Co-Creation of Public Values: Citizenship, Social Justice, and Well-Being

How do we create communities where people feel valued and add value to others? How can the public sector, citizens and stakeholders work together to support citizenship, social justice and well-being? There is an urgent need for political consensus, collaboration and co-creation across the whole of government,and the whole of society, to achieve sustainable development and create well-being for all, leaving no one behind (United Cities and Local Governments [UN], 2015; World Health Organization [WHO], 2019a). Equity, health, and well-being are crucial determinants of sustainable societies, and for which collaboration and inclusive participation is imperative (European Commision [EU], nd; Kickbush 2012; Marmot, 2014; Marmot et al., 2020; OECD, 2020; WHO, 2019a,b). The importance of well-being is highlighted in the UNs SDG#3; ÅLEnsure healthy lives and promote wellbeing for all at all agesÅL. Although, moderate progress has been made to reach SDG#3 goals, the SDG goal #10 on reducing inequity requires attention to achieve social justice.

High levels of inequality create social gaps in health and well-being, and harms society in many ways.It hampers social cohesion and can reduce a sense of citizenship, resulting in lost opportunities for many aligned with increased crime and social vulnerability affecting the whole population (International Institute for Democracy and Electoral Assistance, 2013; Marmot, 2014; Wilkinson & Pickett, 2009). Moreover, it reduces social trust in general, and especially in public and democratic institutions (International Institute for Democracy and Electoral Assistance, 2013; OECD, 2020; WHO, 2019b). The need to belong and the dependency to other people is universal and a basic part of being human (Baumeister & Leary, 1995). According to Prilletensky (2020), many of the above-mentioned problems origins in what he describes as an ‘Me-culture’ formed by societal fragmentation and neoliberal tendencies in the society. However, a ‘We-culture’ of inclusiveness, belonging, compassion and reciprocal support is required to support wellbeing for all, and, as the SDG’s urges; to leaving no one behind.

The WHO Health Equity Status Report (WHO, 2019a) captures the impact of policies on inequities in health and well-being over the last 10 to 15 years. This report have identified five critical factors and
assigned to each a percentage reflecting its contribution to the overall burden of health inequity: Income security and social protection (35%); living conditions (29%); social and human capital (19%); access to and quality of health care (10%); and employment and working conditions (7%). Addressing these factors is above all a political choice, and where opinions and political will-formation are informed by democratic participation (WHO, 2019b; Marmot et al., 2020). These factors are also connected to measures beyond available public services. Acknowledging the significance of social support, public services cannot simply ‘deliver’ friendships and caring social networks to citizens as a service. The public sector also has limited measures available for creating good living environments and meaningful work for all that ensures economic safety, as these values are highly dependent on stakeholders outside of the public sector. Creating public value that addresses the abovementioned factors thus relies on collaboration and co-creation across the whole of society, crosswise sectors, at multiple levels.

In general, the responsibility for participatory processes to create public value falls to the public sector, with a particular responsibility on administrations and political leaders. However, participatory processes can also be invited by companies, non-governmental organizations and social entrepreneurs, who might enable numerous entry points and openings to endorse more participatory and empowering processes, even in settings in which there are no participatory traditions (WHO, 2019b). Contrary to making progress towards social justice and well-being for all, political parties and political views are becoming more polarized, people are getting more disengaged, and those affected by low levels of well-being tend to be excluded from democratic processes (International Institute for Democracy and Electoral Assistance, 2013; OECD, 2020; WHO, 2019a,b). In parallel, social inequities in health and well-being are accelerated by neoliberal societal tendencies, and where late stage neoliberalism has contributed to alienate people from ‘the collective’ (Gergen, 2009; Pūras, 2020). Such societal tendencies are leading to pressing public health problems, crime, polarization and marginalization, and are threatening human rights and sustainable development across the globe (Pūras, 2020; WHO, 2019a,b; Wilkinson & Pickett, 2009).

Social justice is vital to achieve well-being for all, aligned with deepening democracy and to revive trust in public institutions (OECD, 2020; WHO, 2019b). However, progress to create equal opportunities within and between populations is slower than expected (UN, 2019). The creation of well-being for all, and sustainable development as fundamental public values, are linked to a whole-systems-approach, including the need for participation and co-creation between stakeholders, sectors and levels of government (WHO, 2013; 2016). Building solutions for achieving well-being and citizenship is good for both people and society. It empowers citizens, is good for decision-making processes, ensures that solutions address real needs and desires, and legitimizes policies and political decisions. However, the paradox is that citizens who have lower levels of well-being than the average population, also tend to participate less in developing policies that affects their lives (Hanefeld et al., 2019; OECD, 2020; WHO 2019a,b). Even though that it is important that everybody actively participates in democracy and society, it is even more crucial to foster participation amongst those who are marginalized, vulnerable, silent and potentially anti-social (Hanefeld et al., 2019; International Institute for Democracy and Electoral Assistance, 2013; Smith, 2009).

According to the International Institute for Democracy and Electoral Assistance (International IDEA; 2013) and WHO (2019a), groups who suffer from marginalized vulnerable living conditions tend to be subjected to lower levels of well-being and are at the same time being politically less active. Examples of such groups are people with low socio-economic status, ethnic and linguistic minorities and migrants, people with disabilities; young people; people not in education, employment or training; fragile elderly people; indigenous peoples; those from remote and rural geographic locations; and people discriminated against on the basis of their gender or sexual orientation. Nevertheless, equity in participation in processes as well as fair outcomes resulting from co-creation processes is hard to achieve (WHO, 2019b; OECD, 2020). Thus, innovation and sociological imagination are needed (Atkinson et al., 2017) in the processes of co-creating well-being as a public value.

In order to put the citizens as a resource and active contributors, rather than consumers in the public sector, public policy reforms across the globe are currently desired a transition into the megatrend “New Public Governance” (NPG) aligned with co-production and co-creation approaches to inclusive participation towards well-being (Brix et al., 2020; Commission on the Future Delivery of Public Services 2011; Mortensen et al., 2020; OECD 2011; Pestoff, 2019; Storch & Hornstrup, 2020). Co-creation with citizens, living in vulnerable and marginalized situations, is a promising approach to reduce inequities and to build strong foundations for more sustainable and democratic well-being societies. The aim of this chapter is to discuss how societies can be made more socially inclusive, sustainable and fair by using co-creational processes. Questions needed to be discussed is then: Who should participate? How? Where? And with what purpose and consequence? This involves how voices of citizens in marginalized and vulnerable life situations needs to be included and recognized in co-creation processes in democracy and public sector service delivery and decision-making.