When youth participation becomes symbolic: voices and influence in global health governance

Global health discussions have, in recent years, made a point of involving young people. Conferences feature youth panels, international organisations hold youth consultations, and most major health strategies now list youth engagement as a priority. All in all, it seems only fair, given that the challenges being debated today (for instance, pandemic preparedness and management, antimicrobial resistance, and climate change) will shape the lives of younger generations for decades. Yes, they should have some say in how those problems are addressed. But what kind of say, exactly?

Being invited to a conference is not the same as influencing what gets discussed or decided there. Young participants can be present at consultations and advisory boards, while the structures where policy is actually made remain largely unchanged. Youth involvement signals openness without necessarily altering how priorities are set or resources distributed. Participation, in other words, can be real without being meaningful.

This difference between symbolic and meaningful participation matters most in fields with long time horizons. Antimicrobial resistance (AMR) is a good example. Because its consequences will unfold over decades, younger generations are routinely described as key stakeholders in the global response. International efforts to address AMR, including the Quadripartite collaboration between WHO, FAO, UNEP and WOAH, increasingly emphasise the importance of engaging a broad range of societal actors, including young people. A 2025 commentary in Nature Communications described young people as potential “change-makers” in AMR efforts, and a study in PLOS Global Public Health the same year argued that youth, particularly in regions heavily affected by infectious diseases, remain underrepresented in decision-making despite their potential contributions. These discussions reflect a broader body of literature that is emerging and examines how youth participation is incorporated into global health governance.

And yet, as a study I recently co-authored shows, being named a stakeholder and being given real influence are quite different things. In our study, Beyond symbolic participation: youth-led organisations’ voices and actions against antimicrobial resistance in Africa south of the Sahara, conducted in collaboration with the Roll Back Antimicrobial Resistance (RBA) Initiative, we examined how youth organisations across sub-Saharan Africa engage with AMR through awareness campaigns, community education, and advocacy. We found that these organisations are far from passive. Many are doing creative, committed work under significant resource constraints – yet the very organisations expected to mobilise communities against antimicrobial resistance often lack stable funding, institutional recognition, or access to the policy spaces where decisions are made.

A pattern emerges. Youth organisations are frequently invited to meetings and international events related to AMR, but this involvement rarely translates into meaningful influence over decisions. Participation often serves as a signal of inclusiveness rather than a mechanism for change. The term for this is tokenism: when representation serves mainly to legitimise a process rather than to reshape it. This is not just a practical problem; it is an ethical one. If younger generations are expected to live with the long-term consequences of today’s health policies, participation that remains purely symbolic is difficult to justify.

That said, influence is not only exercised through formal seats at decision-making tables. Youth-led organisations often operate entirely outside traditional governance structures, shaping debates through grassroots mobilisation and public engagement in ways that institutional frameworks often fail to capture. These contributions matter, even when they are harder to measure.

The question facing global health governance today is not really whether young people should be involved (that case has already been made). It is how their involvement should be structured so that it amounts to something. In a field like antimicrobial resistance, where the decisions being made now will have consequences for generations, ensuring that participation is meaningful rather than symbolic is a matter of intergenerational justice.

Samwel, E. V., Biasiotto, R., Mosha, M., & Ancillotti, M. (2025). Beyond symbolic participation: youth-led organisations’ voices and actions against antimicrobial resistance in Africa South of the Sahara. Global Health Action, 18(1). https://doi.org/10.1080/16549716.2025.2601409

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