top of page


in collaboration with the 



Arnstein's Ladder of Participation

—Sherry Arnstein’s Ladder is central to developing our thinking on the engagement between individuals and the decision-makers in the NHS and social care.


—It helps shape public involvement policy in the contemporary health environment.


—Applying Arnstein’s model opens numerous options, and supports the development of insight into how communities can influence large bureaucratic organisations. 

RUNGS 1 and 2 ....... Manipulation and Therapy

These two rungs describe levels of "non-participation" that have been contrived by some to substitute for genuine participation. Their real objective is not to enable people to participate in planning or conducting programs, but to enable powerholders to "educate" or "cure" the participants.


Rungs 3 and 4 progress to levels of "tokenism" that allow the have-nots to hear and to have a voice. When they are proffered by power-holders as the total extent of participation, citizens may indeed hear and be heard. But under these conditions they lack the power to insure that their views will be heeded by the powerful.


When participation is restricted to these levels, there is no follow-through, no "muscle," hence no assurance of changing the status quo.


This is simply a higher level tokenism because the ground rules allow have-nots to advise, but retain for the powerholders the continued right to decide.

Further up the ladder are levels of citizen power with increasing degrees of decision-making clout. Citizens can enter into a Partnership that enables them to negotiate and engage in trade-offs with traditional power holders.


At the topmost rungs, have-not citizens obtain the majority of decision-making seats, or full managerial power.

Obviously, the eight-rung ladder is a simplification, but it helps to illustrate the point that so many have missed ... that there are significant gradations of citizen participation.


Knowing these gradations makes it possible to cut through the hyperbole to understand the increasingly strident demands for participation from the have-nots, as well as the gamut of confusing responses from the power-holders.

Though the typology uses examples from federal programs such as urban renewal, anti-poverty, and Model Cities, it could just as easily be illustrated in:


  • The Church, currently facing demands for power from Priests and Laymen who seek to change its mission 

  • Colleges and Universities which, in some cases, have become literal battlegrounds over the issue of student power

  • Public Schools

  • City Halls

  • Police Departments

  • Big business, which is likely to be next on the expanding list of targets


The underlying issues are essentially the same - "nobodies" in several arenas, trying to become "somebodies" with enough power to make the target institutions responsive to their views, aspirations, and needs.

RUNGS 3 and 4 ........ Informing and Consultation
RUNG 5 .......... Placation
RUNG 6 ......... Partnership
RUNGS 7 and 8 ........ Delegated Power and Citizen Control
bottom of page