The Role of Governance in Creating a Healthy Democracy

Read our Democracy & Governance blog series

By Sarah de Guia

  • In this third entry in ChangeLab Solutions’ Democracy & Governance series, CEO Sarah de Guia discusses how good governance is crucial to creating truly democratic health laws and policies.
  • Good governance principles — such as understanding historical context; meaningful participation; transparency and accountability; responsiveness and efficiency; and respect for the rule of law — advance trust, improve community health, and support a just society.
  • Good governance principles extend to leaders both inside and outside of government, including business and community leaders.
  • To advance democracy in our current political circumstances, we need to insist that leaders in government and other institutions adopt inclusive governance practices, listen to community needs, and implement policies that promote health and equal opportunities.

Good Governance Shapes Health & Democracy ― and It’s Under Threat

ChangeLab Solutions has long acted on the belief that our government and its governance practices are crucial to supporting health and well-being for everyone. Right now, good governance in our country is being tested.

What do we mean by governance? ChangeLab defines governance as “the process of aligning stakeholders and getting to agreement.” Governance is crucial to health because how decisions are made often determines who gets resources and who holds power, which in turn determine whether policies reinforce structural discrimination or improve health outcomes.

Consider a city council that is deciding how to allocate transportation funding. If governance is transparent and inclusive and supports meaningful engagement of community members in decision making, the city might prioritize distributing resources to underserved areas to repair sidewalks, improve public transportation routes, and make bike lanes safer. But if decision making happens without good governance practices in place, resources instead might flow to areas that already have an abundance of resources, missing opportunities to increase residents’ access to groceries, jobs, child care providers, or medical appointments.

ChangeLab uses the tools of law and policy to advance health and equity. We believe in the power of local governments as laboratories for change, offering avenues to advance health and reverse long-standing inequities. Our work with government leaders and their staff remains vital to achieving a healthy democracy, yet ongoing tensions about the balance of power between the executive, legislative, and judicial branches of government raise equally vital questions about the durability of institutional checks and balances and the protection of civil rights. We see and feel the harmful impacts of efforts to render whole communities invisible and the use of violent or inhumane measures against them.

In the face of these tumultuous times — including recent budget and staffing cuts to federal agencies and programs — our team has been tracking and analyzing many federal actions, including the president’s executive orders and subsequent litigation aimed at stopping some of the most egregious actions. We are reviewing and assessing the legality of these actions in order to offer guidance and support to local and state government partners. We want to ensure that government at all levels supports our health and our democracy.

Principles for Good Governance

While there is no specific formula for good governance, researchers and sociologists have identified a common set of principles of good governance. We have aligned these findings with our research from A Blueprint for Changemakers to offer a set of good governance principles with examples from our partners across the nation. These principles offer guidance to policymakers and staff working in partnership with the communities they serve.

Understanding a Community’s Historical Context

Ensuring that all community members can reach their highest health potential requires removing persistent health inequities. Research confirms that poor health outcomes are a primary result of systemic inequities, not individual behaviors. This finding means that governments must understand and account for historical inequities and subsequently allocate resources and implement policies in ways that account for these injustices.

Good governance practices include assessing community needs and assets to create a roadmap for change. Assessing community needs through examination of qualitative and quantitative data as well as lived experience helps all stakeholders identify the underlying social, economic, and environmental root causes of poor health and begin to create shared understanding, goals, and desired outcomes for change. In addition, getting to know a community’s strengths and assets will uncover experiences, knowledge, and skills that support positive change and will promote an approach based on resilience, centering relationships, and creating a shared vision for health. Governments can also formalize their commitment to center equity and inclusion as a goal in local decision making through a resolution, ordinance, or interagency memorandum.

A Health in All Policies approach and ChangeLab Solutions' involvement in the Collaborative for Anti-Racism & Equity (CARE) — a working group of partners who are advancing health and racial equity through research, communication, policy, advocacy, and development of resources and frameworks — exemplify how integrating historical community context into good governance practices can help create systemic change, ensuring that policies actively address past injustices and promote equitable health outcomes.

Meaningful Participation

For over two decades, ChangeLab has partnered with government staff and community leaders to ensure that policymaking and decision-making processes meaningfully include voices, opinions, and solutions from the communities that are most affected by policies and decisions, especially those that have historically been marginalized. Research suggests that when governments prioritize community engagement, take time to understand the deeper impact of government actions on the root causes of poor health, build trust with community members, and implement culturally appropriate interventions, the results include better decisions, better health outcomes, and a greater sense of buy-in and support across stakeholders. Conversely, when governments fail to meaningfully share power with community members, the result is tokenization and poor governance. Government needs meaningful community engagement to understand what communities themselves want from governance and to identify solutions that effectively serve and improve the lives of residents. Some local governments, for example, have enacted budgeting processes that allow community members to provide input on funding decisions. By empowering residents to shape budget decisions through public meetings, opportunities for feedback, and transparent decision making, governments can help ensure that communities can participate in policymaking in a meaningful way.

When done successfully, meaningful community engagement begins with building and fostering genuine relationships with diverse populations within a community. Community members are experts on their lived experience and therefore can provide valuable input to inform decision making. Enabling community members to provide their expertise during decision making is key to establishing trust between residents and policymakers. While there is no one-size-fits-all model for community engagement, there are important foundational practices that support good governance. These basics include (1) developing engagement and decision-making protocols to support role clarity at each step; (2) supporting engagement through inclusive meeting practices such as offering cultural and linguistic supports, community-centered meeting locations, child care, and food; and (3) establishing communication channels that support accountability, transparency, and inclusiveness for all stakeholders — for example, building in evaluation processes to hold government and other key partners accountable for successful implementation.

In Rhode Island, for example, the state department of health used community-led collaboratives that had been established before the pandemic as part of their Health Equity Zones initiative to identify and implement place-based interventions to support workforce development programs and temporary rental assistance during the COVID-19 pandemic. Rhode Island’s approach demonstrates how investing in sustained community-led collaborations, like Health Equity Zones, can help create responsive, place-based solutions that exemplify meaningful participation and advance health equity.

Transparency & Accountability

The principles of transparency and accountability are fundamental to good governance and a strong democracy. Transparency means that decisions and enforcement follow rules and regulations and that the information used to make those decisions is readily available to the public. Accountability means that decision makers take responsibility for decisions that affect their community and their constituents, with structures that facilitate community input.

When government leaders operate from supportive principles like accountability, transparency, and shared power, they can better serve community needs and thus create more equitable health outcomes. When they don’t, imbalances in power will favor some stakeholders over others, ultimately resulting in worse health status and decreased life expectancy for those who do not hold power.

Elected officials and their staff across all levels of government are responsible for managing, distributing, and protecting public resources through laws, regulations, and processes. These public resources include the infrastructure and institutions that we, the public, use and access to fulfill our basic needs — for example, roads and hospitals, libraries and schools. These public goods and institutions should be available to all constituents and communities, regardless of political affiliation, ability, religion, income, or other personal characteristics.

State and local governments can also guarantee that community input is integrated into planning and policy development and hold decision makers accountable for community priorities. Governments can support robust transparency and accountability by, for example, creating advisory committees to review decisions and inviting community members to be part of them; allowing adequate time for input and feedback by constituents; responding quickly to feedback received; and tracking public participation.

Responsiveness & Efficiency

How government responds in both emergency and routine contexts is essential to building and sustaining trust with communities and constituents and ultimately has deep impacts on health outcomes. For example, during the COVID-19 pandemic, many state and local governments across the nation proactively took action to protect their residents who were experiencing health or financial difficulties. In some cases, these responses were born from calls for action by community leaders.

In California, for instance, the City of Los Angeles worked with local community organizations to seek recommendations on how to support elderly Asian community members whose first language was not English. As a result of a partnership between a local community organization and the Los Angeles State Historic Park, teams set up outdoor spaces for seniors to gather and exercise safely. At the state level, the governor issued a temporary statewide eviction moratorium for tenants who were unable to work because they had COVID or were caring for a family member with COVID.

Local and state governments often have critical resources and authority to support their communities and residents, but they don’t always have the experience, cultural awareness, or community trust to fully engage and support the most vulnerable and traditionally marginalized communities. Consequently, building response systems before emergencies hit, coordinating and collaborating with agencies and organizations inside and outside of government, and connecting response systems to ongoing efforts to support health are essential for effective and efficient government response.

Respect for the Rule of Law

To be lawful and effective, governance policies and practices must be grounded in strong legal practice and precedent and must require compliance across levels of government. Recent events at federal and state levels have shown how vulnerable a functioning democracy can be. At ChangeLab Solutions, we have reviewed the scope of recent executive orders, the legal challenges associated with them, and how they could shape the future of public health and equity. Our resources Confronting Misinformation and Supporting Equitable Community Engagement offer guidance on strengthening public trust, stopping the proliferation of inaccurate and harmful information, and ensuring that community voices drive policy solutions. Laws and executive orders are not necessarily lawful just because they are passed or issued. Local and state leaders and policymakers defend the rule of law when they challenge unlawful policies in court. Respect for the rule of law and ensuring that checks and balances are in place are crucial to bolstering public confidence in the democratic process.

Good Governance in Other Sectors

Good governance isn’t just the work of government. Business leaders also play a role in governance. Many businesses and anchor institutions, including hospitals and universities, support local economies through procurement and contracting practices, employment of local residents, and even land use planning related to their interest in owning or leasing commercial buildings. For example, ChangeLab’s work with health care institutions in support of food access and nutrition revealed ways in which these businesses support healthy food options by establishing innovative procurement practices, offering farmers markets in their parking lots, and coordinating with food support programs, as well as supporting local businesses and local hiring policies and fostering community engagement through support of culturally significant food celebrations.

Having a diverse and expansive group of stakeholders, including business leaders, engaged in policymaking is imperative for good governance practices. However, over the past decade, we have increasingly seen corporate interests wield negative influence on local and state governance. For example, corporations have opposed efforts to increase wages, expand broadband access, or require paid leave for employees. ChangeLab has been engaged with efforts to support local government and public health organizations in stopping this type of negative preemption. Specifically, we have been working in coalition to overturn a state law that prohibits local taxes on sugary drinks. The law was passed using blackmail-like tactics and backed by corporate associations with millions of dollars to prevent local governments from exercising their right to advance policies for their local residents. In addition, we are now seeing preemptive tactics at the federal level. ChangeLab will continue to provide legal and interdisciplinary analysis, assessment, and guidance to partners to support good governance and equitable policy change.

Advancing Good Governance for Health & Democracy

Although governance challenges persist, local and state governments and community leaders still have the power to develop and implement policies that support better health, which will ultimately support a stronger democracy.

Now is the time to focus on improving governance by applying good governance principles. We need to ensure that local, community-driven solutions are at the center of decision-making priorities and processes. By doing so, government leaders and their partners can make tangible impacts on health outcomes, even in uncertain and challenging times.

We urge you to stay engaged and connected with ChangeLab as we continue to elevate our tools, training, and technical assistance through our Accelerating Policy Change series.

Good Governance Resources from ChangeLab Solutions

Training resources

Reports with recommendations

Guidance documents

Read the other posts in our Democracy & Governance series:

Thank you to the ChangeLab Solutions staff who contributed to this blog: Patrick Glass, Wesley Hartman, Maya Hazarika Watts, and Sabrina Adler. And, thank you to Lori Dorfman from Berkeley Media Studies Group for her helpful review and guidance. 

5/14/2025