Putting ‘enabling governance’ at the heart of community-led prevention

Following on from his recent blog for CHEX, Ally Boyle, Chair of Public Health Scotland, explores why ‘enabling governance’ is so crucial to delivering community-led, preventative approaches that are grounded in lived experience.

It is easy, even with good intentions, for governance to drift away from communities.

Risk increasingly becomes defined in financial, legal or reputational terms. Performance measures can crowd out meaning. Board discussions become abstracted from lived reality.  

The outcome is rarely dramatic failure. More often, it is a gradual loss of connection with communities and a loss of focus on who is affected and what their voices are telling us.

This matters deeply for community-led health. Preventive and relational work is often the first to feel pressure when systems are under strain. Governance that is distant from communities may not see what is being lost until it has already gone.

From my experience in the charity sector, including as a trustee of Blood Cancer UK and through several years co-chairing Cancer Research UK’s patient and public involvement panel for its research funding committees, the contrast is clear.

Where governance remains grounded in lived experience, decisions are not easier, but they are clearer and more effective. Strategic choices are continually tested against the realities faced by people living with illness and inequality, rather than being driven solely by organisational convenience.

Governance as a determinant of health

 We are rightly comfortable talking about the social determinants of health such as income, housing, education, employment and environment. Governance belongs within that conversation.

Governance determines whose voices influence decisions, how power is shared, and whether prevention is sustained or pushed aside. It shapes whether participation is meaningful or tokenistic, and whether communities are enabled to shape change or simply respond to it.

For community led health, governance culture can either reinforce existing power imbalances or actively help to dismantle them.

What enabling governance looks like

 Enabling governance is rarely about perfect structures; it is more about how boards behave. 

It begins with clarity of purpose rather than an over focus on compliance. Actively seeking to understand local context rather than relying solely on abstraction. Valuing lived experience as useful evidence, not anecdote. Creating space to learn from communities, partners and those delivering services on the ground. Enabling governance allows boards to say, with confidence, that they need to understand more before deciding. 

This kind of governance stays connected to place, to people and to purpose. 

The role of board leadership

 Chairs and trustees have a particular responsibility in shaping governance culture.

Leadership at board level is not about control; it is about stewardship. Creating conditions where humility is modelled, curiosity is encouraged and learning from others is expected. That learning must include communities, partners and those whose experiences challenge institutional assumptions.

From my own journey, as a public servant, a patient and a trustee, I have learned that the most effective governance is often quiet. It asks better questions. It listens carefully. It remains open to being changed by what it hears.

 Why this matters now

Community led health operates in an increasingly fragile environment. Funding is short term, workforce and volunteer fatigue is real, and inequalities remain deeply entrenched.

In this context, governance can either compound pressure or create space for possibility. Governance that is culturally rigid will narrow what can be imagined. Governance rooted in context, connection and humility offers a better chance of sustaining meaningful change over the long term.

Perhaps one of the most important questions for those involved in governance is simple. Whose voices are we hearing most clearly, and whose are we still struggling to hear? I once had someone say to me that it wasn’t that they were seldom heard but more that it felt they were just easy to ignore. That has really stuck with me.

Good intentions are not enough. Community-led health needs governance that understands its power, stays connected to communities, and is willing to learn, especially from those most affected by the decisions it makes.

Ally Boyle MBE is the Chair of Public Health Scotland. He has extensive experience in governance across public services and the charity sector, with a longstanding commitment to patient and public involvement, prevention, and learning from lived experience.