Co-creation, co-design and co-production for public health: a perspective on definitions and distinctions

Collaboration between community members, researchers, and policy makers drives efforts to solve complex health problems such as obesity, alcohol misuse, and type 2 diabetes. Community participation is essential to ensure the optimal design, implementation and evaluation of resulting initiatives. The terms ‘co-creation’, ‘co-design’ and ‘co-production’ have been used interchangeably to describe the development of initiatives involving multiple stakeholders. While commonalities exist across these concepts, they have essential distinctions for public health, particularly related to the role of stakeholders and the extent and timing of their engagement. We summarise these similarities and differences drawing from the cross-disciplinary literature, including public administration and governance, service management, design, marketing and public health. Co-creation is an overarching guiding principle encompassing co-design and co-production. A clear definition of these terms clarifies aspects of participatory action research for community-based public health initiatives. Background Increasing the participation and involvement of key stakeholders (e.g. employers, partners, customers, citizens, policy makers, end-users) can strengthen innovation, implementation and overall success of population health initiatives.1,2 Engaging, respecting and applying these multiple perspectives provides context-specific, practical and relevant knowledge with flow-on impacts on health equity, citizenship and social justice.1,3 The engagement of stakeholders in the development and implementation of initiatives is captured under the broader term ‘Participatory Action Research’ (PAR).3 More recently, co-creation, co-design and co-production have been used to describe specific PAR-type methods.