vargas, C., Whelan, J., Brimblecombe, J., Allender, S. 2022. Co-creation, co-design and co-production for public health: a perspective on definitions and distinctions. Public Health Research & Practice; 32(2):e3222211.


Acknowledgement: Thanks to Rebecca Edwards of the Consumers Health Forum of Australia for her valuable input and assistance with access to co-design and participatory methods documents.


Leonie Short (Cert DT, Dip Clin Hyp, BA (UOW), MHP (UNSW), Grad Cert HSM (Aged Care) (UTAS), AFCHSM, CHM, Director) is a PHAA member, and the Director of Seniors Dental Care Australia.

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Featured image: Vardan Papikyan/Unsplash

In-text image: Courtesy of Leonie Short

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