Youth engagement in digital public health: from visibility to influence, accountability, and reach

Abstract

Digital tools increasingly shape the health of adolescents and young adults, yet these young people with the highest stakes often hold the least power over how these tools are designed, governed, and evaluated. Calls for meaningful youth engagement have become widespread, and a visible infrastructure of advisory boards, forums, and delegations has grown around it. However, participation has expanded faster than the influence it implies. In this perspective, we argue that the gap between participatory rhetoric and governance reality is largely structural: the mechanisms now in place tend to make youth engagement visible without converting it into influence over what is decided. We trace this through three tensions—visibility without influence, consultation without accountability, and global rhetoric with local exclusion—each showing how the vocabulary of participation can describe arrangements that carry little real power. Moving from consultation to leadership, we argue, calls for attention to three considerations: formal, age-appropriate decision rights for young people; a duty on institutions to document and answer youth input; and governance capacity in the settings where digital tools are actually used. We set out illustrative mechanisms and safeguards for each, to inform the digital health strategies now being drafted.